Цереброваскулярные расстройства у женщин в перименопаузальный период

Табеева Г.Р. Цереброваскулярные расстройства у женщин в перименопаузальный период. Consilium Medicum. 2016; 18 (9): 68–72. DOI: 10.26442/2075-1753_2016.9.68-72

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Tabeeva G.R. Cerebrovascular disorders in women in perimenopausal period. Consilium Medicum. 2016; 18 (9): 68–72. DOI: 10.26442/2075-1753_2016.9.68-72

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Аннотация

Цереброваскулярные заболевания являются одними из наиболее дезадаптирующих расстройств как у мужчин, так и среди женщин. Между тем в женской популяции по сравнению с мужской инсульты возникают существенно позже. Инсульты у женщин характеризуются более высокой частотой традиционных факторов риска, таких как артериальная гипертензия, мерцательная аритмия, а также наличием специфических факторов, таких как использование оральных контрацептивов и периоды беременности. Кроме того, у женщин по сравнению с мужчинами больше доля тяжелых инсультов, выше частота госпитальных медицинских осложнений и смертельных исходов, а также число случаев тяжелой инвалидизации после инсульта. В формировании половых различий патофизиологии инсультов принимают участие как гормональные механизмы, так и другие факторы, не связанные с влиянием репродуктивных гормонов. Понимание этих закономерностей важно для разработки стратифицированных подходов к ведению пациентов женского пола с цереброваскулярными заболеваниями.

Ключевые слова: цереброваскулярные заболевания, инсульт, гендерные особенности.

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Cerebrovascular diseases are one of the most maladaptive disorders in both men and women. Meanwhile, in the female population when compared to men, strokes occur much later. Strokes in women have a higher frequency of traditional risk factors such as hypertension, atrial fibrillation, as well as the presence of specific factors, such as the use of oral contraceptives and during pregnancy. In addition, in women compared with men more than the proportion of severe stroke, the higher the frequency of hospital medical complications and deaths, as well as the number of cases of severe disability after stroke. In the formation of sex differences in the pathophysiology of stroke participate as hormonal mechanisms, and other factors not related to the influence of reproductive hormones. Understanding these laws is important in order to develop a stratified approach to the management of female patients with cerebrovascular disease.

Key words: cerebrovascular disease, stroke, gender characteristics.

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1. Salomon J, Wang Н, Freeman M et al. Healthy lifee xpectancy for 187 countries 1990–2010: a systematic analysis for the Global Burden Disease Study 2010. Lancet 2012; 380: 2144–62.
2. Stevenson J. A woman's journey through the reproductive, transitional and postmenopausal periods of life: impact on cardiovascular and musculoskeletal risk and the role of estrogen replacement. Maturitas 2011; 70 (2): 197–205.
3. Hjortland MC, McNamara PM, Kannel WB. Some atherogenic concomitants of menopause: the Framingham Study. Am J Epidemiol 1976; 103: 304–11.
4. Chomistek A, Manson J, Stefanick M et al. Relationship of sedentary behavior and physical activity to incident cardiovasculardisease: results from the Women's Health Initiative. J Am Coll Cardiol 2013; 61 (23): 2346–54.
5. Reeves MJ, Bushnell CD, Howard G et al. Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. Lancet Neurol 2008; 7: 915–26.
6. Redon J, Olsen MH, Cooper RS et al. Stroke mortality and trends from 1990 to 2006 in 39 countries from Europe and Central Asia: implications for control of high blood pressure. Eur Heart J 2011; 32: 1424–31.
7. Feigin VL, Lawes CM, Bennett DA et al. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol 2009; 8: 355–69.
8. Carandang R, Seshadri S, Beiser A et al. Trends in incidence, lifetime risk, severity, and 30-day mortality of stroke over the past 50 years. JAMA 2006; 296: 2939–46.
9. Towfiglii A, Saver JL, Engelhardt R. Ovbiagele B. A midlife stroke surge among women in the United States. Neurology 2007; 69: 1898–904.
10. Roger VL. Go AS, Lloyd-Jones DM et al. Heart disease and stroke statistics–2011 update: a report from the American Heart Association. Circulation 2011; 123: 18–209.
11. Bushnell CD. Stroke and the female brain. Nat Clin Pract Neurol 2008; 4: 22–33.
12. Lisabeth L, Bushnell C. Stroke risk in women: the role of menopause and hormone therapy. Lancet Neurol 2012; 11: 82–91.
13. Holroyd-Leduc JM, Kapral MK, Austin PC, Tu JV. Sex differences and similarities in the management and outcome of stroke patients. Stroke 2000; 31: 1833–7.
14. Haast RAM, Gustafson DR., Kiliaan AJ. Sex differences in stroke. Journal of Cerebral Blood Flow & Metabolism 2012; 32: 2100–07.
15. Gall SL, Donnan G, Dewey HM et al. Sex differences in presentation, severity, and management of stroke in a population based study. Neurology 2010; 74: 975–81.
16. Petrea RE, Beiser AS, Seshadri S et al. Gender differences in stroke incidence and poststroke disability in the Framingham heart study. Stroke 2009; 40: 1032–7.
17. Appelros P, Stegmayr B, Terent A. A review on sex differences in stroke treatment and outcome. Acta Neurol Scand 2010; 121: 359–69.
18. Anonymous. A randomized trial of aspirin and sulfinpyrazone in threatened stroke. The Canadian Cooperative Study Group. N Engl J Med 1978; 299: 53–9.
19. Appelros P, Stegmayr B, Terent A. Sex differences in stroke epidemiology: a systematic review. Stroke 2009; 40: 1082–90.
20. Skoromets A.A., Tanashjan M.M., Chukanova E.I. i dr. Mnogocentrovaja programma po ocenke jeffektivnosti i bezopasnosti novoj shemy terapii bol'nyh s hronicheskoj cerebrovaskuljarnoj nedostatochnost'ju. Mezhdunarodnyj nevrologicheskij zhurnal. 2009; 3 (25). [in Russian]
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22. Liu M, Kelley MH, Herson PS, Hum PD. Neuroprotection of sex steroids. Minerva Endocrinol 2010; 35: 127–43.
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24. Morrison JH, Brinton RD, Schmidt PJ, Gore AC. Estrogen, menopause, and the aging brain: how basic neuroscience can inform hormone therapy in women. J Neurosci 2006; 26: 10332–48.
25. Alkayed NJ, Murphy SJ, Traystman RJ et al. Neuroprotective effects of female gonadal steroids in reproductively senescent female rats. Stroke 2000; 31: 161–8.
26. Tian Y, Stamova B, Jickling GC et al. Effects of gender on gene expression in the blood of ischemic stroke patients. J Cereb Blood Flow Metab 2012; 32: 780–91.

Авторы

Г.Р.Табеева

ФГБОУ ВО Первый Московский государственный университет им. И.М.Сеченова Минздрава России. 119991, Москва, ул. Трубецкая, 8, стр. 2
grtabeeva@gmail.com

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G.R.Tabeeva

First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaya, d. 8, str. 2
grtabeeva@gmail.com

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