Endothelial Function Is Impaired across the Stages of the Menopause Transition in Healthy Women
Endothelial Function Is Impaired across the Stages of the Menopause Transition in Healthy Women
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DOI：
10.1210/jc.2012-2244
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发表时间：
2012-12-01
影响因子：
5.8
通讯作者：
Kohrt, Wendy M.
中科院分区：
文献类型：
--
作者：
Moreau, Kerrie L.;Hildreth, Kerry L.;Kohrt, Wendy M.
背景：绝经过渡阶段的特点是卵巢激素的变化和心血管疾病(CVD)危险因素和血管运动症状的增加，这可能对血管健康产生不利影响。目的：我们检验了一种假说，即血管内皮功能是心血管疾病的预测因子，在绝经过渡的各个阶段都会降低，与心血管疾病危险因素和血管运动症状无关。设计、背景和参与者：这是一项横断面研究，来自普通社区的132名健康女性，年龄22-70岁，被归类为绝经前(n=33，32+/-6岁；平均+/-SD)，围绝经期早期(n=20，49+/-3年)或围绝经期晚期(n=22，50+/-4年)，或早期(n=30，55+/-3年)或绝经后晚期(n=27，61+/-4年)。绝经前妇女(9.9±-2.1%)和绝经后妇女(早期：5.5+/-1.9%；晚期：4.7+/-1.7%)进行性下降的绝经前妇女(早期：8.2+/-2.5%；晚期：6.5+/-1.9%)最高。对危险因素、血管舒缩症状和性激素的调整并没有改变这种关联(P<；0.001)。在对50-59岁妇女的亚组分析中，与围绝经期早期妇女相比，围绝经期晚期、绝经早期和绝经晚期妇女的肱动脉FMD值较低(P<；0.001)，但在围绝经期晚期和绝经早期或绝经后早期或晚期妇女之间没有差异。结论：我们的研究结果表明，内皮功能的下降始于绝经早期(围绝经期)，随着卵巢功能的丧失和雌激素缺乏的延长而加重。这些数据增加了越来越多的证据，表明围绝经期窗口是心血管疾病风险不利变化的关键时间段。(临床内分泌代谢酶97：4692-4700,2012)
Context: The stages of the menopause transition are characterized by changes in ovarian hormones and increased cardiovascular disease (CVD) risk factors and vasomotor symptoms that may adversely affect vascular health.Objective: We tested the hypothesis that endothelial function, a predictor of CVD, would be reduced across the stages of the menopause transition, independent of CVD risk factors and vasomotor symptoms.Design, Setting, and Participants: This was a cross-sectional study of 132 healthy women from the general community aged 22-70 yr, categorized as premenopausal (n = 33, 32 +/- 6 yr; mean +/- SD), early perimenopausal (n = 20, 49 +/- 3 yr) or late perimenopausal (n = 22, 50 +/- 4 yr), or early (n = 30, 55 +/- 3 yr) or late postmenopausal (n = 27, 61 +/- 4 yr).Main Outcome: Endothelial-dependent vasodilation was measured by brachial artery flow-mediated dilation (FMD) using ultrasound.Results: Brachial artery FMD was significantly different among the groups (P < 0.001). It was highest in premenopausal women (9.9 +/- 2.1%) with progressive decrements in perimenopausal (early: 8.2 +/- 2.5%; late: 6.5 +/- 1.9%) and postmenopausal women (early: 5.5 +/- 1.9%; late: 4.7 +/- 1.7%). Adjustment for risk factors, vasomotor symptoms, and sex hormones did not alter the association (P < 0.001). In subgroup analyses of women aged 50-59 yr, brachial artery FMD was lower in late peri-and early and late postmenopausal compared with early perimenopausal women (P < 0.001) but was not different between late perimenopausal and either early or late postmenopausal women.Conclusions: Our findings suggest that a decline in endothelial function begins during the early stages of menopause (perimenopause) and worsens with the loss of ovarian function and prolonged estrogen deficiency. These data add to the accumulating evidence that the perimenopausal window is a critical time period for adverse changes in CVD risk. (J Clin Endocrinol Metab 97: 4692-4700, 2012)