International Circulation : Today we have a short interview with Prof. Joanna E. Manson. In the primary prevention of CVD risk in women， what are the controversies in the application of aspirin， estrogen， or vitamin D supplementation?
《国际循环》：女性心血管风险一级预防时，目前在现在使用阿司匹林、雌激素和维生素D补充剂方面存在哪些争议？
Prof. Manson : The decision about whether or not to take estrogen and menopausal hormone therapy is a very complex one， but the first question is whether a woman has menopausal symptoms such as moderate to severe hot flashes or night sweats where the quality of life benefits from hormone therapy are likely to outweigh any risk. It is also important to evaluate some of the woman’s risk factors， her age， her time since menopause， her underlying cardiovascular disease risk score， and we recommend that if a woman has a high underlying risk of cardiovascular disease that she avoid hormone therapy especially oral hormone therapy which can increase thrombosis， and either take a low dose transdermal product or perhaps a non hormonal treatment for hot flashes and night sweats. We do have a mobile app， a free mobile app to help women to evaluate their own risk of cardiovascular disease along with their clinician when they are talking to their healthcare provider， so they can have shared decision making in the choice of hormonal versus non-hormonal treatments. We also recommend that they consider lifestyle modifications and behavior factors that may be helpful for their hot flashes.
Manson教授：女性是否使用雌激素和绝经期激素治疗的决策非常复杂，但首要问题是需要明确是否有绝经期症状，如中重度的潮热或夜间盗汗，对于这些患者，使用激素疗法的生活质量改善的获益大于风险。评估女性的危险因素也很重要，包括年龄、绝经时间、潜在的心血管疾病风险评分。我们推荐如果有高危心血管疾病风险者，应避免激素疗法尤其口服激素治疗，因为这可能会增加血栓风险，此时可使用一种经皮治疗的产品或可能使用非激素疗法治疗潮热或夜间盗汗。目前，在医生帮助下，使用免费的移动应用软件，女性可评估自身的心血管疾病风险，就诊时可为医生提供相关信息，便于与医生分享治疗决策，决定使用激素治疗还是非激素治疗。我们也推荐这类女性采取生活方式干预和行为疗法，这可能对潮热有作用。
Prof. Manson : There is a lot of controversy about vitamin D and risk of heart disease， stroke， and cancer. We do know vitamin D is very important for bone health， but at the present time， the jury is out in terms of whether vitamin D supplementation can lower risk of heart attack， stroke， cancer， and many of the non-skeletal health outcomes. There are randomized trials that are in progress to test vitamin D supplementation. We are doing the vitamin D and omega 3 trial which is testing 2000 IUs a day. And over the course of the next 2 to 3 years some results will be available from the large randomized trials of vitamin D that are being done throughout the world.
Manson教授：维生素D与心脏疾病风险、卒中和癌症的关系争议颇多。维生素D对骨骼的重要作用非常明确，但目前的情况是，其以维生素D补充剂的形式，被大量研究外展至能否降低心肌梗死、卒中、癌症和其他非骨骼相关健康预后。有大量研究在观察维生素D的这些作用。我们正在开展一项关于维生素D和Ω-3多不饱和脂肪酸的试验，旨在检测每天使用2000单位的作用。未来2~3年，从全球各地的维生素D相关大型随机试验中将会获取一些有用的结果。
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