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<\/p>\nProf. Dr. Bing\u00fcr S\u00f6nmez<\/p>\n<\/div>\n
HER \u015eEY TERS\u0130NE D\u00d6NER<\/strong><\/p>\n Y\u0131llard\u0131r kad\u0131nl\u0131k hormonu olan \u00f6strojen, kalp koruyucu hormon olarak kabul edilmi\u015ftir. Yap\u0131lan ara\u015ft\u0131rmalar kalp-damar hastal\u0131klar\u0131n\u0131n, bu hormondan mahrum olan erkeklerde, kad\u0131nlara g\u00f6re yakla\u015f\u0131k 10 y\u0131l daha erken ortaya \u00e7\u0131kt\u0131\u011f\u0131n\u0131 g\u00f6stermektedir. Fakat kad\u0131nlarda da menopoz d\u00f6neminde bu hormonun ortadan kalkmas\u0131yla beklenmedik \u015fekilde ortaya \u00e7\u0131kan y\u00fcksek tansiyon, kan ya\u011flar\u0131n\u0131n y\u00fckselmesi, ritim bozukluklar\u0131, obezite ve hesapta olmayan diyabet tabiat\u0131 tamamen tersine \u00e7evirmektedir.<\/p>\n DAMARLAR YA\u015eLANIR<\/strong><\/p>\n Kad\u0131nlarda do\u011fal veya cerrahi menopoz sonras\u0131 olu\u015fan \u00f6strojen kayb\u0131n\u0131n kalp damar sistemi \u00fczerindeki etkileri ciddi \u015fekilde ara\u015ft\u0131r\u0131lmaktad\u0131r. \u00d6strojen damar i\u00e7 cidar\u0131ndaki tabakada (endotel)\u00a0 bulunan \u00f6strojen resept\u00f6rleri \u00fczerinden vazodilatasyonu (damar geni\u015flemesi) sa\u011flad\u0131\u011f\u0131 gibi endoteli korudu\u011fu da kesinlik kazanm\u0131\u015ft\u0131r. B\u00fct\u00fcn \u00e7al\u0131\u015fmalar, menopoz sonras\u0131 kad\u0131nlar\u0131n, menopoz \u00f6ncesi kad\u0131nlara g\u00f6re damar ya\u015flanmas\u0131n\u0131n, (bilinen bir belirteci olan damar sertli\u011finin) daha fazla ortaya \u00e7\u0131kt\u0131\u011f\u0131n\u0131 g\u00f6stermi\u015ftir.<\/p>\n \u0130\u015eTE ARA\u015eTIRMA SONU\u00c7LARI<\/strong><\/p>\n \u00d6nceki y\u0131llarda bir\u00e7ok uzman aras\u0131ndaki yayg\u0131n anlay\u0131\u015f\u0131n aksine, Women’s Health Initiative (WHI) \u00e7al\u0131\u015fmas\u0131, 50 ila 54 ya\u015f aras\u0131ndaki menopozdaki kad\u0131nlara \u00f6strojen takviyesi uyguland\u0131\u011f\u0131nda a\u00e7\u0131k\u00e7a kalbi korudu\u011funu g\u00f6stermi\u015ftir. Histerektomi ge\u00e7irmi\u015f (cerrahi menopoz) veya 50 ila 59 ya\u015flar\u0131 aras\u0131nda olan denekler aras\u0131nda, \u00f6strojen tedavisi alan kad\u0131nlar\u0131n menopoz s\u0131ras\u0131nda s\u0131ras\u0131nda ve sonras\u0131nda daha d\u00fc\u015f\u00fck koroner kalp hastal\u0131\u011f\u0131 riskine sahip oldu\u011fu g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Kad\u0131nlar \u00fczerinde devam eden ve 59 bin 337 denekle en b\u00fcy\u00fck g\u00f6zlemsel \u00e7al\u0131\u015fmalardan biri olan Nurses’ Health Study (NHS) sonu\u00e7lar\u0131 \u00e7ok nettir. Menopozda hormon tedavisi (MHT) alan kad\u0131nlarda koroner kalp hastal\u0131\u011f\u0131 istatistiksel olarak olduk\u00e7a anlaml\u0131 bir d\u00fc\u015f\u00fc\u015f g\u00f6stermeye devam etmi\u015ftir.