Некоторые особенности факторов риска ишемической болезни сердца у женщин. Часть 2

Abstract

Во второй части обзора показано влияние на возникновение ишемической болезни сердца у женщин таких факторов риска, как ожирение, гиподинамия, психосоциальные фактори, наследственность, а также факторов, уникальних для женщин (применение оральных контрацептивов, нарушения при беременности, менопауза и эстрогенная недостаточность); В другій частині огляду показано вплив на виникнення ішемічної хвороби у жінок таких факторів ризику, як ожиріння, гіподинамія, психосоціальні фактори, спадковість, а також факторів, унікальних для жінок (застосування оральних контрацептивів,порушення при вагітності, менопауза та естрогенна недостатність); Influence of such risk factors as obesity, hypodynamia, psychosocial factors, heredity and female factors (using of oral contraceptive, disorders in pregnancy, menopause and estrogenic deficiency) upon rise of ischemic heart disease (IHD) in women is presented in the review. It was revealed that women with obesity have a risk of IHD in three times more than women with normal body weight. It increases significantly in women with the increase of ratio waist/thigh. Research WISE (Women’s Ischemia Syndrome Evaluation) recommends to physician for estimation of cardiovascular diseases’ risk to give more attention to metabolic disorders than obesity. This research doesn’t allow to consider general obesity as predictor of IHD. Obesity and hypodynamia correlate with each other significantly. Decrease of physical activity influences upon women more reliable – among patients with IHD near 50 % lead sedentary life-style. Many scientists suppose that social relations and individual structure of social interrelation influence upon etiology of IHD and these risk factors differ in men and women. Psychological status of women of different age has peculiarities also. They don’t cause life quality and social-labour prognosis only, but also risk of rise and following course of IHD. Family character of IHD in women is also independent risk factor, but its significance is less than in men. Strong correlation between simultaneous using of oral contraceptives and smoking concerning the increase of IHD risk, in women over 35 years old particularly, is observed. Preeclampsia and eclampsia has peculiar place among causes of IHD in fertile women. But even uncomplicated pregnancy can cause cardiovascular diseases, and myocardial infarction among them isn’t very large rareness – 1 case on 10 thousands of labors. Hormonal differences and protective role of female sex hormones is one of main causes of occurrence of disease in women 10-15 years later. Indirect evidence of it – reliable rise of risk of female IHD and myocardial infarction in case of premature menopause and oophorectomy. Vascular endothelium and cardiac hystiocytes can be place of estrogens’ action. Beside direct influences estrogens also act indirectly by means of neurohumoral systems and metabolic processes. Deficiency of estrogens can cause formation and progressing of number of mechanisms, which can lead both to development of arterial hypertension and the increase of IHD risk. A series of multicentral researches on study of influence of hormonal replacement therapy upon rise, course and cardiovascular mortality has been carried out. But their results, unfortunately, didn’t confirm expectations. Until now unambiguous answer concerning expedience of hormonal replacement therapy using with purpose of prophylactics of IHD in women of different age groups is absent. Decrease of estrogens’ level with parallel atherogenic changes of lipid spectrum of the blood is natural, unique risk-factor of IHD in women, but influence of hormonal replacement therapy upon this risk factor need further study. Insufficient attention to menopause as risk factor causes absent of social watchfulness and as result – hypodiagnostics of IHD in women. So, foregoing information allow to make conclusion about presence of peculiarities of risk factors in women. Understanding and knowledge of risk factors is important for carrying out of primary and secondary prophylactics of IHD by means of decreasing of risk factors’ intensity.