采访精选

　　患者需与医生共同决策雌激素的使用

　　女性是否使用雌激素和绝经期激素治疗的决策非常复杂，但首要问题是需明确其是否有绝经期症状，如中重度的潮热或夜间盗汗，对于这些患者，激素疗法对于生活质量改善的获益大于风险。评估女性危险因素非常重要，包括年龄、绝经时间、潜在心血管疾病（CVD）风险评分。如果有较高的CVD风险，应避免采用激素疗法尤其口服激素治疗，因为这可能会增加血栓风险，此时可使用经皮制剂或非激素疗法治疗潮热或夜间盗汗。目前，在医生帮助下，女性使用免费移动应用软件可评估自身CVD风险，就诊时能为医生提供相关信息并分享治疗决策，决定是否使用激素治疗。对于这类女性，生活方式干预和行为疗法可能对潮热亦发挥作用。

　　维生素D相关研究在争议中前行

　　维生素D与心脏病风险、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。Manson教授团队正开展一项关于维生素D和Ω-3多不饱和脂肪酸试验，旨在检测每天使用2000单位以上制剂的作用。未来2~3年，全球维生素D相关大型随机试验将展示一些有用结果。

　　The decision about whether or not to take estrogen and menopausal hormone therapy is very complicated， 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 women’s risk factors， age， time since menopause， underlying cardiovascular disease risk score， and we recommend that if a woman has a high underlying risk of cardiovascular disease， she avoids 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 free mobile app to help women to evaluate their own risk of cardiovascular disease along with their clinicians， 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.

　　There is a lot of controversies 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 non-skeletal health outcomes. There are randomized trials that are in progress to test vitamin D supplementation. We are doing a vitamin D and omega-3 trial which is testing 2000 IUs a day. Over 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.

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