<\/p>\n TE\u015eH\u0130S YOLLARI<\/span><\/b><\/p>\n Damar sertli\u011finin tespit ve takibi, karotis (\u015fah damar\u0131) doppleri yap\u0131larak intima-media (atar damar duvarlar\u0131n\u0131n en i\u00e7teki iki katman\u0131) kal\u0131nl\u0131\u011f\u0131 (CIMT) \u00f6l\u00e7\u00fclerek ve radyolojik olarak da koroner arter kalsiyum skorlamas\u0131 ile yap\u0131labilir (CAC).<\/p>\n Tedaviye Ne zaman ba\u015flanmal\u0131?<\/span><\/b><\/p>\n Kaynaklara g\u00f6re kalp damar hastal\u0131\u011f\u0131n\u0131n \u00f6nlenmesinde hormon tedavisine ba\u015flama zaman\u0131 da \u00e7ok \u00f6nemlidir. Asl\u0131nda yeterli miktarda veri, hormon tedavisinin kalbi koruyucu etkilerinin ba\u015flama zaman\u0131na ba\u011fl\u0131 oldu\u011fu ve menopozdan sonra de\u011fil de perimenopozal (menopoza ge\u00e7i\u015f s\u00fcreci) veya erken postmenopozal (hemen menopoz sonras\u0131) d\u00f6nemde ba\u015fland\u0131\u011f\u0131nda daha yararl\u0131 oldu\u011funu desteklemektedir. Buna g\u00f6re, ya\u015f, menopoz durumu ve tedavinin ba\u015flama zaman\u0131na g\u00f6re \u00f6strojenin damar endotelini tekrar aktive etmesi yararl\u0131 olacakt\u0131r.<\/p>\n 1998’de Thomas Clarkson di\u015fi maymunlar \u00fczerindeki \u00e7al\u0131\u015fmalar\u0131na dayanarak, aterosklerotik damar plaklar\u0131 (damar sertli\u011fi plaklar\u0131) olu\u015ftuktan sonra maymunlara CEE (Conjugated Equine Estrogen) verdikten sonra plaklarda gerileme olmad\u0131\u011f\u0131n\u0131, hormon tedavisinin faydal\u0131 etkilerinin plak olu\u015fmadan \u00f6nce ba\u015fland\u0131\u011f\u0131nda fayda sa\u011flad\u0131\u011f\u0131n\u0131 saptam\u0131\u015ft\u0131r.<\/p>\n Ayn\u0131 \u015fekilde Clarkson erken \u00f6strojen tedavisinin, erken menopoz sonras\u0131 normal ki\u015filerde plak olu\u015fumunu \u00f6nledi\u011fini, ancak tedaviye ge\u00e7 ba\u015fland\u0131\u011f\u0131 zaman plak geli\u015fimini \u00f6nlemedi\u011fi gibi olu\u015fmu\u015f olan plaklarda da gerileme sa\u011flamad\u0131\u011f\u0131n\u0131 saptam\u0131\u015f, ge\u00e7 ba\u015flanan tedavinin kalp koruyucu etkisinin olmad\u0131\u011f\u0131n\u0131 yay\u0131nlam\u0131\u015ft\u0131r. Salpeter ve arkada\u015flar\u0131 da cerrahi menopozun hemen ard\u0131ndan olu\u015fan akut menopozda \u00f6strojen alan kad\u0131nlarda bu tedavinin kalp-damar komplikasyonlar\u0131na kar\u015f\u0131 koruma sa\u011flad\u0131\u011f\u0131n\u0131 ortaya koymu\u015ftur.<\/p>\n \u00d6zetle, meme ve serviks (rahim a\u011fz\u0131) kanseri riski olmad\u0131k\u00e7a \u00f6zelikle erken menopoza girenlere (cerrahi veya ba\u015fka nedenlerle) tedaviye ba\u015flanmas\u0131 \u00f6nerilir. Bir\u00e7ok ara\u015ft\u0131rmac\u0131 do\u011fal menopozla ilgili olarak, menopozun ilk 10 y\u0131l\u0131nda veya menopoz semptomlar\u0131n\u0131n ba\u015flang\u0131c\u0131nda hormon tedavisinin ba\u015flat\u0131lmas\u0131n\u0131 \u00f6nermektedir.<\/p>\n Tedavi Ne zaman sonland\u0131r\u0131lmal\u0131?<\/span><\/b><\/p>\n G\u00fcvenli tedavi s\u00fcresinin k\u0131salt\u0131lmas\u0131na veya menopoz komplikasyonlar\u0131n\u0131n \u00f6nlenmesine ili\u015fkin prospektif (ileriye d\u00f6n\u00fck) bir veri mevcut de\u011fildir. Tedavinin ne zaman durdurulaca\u011f\u0131na dair bilimsel olarak toplanm\u0131\u015f yeterli bilgi hen\u00fcz yoktur.