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34
| 4 | 2004
Klinisk Biokemi i Norden
for H6H6 genotypen i FVII intron7(37bp)
n
polymorfien.
HRT var associeret med lavere koncentrationer af TAFI hos
homozygote for det sjældne TAFI –438A allel. Rygning
modvirkede effekten af HRT på fibrinogen og FVII.
Samlet set var HRT associeret med en gunstig effekt
på den fibrinolytiske profil, og med gunstige lavere
koncentrationer af fibrinogen og homocystein, mens det
nedsatte niveau af TFPI og forhøjelsen af FVII (ved den
rene østrogenbehandling) var potentiel skadelig. Nogle
effekter var genotype-specifikke, og rygning modvirkede
virkningen af HRT på fibrinogen og FVII. Hvilken relativ
betydning for risikoen for IHS som disse HRT associerede
ændringer måtte medføre er vanskelige at vurdere, og
kan ikke bedømmes på basis af disse studier. Forskellige
HRT regimer vil desuden have varierende effekter på den
metaboliske risikoprofil for IHS, ligesom interaktioner med
genetiske, miljømæssige og individuelle faktorer kan være
vigtige faktorer. Derfor må et mål for fremtidige studier
være at undersøge effekten af
forskellige
HRT behand-
linger (type, dosis, administationsform) hos
forskellige
kvinder (alder, genetik, livsstil, præeksisterende sygdom)
på
forskellige
intermediære effektmål, for derigennem at
opnå øget indsigt i fundamentale biologiske mekanismer
og effekter, der kan danne basis for etablering af kliniske
studier, der sætter os i stand til i højere grad at målrette
behandlingen hos postmenopausale kvinde.
1. Hu FB, Grodstein F. Postmenopausal hormone
therapy and the risk of cardiovascular disease:
the epidemiologic evidence. Am J Cardiol 2002;
90:26F-29F.
2. van Baal WM, Kooistra T, Stehouwer CD.
Cardiovascular disease risk and hormone repla-
cement therapy (HRT): a review based on ran-
domised, controlled studies in postmenopausal
women. Curr Med Chem 2000: 7:499-517.
3. Hulley S, Grady D, Bush T, Furberg C, Herrington
D, Riggs B, Vittinghoff E. Randomized trial
of estrogen plus progestin for secondary pre-
vention of coronary heart disease in postme-
nopausal women. Heart and Estrogen/proge-
stin Replacement Study (HERS) Research Group.
JAMA 1998; 280:605-13.
4. Hulley S, Furberg C, Barrett-Connor E, Cauley J,
GradyD,HaskellW,KnoppR, LoweryM, Satterfield
S, Schrott H, Vittinghoff E, Hunninghake D.
Noncardiovascular disease outcomes during 6.8
years of hormone therapy: Heart and Estrogen/
progestin Replacement Study follow-up (HERS II).
JAMA 2002; 288:58-66.
5. Women’s Health Initiative Steering Committee.
Risks and benefits of estrogen plus progestin in
healthy postmenopausal women: principal results
From the Women’s Health Initiative randomized
controlled trial. JAMA 2002; 288:321-33.
6. Women’s Health Initiative Steering Committee.
Effects of conjugated equine estrogen in post-
menopausal women with hysterectomy: the
Women’s Health Initiative randomized controlled
trial. JAMA. 2004; 291:1701-12.
7. Mosekilde L, Hermann AP, Beck-Nielsen H,
Charles P, Nielsen SP, Sorensen OH. The Danish
Osteoporosis Prevention Study (DOPS): project
design and inclusion of 2000 normal perimeno-
pausal women. Maturitas 1999; 31:207-19.
8. Madsen JS, Kristensen SR, de Maat MPM, Abra-
hamsen B, Rejnmark L, Brixen K, Gram J, Chris-
tensen K, Jespersen J. No Effect of Long-term
Hormone Replacement Therapy on Fibrinogen
Level in Smoking Women: A Randomized Con-
trolled Study. Manuscript.
9. Madsen JS, Kristensen SR, KlitgaardNA, Bladbjerg
EM, Abrahamsen B, Stilgren L, Jespersen J. Effect
of long-term hormone replacement therapy on
plasma homocysteine in postmenopausal women:
a randomized controlled study. Am J Obstet
Gynecol 2002; 187:33-9.
10. Bladbjerg EM, Madsen JS, Kristensen SR, Abra-
hamsen B, Brixen K, Mosekilde L, Jespersen J.
Effect of Long-termHormoneReplacement The-rapy
on Tissue Factor Pathway Inhibitor and Thrombin
Activatable Fibrinolysis Inhibitor in Healthy
Postmenopausal Women: A Randomized Controlled
Study. J Thromb Haemost 2003;1:1208-14.
11. Madsen JS, Kristensen SR, Gram J, Bladbjerg EM,
Henriksen FL, Gram J, Christensen K, Jespersen J.
Positive impact of hormone replacement therapy
on the fibrinolytic system: a long-term randomi-
zed controlled study in healthy postmenopausal
women. J Thromb Haemost 2003; 1:1984-91.
12. Madsen JS, Bladbjerg EM, Gram J, Hermann AP,
Brixen K, Rejnmark L, Jespersen J, Kristensen
SR. Effect of Long-term Hormone Replacement
Therapy and Polymorphisms in the Factor VII
Gene on Coagulation Factor VII: A Randomized
Controlled Study in Healthy Postmenopausal
Women. Manuscript.
