Repercussões das alterações hormonais da menopausa nos níveis séricos de fosfato e associação com a doença cardiovascular : uma revisão narrativa

Abstract

Menopause is a process that occurs in women in their fifties, and consists of the cessation of menstrual cycles due to aging that causes a series of changes in the structure and function of the ovaries. With these changes in the female body, the homeostasis of some important components for maintaining health can be impaired, such as phosphate, which plays key roles in the modulation of a series of metabolic processes. Faced with this new hormonal environment, this population is more exposed to certain diseases, such as diseases that affect the cardiovascular system. Due to this problem, the objective of this narrative review was to investigate the association between menopause, serum phosphate levels and the development of cardiovascular diseases. Research was carried out in the PUBMED/MEDLINE and SciELO databases, with selected articles published between the years 2000 to 2020, which followed the pre-established inclusion criteria. As results obtained through the survey of studies, there was a scarce number of evidences that guarantee the direct relationship between the three central elements of the work, although the reduction of serum phosphate concentrations by estrogen and its consequent increase in menopause are mentioned, no established association with cardiovascular disease. The high complexity of risk factors for cardiovascular disease associated with the range of physiological effects of phosphate makes it difficult to pinpoint the causality of pathological events in women in the menopause phase. The confounding factors in the studies analyzed contributed to these results, such as the inclusion in the clinical trials of individuals with pre-existing diseases, such as chronic kidney disease; and animal studies, which experience menopause in an artificial way, distinguishing itself from the natural way that most women experience this phase. Hormone therapy as a potentially beneficial strategy in reducing the adverse events characteristic of menopause, including cardiovascular ones, should be considered regarding their associated risks, in order to select the most efficient and safe treatment protocol.