Vascular function in women: when studying perimenopause is peri important.
Vascular function in women: when studying perimenopause is peri important.
复制标题
女性的血管功能：在研究围绝经期时非常重要。
DOI：
10.1113/ep091066
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发表时间：
2023
影响因子：
2.7
通讯作者：
Lefferts,WesleyK
中科院分区：
文献类型：
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作者：
DuBose,LyndseyE;Lefferts,WesleyK
更年期过渡期是心血管老化加速、心血管疾病（CVD）等慢性疾病易感性增加的时期。越来越多的数据支持心血管因素对大脑衰老的影响，然而，女性的这一特征仍不清楚。 Ruediger 等人描述了健康中年绝经前 (n= 10)、绝经早期 (n= 15) 和绝经晚期 (n= 14) 女性的外周和脑血管功能的群体差异及其各自与性激素和一氧化氮生物利用度的关系（Ruediger 等，出版中）。作者应该为进行这项全面的研究而受到赞扬，并在缩小知识差距方面迈出了重要的一步。因此，我们希望强调考虑（i）更年期过渡作为一个加速风险和临床与统计显着性的时期的重要性，（ii）可能改变血管衰老轨迹的受试者特征，以及（iii）绝经期间脑血管血流动力学数据的缺乏以及考虑不同血管方法的重要性。首先，更年期过渡是一个本质上的生理动态时期。排除部分个体（例如围绝经期女性）的横断面研究无法解释绝经过渡期间的动态生理变化。排除围绝经期女性的横断面研究也限制了激素的分布，降低了检测激素与血管结果之间相关性的能力。在绝经过渡期早期，促性腺激素开始上升，随后雌二醇下降；然而，这些变化在末次月经期间会加速。主动脉僵硬度的增加在末次月经前的一年内加速，内皮功能的逐渐减少在围绝经期早期开始，但在围绝经后期加速（Samargandy 等，2020；Moreau 等，2020）。实验数据表明，雌激素缺乏会导致更年期内皮功能下降，并证明女性卵泡刺激素与外周血管功能之间存在更强的关联，这表明还有其他机制起作用（Moreau et al., 2020）。在 Ruediger 等人的研究结果背景下考虑这些数据非常重要
The menopause transition is a time of accelerated cardiovascular aging and increased susceptibility to chronic diseases including cardiovascular disease (CVD). Growing data support a cardiovascular contribution to brain aging however, characterization of this in women remains unclear. Ruediger et al., characterized group differences in peripheral and cerebrovascular function and their respective associations with sex hormones and nitric oxide bioavailability in healthy middle-aged premenopausal (n= 10), early postmenopausal (n= 15) and late postmenopausal (n= 14) women (Ruediger et al., In Press). The authors should be applauded for conducting this comprehensive study and have taken an important step towards closing a critical gap in knowledge. Accordingly, we wish to highlight the importance of considering (i) the menopausal transition as a period of accelerated risk and clinical versus statistical significance,(ii) subject characteristics that may alter vascular aging trajectories, and (iii) the paucity of data on cerebrovascular hemodynamics during menopause and importance of considering differing vascular methodology.First, the menopause transition is an inherently physiologically dynamic period. Crosssectional studies that exclude a portion of individuals (eg, perimenopausal women) cannot account for the dynamic physiological changes during the menopause transition. Crosssectional studies that exclude perimenopausal women also limit the distribution of hormone, reducing the ability to detect correlations between hormones and vascular outcomes. Gonadotropins begin to rise early in the menopause transition prior to declines in estradiol; however, these changes are accelerated around the final menstrual period. Increases in aortic stiffness are accelerated within one year prior to the final menstrual period and progressive reductions in endothelial function begin in early perimenopause but accelerate in late perimenopause (Samargandy et al., 2020; Moreau et al., 2020). Experimental data suggest that estrogen-deficiency contributes to reductions in endothelial function with menopause and demonstrate a stronger association between follicle stimulating hormone and peripheral vascular function in women, suggesting additional mechanisms contribute (Moreau et al., 2020). These data are important to consider within the context of findings by Ruediger et