Long-term estrogen therapy improves vascular function in male to female transsexuals
Long-term estrogen therapy improves vascular function in male to female transsexuals
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DOI：
10.1016/s0735-1097(97)00080-6
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发表时间：
1997-06-01
影响因子：
24
通讯作者：
Meredith, IT
中科院分区：
文献类型：
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作者：
New, G;Timmins, KL;Meredith, IT
目标。这项研究试图检测长期雌激素治疗对男性变性者血管功能的影响，并将其与男性和绝经前女性的研究结果进行比较。冠状动脉疾病的性别差异在很大程度上归因于雌激素对女性血管功能和血脂的有益影响。然而，雌激素对男性血管系统的影响尚未被广泛研究。我们比较了14名男性和女性变性者、14名年龄匹配的男性和15名绝经前女性雌激素对血管功能的影响。使用非侵入性超声评估PLW介导的血管扩张和对硝酸甘油的反应。变性者和女性的血流介导的血管扩张相似，但高于男性([Mean+/-SE]11.5+/-1.3%和9.4+/-1.1%vs，5.2+/-1.0%，p<；0.005)。变性者和女性对硝酸甘油的反应也比男性更大(分别为21.6%+/-1.7%和21.0+/-0.9%对14.5+/-1.2%，p=0.0005)。即使在对血管大小进行调整后，这些差异仍然存在。尽管总胆固醇水平相似，变性者的高密度脂蛋白胆固醇水平与女性相似，但高于男性(分别为1.76+/-0.12和1.82+/-0.11mmol/升vs.1.35+/-0.07mmol/升，p<；0.005)。此外，变性者的甘油三酯水平高于男性和女性，低密度脂蛋白胆固醇颗粒较小(分别为26.2+/-0.1和26.6+/-0.1 nm，p=0.0001)，变性者的血清睾酮(雌激素治疗的一个指标)明显受到抑制，与女性相似。单因素分析显示血清睾酮水平与血流介导的血管扩张功能呈显著负相关(r(S)=-0.48，p<；0.005)。多因素分析显示，Dow介导的血管扩张的最佳预测因子组合为血睾酮、血管大小和低密度脂蛋白胆固醇(R2=0.3p<；0.005)。长期的雌激素治疗似乎改善了男性变性者到女性变性者的血管功能，尽管甘油三酯水平较高，且存在小而致密的低密度脂蛋白-C，但仍会发生这种情况。雌激素的有益作用不是性别特有的，也不完全是通过内皮衍生的一氧化氮来调节的。(C)1997年由美国心脏病学会主办。
Objectives. This study sought to examine the effects of longterm estrogen therapy on vascular function in male to female transsexuals and to compare the findings with those observed in men and premenopausal women.Background. Gender differences in coronary artery disease have largely been attributed to the beneficial effects of estrogen on vascular function and plasma lipids in women. However, the effects of estrogen on the male vasculature have not been widely studied.Methods. We compared the effects of estrogen on vascular function in 14 male to female transsexuals, 14 age-matched men and 15 premenopausal women. Plow-mediated vasodilation and response to nitroglycerin were assessed in the brachial artery using noninvasive ultrasound.Results. Flow-mediated vasodilation was similar in transsexuals and women but greater than that in men ([mean +/- SE] 11.5 +/- 1.3% and 9.4 +/- 1.1% vs, 5.2 +/- 1.0% respectively, p < 0.005). Responses to nitroglycerin were also greater in transsexuals and women than in men (21.6 +/- 1.7% and 21.0 +/- 0.9% vs. 14.5 +/- 1.2%, respectively, p = 0.0005). These differences persisted even after adjusting for vessel size. Despite similar total cholesterol levels, transsexuals had high density lipoprotein cholesterol levels similar to those in women and greater than those observed in men (1.76 +/- 0.12 and 1.82 +/- 0.11 mmol/liter vs. 1.35 +/- 0.07 mmol/liter, respectively, p < 0.005). Moreover, triglyceride levels were greater in transsexuals than in men and women, and low density lipoprotein cholesterol (LDL-C) particle size was smaller (25.7 +/- 0.2 nm vs. 26.2 +/- 0.1 and 26.6 +/- 0.1 nm, respectively, p = 0.0001), Serum testosterone (an index of estrogen therapy in transsexuals) was markedly suppressed in transsexuals and similar to that in women. Univariate analysis revealed that there was a strong inverse correlation between serum testosterone and flow-mediated vasodilation (r(s) = -0.48, p < 0.005). Multivariate analysis revealed that the best combination of predictors of dow-mediated vasodilation was serum testosterone, vessel size and LDL-C (R-2 = 0.3, p < 0.005).Conclusions. Long-term estrogen therapy appears to improve vascular function in male to female transsexuals and occurs despite higher triglyceride levels and the presence of small, dense LDL-C. The beneficial effects of estrogen are not gender specific or solely mediated through endothelium-derived nitric oxide. (C) 1997 by the American College of Cardiology.