Pamela S. Douglas教授　　美国杜克医学院

　　<International Circulation>: What are special issues women face when it comes to CV health?

　　《国际循环》：女性心血管健康方面有何特点？

　　Prof. Pamela Douglas: There are a whole host of differences risk factors.  For example， diabetes is much worse in women than in men. There some risk factors that don’t exist in men， such as early menopause. They also perform differently in diagnostic tests， which may be less accurate in women. Finally， there are differences in medication dosage and benefit. It runs the whole gambit， from risk to diagnosis to treatment. There is also another issue that is important to women and providers， who tend to underestimate the amount of risk they have. Of course， you cannot treat something if you are not concerned about it; you cannot prevent something if you are not following it or worried about contracting it.

　　Douglas教授：在危险因素方面差异很大。例如，女性糖尿病的问题更严重。还有一些危险因素在男性中不存在，例如提前绝经。女性在诊断检查方面的表现也不同，有些检查对女性的准确率可能较低。在药物剂量及获益方面也存在差异。差异是全方位的，从危险因素到诊断和治疗。还有一个问题对于女性和医务人员都很重要，医务人员往往会有低估女性心血管风险的倾向。显然，如果没有考虑到问题，就没法进行相应治疗，如果没有对可能的情况进行追踪或者没有考虑过进行处理，那么就无法预防其发生。

　　<International Circulation>: What kind of work is being done in your practice to allow women to become more aware of their CV health?

　　《国际循环》：为了使女性能够更加关注她们的心血管健康，您做了哪些工作？

　　Prof. Douglas: We have materials on our website for women’s health practice. We also hold education events several times a year. A number of our faculty are very involved in scholarly about heart disease in women. There are about a half dozen papers mentioned in Circulation: CV Quality and Outcomes. A review paper in the January edition this year of the most important outcomes research in women and about half a dozen papers from our division were cited… Some specific names to look out for would be myself， Kristin Newby， Adrian Hernadez， Eric Peterson.

　　Douglas教授：我们的网站上有关于女性健康的内容。我们每年举行几次健康教育项目。我们的很多同事对女性心血管疾病进行了大量学术研究。今年1月关于发表在Circulation: Cardiovascular Quality and Outcomes杂志上的一篇关于女性心血管疾病结果的重要论文引用了6篇我们部门发表的文章。作者包括我本人、Kristin Newby、Adrian Hernadez和Eric Peterson。

　　<International Circulation>: What does role do hormones play in CV disease in women?

　　《国际循环》：激素在女性心血管疾病中起了什么作用？

　　Prof. Douglas: We are still learning about hormones. We know that hormones are protective pre-menopause. We start conjugated-equine estrogen right after menopause it is harmful. There is still an open question about the use of estrogen in the perimenopausal period and if its continued use is protective and， if so， what type and dose. There is some promising work being done that shows how starting estrogen in the perimenopausal period does not have an excessive event rate when compared with starting it ten to fifteen years post menopausal. However， this is very preliminary work. At this point， it appears the estrogen may both prevent the development of plaque and， if present， it may destabilize it. This is a classic yin and yang.

　　Douglas教授：我们目前还在对激素进行研究。我们知道激素在绝经期之前具有保护作用。在绝经之后立即开始使用雌激素是有害的。对于激素在围绝经期的使用方面的问题仍未解决。使用雌激素是否有保护作用，如果有保护作用的话，激素的种类以及剂量这些问题都不明确。目前已经有研究取得了有希望的结果，显示在围绝经期开始使用雌激素与绝经后10-15年开始使用雌激素相比，不增加事件率。然而，这还只是初步的工作。目前的研究显示雌激素可能避免斑块的产生，但如果斑块已经存在，则可能使斑块不稳定。这是经典的中国阴阳理论。

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