Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Apr 2019
ReviewA review of menopausal hormone therapy: recalibrating the balance of benefit and risk.
While menopausal hormone therapy (MHT) was initially marketed to women of menopausal age to prolong youth, it has endured a tumultuous history evaluating the risk-to-benefit ratio. In response to evidence that MHT may confer cardioprotective effects, 2 landmark randomized controlled trials tested this hypothesis, and both were stopped prematurely due to increased incident cancers and cardiovascular events, creating much controversy and confusion. As women and physicians grew reticent to use MHT, most symptomatic menopausal women remained untreated. ⋯ Most recently, the 18-year follow-up data of postmenopausal women in the Women's Health Institute trial did not show any change in long-term survival associated with the use of MHT at any age. More recent studies have evaluated alternative treatments for high-risk women, including lower doses and newer formulations of MHT, along with combined new therapies such as selective estrogen receptor modulators, antidepressants, and exercise therapies, which are effective in reducing vasomotor symptoms and improving menopause-specific quality of life. These alternatives provide new options to symptomatic women who are unable or unwilling to take conventional MHT and allow for more person-centered decision making strategies to support women through the menopause.
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Pol. Arch. Med. Wewn. · Apr 2019
Comparative StudyManagement strategies and 5-year outcomes in Polish patients with stable coronary artery disease versus other European countries: data from the CLARIFY registry.
INTRODUCTION An international registry of ambulatory patients with stable coronary artery disease (CLARIFY) allows a comparison of management and outcomes in real‑life setting. OBJECTIVES We aimed to compare the management strategies and 5‑year outcomes in patients from Poland and from other European countries. PATIENTS AND METHODS Stable coronary artery disease was defined as previous myocardial infarction (MI) or revascularization, coronary stenosis greater than 50%, or documented symptomatic myocardial ischemia. ⋯ Angina control was better in Poland than in other European countries (Canadian Cardiovascular Society class II-IV, 11.5% vs 15.8% of patients; P <0.001). CONCLUSIONS Risk factor control was insufficient both in patients from Poland and in those from other European countries. The more frequent use of revascularization in Polish patients was not linked to improved outcomes, but, together with more extensive prescription of β‑blockers, might have contributed to better angina control.