cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2023.10.n2561cardio-2561Research ArticleМНЕНИЕ ЭКСПЕРТОВOPINION OF EXPERTSРоссийские критерии приемлемости назначения менопаузальной гормональной терапии пациенткам с сердечно-сосудистыми и метаболическими заболеваниями. Согласительный документ Российского Кардиологического Общества, Российского Общества Акушеров-Гинекологов, Российской Ассоциации Эндокринологов, Евразийской Ассоциации Терапевтов, Ассоциации Флебологов РоссииRussian Eligibility Criteria for Prescribing Menopausal Hormone Therapy to Patients With Cardiovascular and Metabolic Diseases. Consensus Document of RSC, RSOG, RAE, EUAT, RAPhttps://orcid.org/0000-0003-2929-0980ШляхтоЕ. В.ShlyakhtoE. V.

Президент Российского кардиологического общества (РКО), академик РАН, профессор, д.м.н., директор ФГБУ НИМЦ им. В. А. Алмазова Минздрава России,

Санкт-Петербург

General director,

St. Petersburg

info@scardio.ruhttps://orcid.org/0000-0002-7712-1260СухихГ. Т.SukhikhG. T.

директор, академик РАН, доктор медицинских наук, профессор,

Москва

Director,

Moscow

secretariat@oparina4.ruhttps://orcid.org/0000-0003-2976-7128СеровВ. Н.SerovV. N.

д.м.н., профессор, академик РАН, президент Российского общества акушеров-гинекологов,

Москва

professor,

Moscow

v_serov@oparina4.ruhttps://orcid.org/0000-0002-8175-7886ДедовИ. И.DedovI. I.

президент ФГБУ «НМИЦ эндокринологии» Минздрава России, член Президиума РАН, академик, доктор медицинских наук, профессор, президент Российской ассоциации эндокринологов, главный внештатный специалист-эксперт эндокринолог Министерства здравоохранения России,

Москва

President,

Moscow

info@rae-org.ruhttps://orcid.org/0000-0002-6645-2515АрутюновГ. П.ArutyunovG. P.

чл.-корр. РАН, д.м.н., профессор, зав. кафедрой пропедевтики внутренних болезней педиатрического факультета,

Москва

Head of the Department of Propaedeutics of Internal Diseases of the Pension Fund,

Moscow

arut@ossn.ruСучковИ. А.SuchkovI. A.

профессор кафедры сердечно-сосудистой, рентгенэндоваскулярной хирургии и лучевой диагностики,

Рязань

Professor of the Department of Cardiovascular, X-ray Endovascular Surgery and Radiation Diagnostics, 

Ryazan

suchkov_med@mail.ruhttps://orcid.org/0000-0002-8160-5612ОрловаЯ. А.OrlovaYa. A.

д.м.н., руководитель отдела Возраст-ассоциированных заболеваний,

Москва

Head of the Department of Age-Associated Diseases Medical Research Center of Moscow State University M.V. Lomonosova,

Moscow

5163002@bk.ruАндрееваЕ. Н.AndreevaE. N.

заместитель директора Центра - директор Института репродуктивной медицины,

Москва

Deputy Director of the Center,

Moscow

prof.andreeva@endocrincentr.ruhttps://orcid.org/0000-0003-2864-066XЮреневаС. В.YurenevaS. V.

ведущий научный сотрудник, отделение гинекологической эндокринологии,

 Москва

Leading Researcher,

Moscow

syureneva@gmail.comhttps://orcid.org/0000-0003-2816-1183ЯвеловИ. С.YavelovI. S.

доктор медицинских наук, заведующий отдела фундаментальных и клинических проблем тромбоза при неинфекционных заболеваниях,

Москва

leading researcher Department of Clinical Cardiology and Molecular Genetics,

Moscow

 

yavelov@yahoo.comЯрмолинскаяМ. И.YarmolinskayaM. I.

профессор РАН, д.м.н., профессор, заведующий отделом гинекологии и эндокринологии , руководитель Центра «Инновационных методов диагностики и терапии эндометриоза»,

Санкт-Петербург

St. Petersburg

m.yarmolinskaya@gmail.comhttps://orcid.org/0000-0001-7652-2962ВиллевальдеС. В.VillevaldeS. V.

