INTRODUCTION Dyslipidemias are common and increase the risk of cardiovascular disease. The menopause transition is associated with an atherogenic lipid profile, with an increase in the concentrations of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), apolipoprotein B (apoB) and potentially lipoprotein (a) [Lp(a)], and a decrease in the concentration of high-density lipoprotein cholesterol (HDL-C). AIM The aim of this clinical guide is to provide an evidence-based approach to management of menopausal symptoms and dyslipidemia in postmenopausal women. The guide evaluates the effects on the lipid profile both of menopausal hormone therapy and of non-estrogen-based treatments for menopausal symptoms. MATERIALS AND METHODS Literature review and consensus of expert opinion. SUMMARY RECOMMENDATIONS Initial management depends on whether the dyslipidemia is primary or secondary. An assessment of the 10-year risk of fatal cardiovascular disease, based on the Systematic Coronary Risk Estimation (SCORE) system, should be used to set the optimal LDL-C target. Dietary changes and pharmacological management of dyslipidemias should be tailored to the type of dyslipidemia, with statins constituting the mainstay of treatment. With regard to menopausal hormone therapy, systemic estrogens induce a dose-dependent reduction in TC, LDL-C and Lp(a), as well as an increase in HDL-C concentrations; these effects are more prominent with oral administration. Transdermal rather than oral estrogens should be used in women with hypertriglyceridemia. Micronized progesterone or dydrogesterone are the preferred progestogens due to their neutral effect on the lipid profile. Tibolone may decrease TC, LDL-C, TG and Lp(a), but also HDL-C concentrations. Low-dose vaginal estrogen and ospemifene exert a favorable effect on the lipid profile, but data are scant regarding dehydroepiandrosterone (DHEA). Non-estrogen-based therapies, such as fluoxetine and citalopram, exert a more favorable effect on the lipid profile than do sertraline, paroxetine and venlafaxine. Non-oral testosterone, used for the treatment of hypoactive sexual desire disorder/dysfunction, has little or no effect on the lipid profile.

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血脂异常女性的更年期症状管理：EMAS 临床指南

引言 血脂异常很常见，会增加心血管疾病的风险。绝经过渡与致动脉粥样硬化的血脂谱有关，总胆固醇 (TC) 和低密度脂蛋白胆固醇 (LDL-C)、甘油三酯 (TG)、载脂蛋白 B (apoB) 和潜在的脂蛋白 (a ) [Lp(a)]，以及高密度脂蛋白胆固醇 (HDL-C) 浓度的降低。目的 本临床指南的目的是提供一种基于证据的方法来管理绝经后妇女的绝经症状和血脂异常。该指南评估了绝经期激素治疗和非雌激素治疗绝经期症状对血脂的影响。材料与方法 文献回顾和专家意见共识。总结建议 初始治疗取决于血脂异常是原发性还是继发性。应使用基于系统冠状动脉风险评估 (SCORE) 系统的 10 年致命心血管疾病风险评估来设定最佳 LDL-C 目标。血脂异常的饮食改变和药物治疗应根据血脂异常的类型进行调整，他汀类药物是治疗的中流砥柱。关于绝经期激素治疗，全身性雌激素诱导 TC、LDL-C 和 Lp(a) 的剂量依赖性降低，以及 HDL-C 浓度的增加；这些作用在口服给药时更为突出。患有高甘油三酯血症的女性应使用透皮雌激素而不是口服雌激素。微粉化孕酮或地屈孕酮是优选的孕激素，因为它们对脂质分布具有中性作用。替勃龙可降低 TC、LDL-C、TG 和 Lp(a)，但也可降低 HDL-C 浓度。低剂量阴道雌激素和欧司哌米芬对血脂有良好的影响，但关于脱氢表雄酮 (DHEA) 的数据很少。非雌激素疗法，如氟西汀和西酞普兰，对血脂的影响比舍曲林、帕罗西汀和文拉法辛更有利。用于治疗性欲减退障碍/功能障碍的非口服睾酮对血脂谱几乎没有影响或没有影响。但关于脱氢表雄酮 (DHEA) 的数据很少。非雌激素疗法，如氟西汀和西酞普兰，对血脂的影响比舍曲林、帕罗西汀和文拉法辛更有利。用于治疗性欲减退障碍/功能障碍的非口服睾酮对血脂谱几乎没有影响或没有影响。但关于脱氢表雄酮 (DHEA) 的数据很少。非雌激素疗法，如氟西汀和西酞普兰，对血脂的影响比舍曲林、帕罗西汀和文拉法辛更有利。用于治疗性欲减退障碍/功能障碍的非口服睾酮对血脂谱几乎没有影响或没有影响。