Coronary artery disease -: is menopause a risk factor?
Coronary artery disease -: is menopause a risk factor?
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DOI：
10.1007/s003950070014
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发表时间：
2000-01-01
影响因子：
9.5
通讯作者：
Gohlke-Bärwolf, C
中科院分区：
文献类型：
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作者：
Gohlke-Bärwolf, C
心血管疾病，尤其是冠状动脉疾病（CAD）是50岁以上女性发病和死亡的主要原因，而年轻女性的情况很少见。这一事实，即女性 CAD 的总体发病率较低且发病延迟 10-15 年，这一事实引发了一个备受争议的问题：绝经是否是 CAD 的危险因素。人们普遍认为，双侧卵巢切除术引起的早期绝经是 CAD 的危险因素，除非替代雌激素，否则相对风险为 2。然而，相关的自然发生的更年期研究显示出不同的结果。本次审查的重点是协会被接受为风险因素所需的标准。自然绝经的发生受到先前存在的风险因素的影响，其影响方式各不相同，部分是相反的。吸烟导致更年期提前，肥胖、高血压和糖尿病推迟。这些复杂的相互作用使统计分析变得复杂。自然绝经与深刻的生化和代谢变化有关，这些变化是既定的危险因素，例如低密度脂蛋白胆固醇增加和高密度脂蛋白胆固醇减少。这些生化和代谢变化是更年期成为危险因素的机制。结论：即使并非所有要求（特别是可逆性要求）都得到满足，更年期也可以被视为危险因素。更年期的发生表明女性 CAD 风险从低风险转变为高风险。
Cardiovascular disease, especially coronary artery disease (CAD), are leading causes of morbidity and mortality in women over the age of 50,whereas this is rarely the case in younger women. This fact, the overall lower incidence of and the 10-15 year retarded occurrence of CAD in women, has led to the controversially discussed question whether menopause is a risk factor for CAD.There has been universal agreement that surgically induced early menopause with bilateral oophorectomy is a risk factor for CAD, associated with a relative risk of 2, unless estrogen is replaced. Yet pertinent naturally occurring menopause studies showed variable results. This review focuses on the criteria required for an association to be accepted as a risk factor. The occurrence of natural menopause is influenced by preexisting risk factors in different, partly opposing ways. Smoking leads to an earlier occurrence of menopause, obesity, hypertension and diabetes to a later occurrence. These complex interactions complicate statistical analysis. Natural menopause is associated with profound biochemical and metabolic changes, which are established risk factors, e.g., increase in LDL and decrease in HDL cholesterol. These biochemical and metabolic changes are the mechanisms by which menopause can act as a risk factor.Conclusions: Menopause can be accepted as a risk factor, even if not all requirements, particularly that of reversibility, are fulfilled.The occurrence of menopause indicates the transition from a low to a higher risk for CAD in women.