д.м.н., профессор, начальник службы анализа и перспективного планирования Управления по реализации федеральных проектов, заведующая кафедрой кардиологии Факультета подготовки кадров высшей квалификации Института медицинского образования,

Санкт-Петербург

Doctor of Medical Sciences, Professor, Head of the Analysis and Long-term Planning Service of the Office for the Implementation of Federal Projects, Head of the Department of Cardiology of the Faculty of Higher Qualification Training of the Institute of Medical Education,

St. Petersburg

 

villevaldes@mail.ruhttps://orcid.org/0000-0003-4979-7420ГригорянО. Р.GrigoryanO. R.

профессор кафедры эндокринологии Института высшего и дополнительного профессионального образования,

 Москва

professor,

Moscow

iceberg1995@mail.ruДудинскаяЕ. Н.DudinskayaE. N.

 кандидат медицинских наук, врач-эндокринолог, заведующая лабораторией возрастных метаболических эндокринных нарушений,

Москва

Head of the Laboratory of Age-Related Metabolic Endocrine Disorders,

Moscow

iluhin-e@yandex.ruИлюхинЕ. А.IlyukhinE. A.

руководитель направления флебологии сети медицинских центров Reaclinic, главный врач клиники «Медальп»

 Санкт-Петербург

Head of phlebology at the Reaclinic network of medical centers, chief physician at the Medalp clinic,

St. Petersburg

iluhin-e@yandex.ruКозиоловаН. А.KoziolovaN. A.

д.м.н., профессор,

 Пермь

MD, Professor, Head Department of propaedeutics of internal diseases №2,

Perm

nakoziolova@mail.ruhttps://orcid.org/0000-0003-1534-3965СергиенкоИ. В.SergienkoI. V.

д.м.н., профессор, гл.н.с. лаборатории фенотипов атеросклероза,

Москва

Doctor of Medical Sciences, Professor, Chief Researcher laboratories of atherosclerosis phenotypes,

Moscow

igorcardio@mail.ruhttps://orcid.org/0000-0002-0627-3902СметникА. А.SmetnikA. A.

к.м.н, заведующая отделением гинекологической эндокринологии,

 Москва

Head of the Department of Gynecological Endocrinology,

Moscow

asmetnik@gmail.comТапильскаяН. И.TapilskayaN. I.

доктор медицинских наук, профессор, заведующий отделом репродуктологии ФГБНУ НИИАГ и Р  им. Д.О. Отта , профессор кафедры акушерства и гинекологии СПбГПМУ,

Санкт-Петербург

Doctor of Medical Sciences, Professor, Head of the Department of Reproductology,

St. Petersburg

tapnatalia@yandex.ruФГБУ «Национальный медицинский исследовательский центр имени В.А. Алмазова» Минздрава РФРоссияAlmazov National Medical Research CenterRussian FederationФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И.Кулакова» Минздрава РФРоссияKulakov National Medical Research Center of Obstetrics, Gynecology and PerinatologyRussian FederationГНЦ РФ ФГБУ «НМИЦ эндокринологии» Минздрава РФРоссияNational Medical Research Center of EndocrinologyRussian FederationФГАОУ ВО РНИМУ им. Н.И. Пирогова Минздрава РФРоссияPirogov Russian National Research Medical UniversityRussian FederationФГБОУ ВО РязГМУ И. П. Павлова Минздрава РФРоссияPavlov Ryazan State Medical UniversityRussian Federation«Медицинский научно-образовательный центр МГУ им. М.В.Ломоносова»РоссияMedical Research and Educational Center, Lomonosov Moscow State UniversityRussian FederationГНЦ РФ ФГБУ «НМИЦ эндокринологии» Минздрава РФ; ФГБОУ ВО «МГМСУ им. А.И. Евдокимова»РоссияNational Medical Research Center of Endocrinology; Evdokimov Moscow State University of Medicine and DentistryRussian FederationФГБУ «Национальный медицинский исследовательский центр терапии и профилактической медицины» Минздрава РФРоссияNational Medical Research Center for Therapy and Preventive MedicineRussian FederationФГБНУ «НИИ акушерства и гинекологии и репродуктологии им. Д. О. Отта»РоссияOtt Research Institute of Obstetrics, Gynecology and ReproductologyRussian FederationРоссийский Геронтологический научно-клинический центр ФГАОУ ВО РНИМУ им. Н. И. Пирогова Минздрава РФРоссияRussian Gerontology Research and Clinical Center, Pirogov Russian Research Medical UniversityRussian FederationООО «Медальп»РоссияOOO “Medalp”Russian FederationФГБУ «Пермский государственный медицинский университет им. акад. Е. А. Вагнера» Минздрава РФРоссияVagner Perm State Medical UniversityRussian FederationФГБУ “Национальный медицинский исследовательский центр кардиологии им. акад. Е.И. Чазова” Минздрава РФРоссияChazov National Medical Research Center of CardiologyRussian Federation2023081120236310928Copyright © Kardiomag, 20232023KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/2561