<\/p>\n Nelere dikkat edilmeli?<\/span><\/b><\/p>\n Women’s Health Initiative (WHI) \u00e7al\u0131\u015f mas\u0131nda, hormon tedavisinin ne zaman ba\u015flat\u0131ld\u0131\u011f\u0131na bak\u0131lmaks\u0131z\u0131n, plaseboya (ila\u00e7 verilmeyen grup) k\u0131yasla tek ba\u015f\u0131na \u00f6strojen alan postmenopozal kad\u0131nlarda meme kanseri g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 ve buna ba\u011fl\u0131 \u00f6l\u00fcm oran\u0131n\u0131n d\u00fc\u015f\u00fck oldu\u011fu g\u00f6sterilmi\u015ftir. Ancak hormon tedavisinde meme\u00a0 kanseri riskine kar\u015f\u0131 mutlaka mamografi yapt\u0131r\u0131lmal\u0131, rutin jinekolojik muayene de (\u00f6zellikle PAP Smear testi) ihmal edilmemelidir. Menopozda kalp-damar hastal\u0131klar\u0131na kar\u015f\u0131 mutlaka sa\u011fl\u0131kl\u0131 beslenmek, ideal kiloda olmak, sigaradan uzak durmak, tansiyonu ve kolesterol\u00fc kontrol alt\u0131nda tutmak da \u00f6nemlidir.<\/p>\n","protected":false},"excerpt":{"rendered":" Kad\u0131nl\u0131k hormonu \u00f6strojenin menopozla birlikte ortadan kalkmas\u0131n\u0131n kalp krizi riskini art\u0131rd\u0131\u011f\u0131n\u0131 hat\u0131rlatan Kalp ve Damar Cerrahisi Uzman\u0131 Prof. Dr. Bing\u00fcr S\u00f6nmez, bu tehlikeye kar\u015f\u0131 al\u0131nmas\u0131 gereken \u00f6nlemlere dikkat \u00e7ekti.<\/p>\n","protected":false},"author":1,"featured_media":100856,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[30],"tags":[3634,3932,6407,12580,376],"class_list":["post-100855","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-saglik","tag-damar","tag-kalp","tag-menopoz","tag-ostrojen","tag-tedavi"],"_links":{"self":[{"href":"https:\/\/haberulus.net\/index.php?rest_route=\/wp\/v2\/posts\/100855","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/haberulus.net\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/haberulus.net\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/haberulus.net\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/haberulus.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=100855"}],"version-history":[{"count":1,"href":"https:\/\/haberulus.net\/index.php?rest_route=\/wp\/v2\/posts\/100855\/revisions"}],"predecessor-version":[{"id":100857,"href":"https:\/\/haberulus.net\/index.php?rest_route=\/wp\/v2\/posts\/100855\/revisions\/100857"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/haberulus.net\/index.php?rest_route=\/wp\/v2\/media\/100856"}],"wp:attachment":[{"href":"https:\/\/haberulus.net\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=100855"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/haberulus.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=100855"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/haberulus.net\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=100855"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}![\"\"](\"https:\/\/i01.sozcucdn.com\/wp-content\/uploads\/2023\/06\/18\/menopoz-18-copy.jpg\" "\\"\\"")
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