Климактерические симптомы могут нарушать ход жизни женщин на пике карьеры и семейной жизни. В настоящее время самым эффективным методом лечения этих проявлений является менопаузальная гормональная терапия (МГТ). Наличие сердечно-сосудистых и метаболических заболеваний само по себе не исключает возможность назначения МГТ с целью купирования климактерических симптомов и улучшения качества жизни. Однако нередко препятствием для использования этого вида гормональной терапии являются опасения врачей, которые боятся принести пациенткам больше вреда, чем пользы. Осторожность особенно важна, когда речь идет о женщинах, страдающих сопутствующими заболеваниями. Более того, следует признать, что качественных исследований относительно безопасности МГТ при основных хронических неинфекционных заболеваниях и часто встречаемых коморбидных состояниях недостаточно. В представленном согласительном документе проведен анализ всех доступных в настоящее время данных, полученных в ходе клинических исследований различного дизайна, и создан свод критериев приемлемости назначения МГТ женщинам с сопутствующими сердечно-сосудистыми и метаболическими заболеваниями. Опираясь на представленный документ, врачи различных специальностей, консультирующие женщин в климактерии, получат доступный алгоритм, позволящий избегать потенциально опасных ситуаций и обоснованно назначать МГТ в реальной практике.

Menopausal symptoms can impair the life of women at the peak of their career and family life. At the present time, the most effective treatment for these manifestations is menopausal hormone therapy (MHT). The presence of cardiovascular and metabolic diseases in itself does not exclude the possibility of prescribing MHT to relieve menopausal symptoms and improve quality of life. However, often an obstacle to the use of this type of hormone therapy is the fear of physicians to do more harm to patients than good. Caution is especially important when it comes to women with concurrent diseases. Moreover, it should be recognized that there is a shortage of high-quality research on the safety of MHT for underlying chronic non-infectious diseases and common comorbidities. The presented consensus analyzed all currently available data from clinical trials of various designs and created a set of criteria for the appropriateness of prescribing MHT to women with concomitant cardiovascular and metabolic diseases. Based on the presented document, physicians of various specialties who advise menopausal women will receive an accessible algorithm that will allow them to avoid potentially dangerous situations and reasonably prescribe MHT in real-life practice.

Менопаузальная гормональная терапиясердечно-сосудистые заболеванияметаболические заболеваниясахарный диабетвенозные тромбоэмболические осложненияMenopausal hormone therapycardiovascular diseasesmetabolic diseasesdiabetes mellitusvenous thromboembolic complicationsКонфликт интересов не заявленReferencesРаспоряжение Правительства РФ от 29 дек. 2022 г. № 4356-р «Об утверждении Национальной стратегии действий в интересах женщин на 2023 - 2030 годы». Доступно на: https://www.consultant.ru/document/cons_doc_LAW_436691Распоряжение Правительства РФ от 29 дек. 2022 г. № 4356-р «Об утверждении Национальной стратегии действий в интересах женщин на 2023 - 2030 годы». Доступно на: https://www.consultant.ru/document/cons_doc_LAW_436691Улумбекова Г.Э., Худова И.Ю. Оценка демографического, социального и экономического эффекта при приеме менопаузальной гормональной терапии. ОРГЗДРАВ: новости, мнения, обучения. Вестник ВШОУЗ. 2020;6(4(22)):23-53. 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The authors declare that there are no conflicts of interest present.