Prospective study of endogenous circulating estradiol and risk of stroke in older women.
Prospective study of endogenous circulating estradiol and risk of stroke in older women.
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DOI：
10.1001/archneurol.2009.322
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发表时间：
2010-02
影响因子：
--
通讯作者：
Cummings, Steven
中科院分区：
文献类型：
--
作者：
Lee, Jennifer S.;Yaffe, Kristine;Lui, Li-Yung;Cauley, Jane;Taylor, Brent;Browner, Warren;Cummings, Steven
为了验证循环内源性雌二醇与老年绝经后妇女中风风险相关的假设。当内源性雌激素水平下降时，绝经后中风发病率增加，然而外源性雌激素增加绝经后老年妇女中风。内源性雌激素与脑卒中的关系尚不清楚。前瞻性病例对照研究。骨质疏松性骨折研究。65岁以上（99%随访）基线时未服用雌激素的妇女。游离雌二醇指数（FEI）是用总雌二醇除以储备基线血清中性激素结合球蛋白浓度来计算的。使用logistic回归，对196名随后证实发生卒中的女性（中位随访8年）与219名随机选择的未发生动脉粥样硬化血栓性卒中的女性（中位随访8年）进行了首次与内源性FEI相关的动脉粥样硬化血栓性卒中的比值比估计。在多变量模型中评估潜在的中介因素。随着FEI四分位数的增加，年龄调整后动脉粥样硬化血栓性卒中的几率增加（p趋势= 0.007）。FEI最高四分位数的女性的年龄调整后的几率比最低四分位数的女性高2.31倍（优势比为2.31；95%可信区间为1.28-4.17）。中心性肥胖程度较高的女性与此有较强的相关性（P =.08）。动脉粥样硬化性血脂异常、2型糖尿病和c反应蛋白水平是这一关系的潜在媒介。内源性雌二醇水平是绝经后老年妇女中风风险的一个指标，特别是那些中枢性肥胖的妇女。潜在的介质，包括动脉粥样硬化性血脂异常、胰岛素抵抗和炎症，可能是这种关联的基础。是否雌二醇，独立于动脉粥样硬化性肥胖，影响这些介质和中风的风险需要确定。雌激素改变剂可能有害或有益取决于内源性雌二醇水平，特别是在中枢性肥胖较大的妇女。
To test the hypothesis that circulating endogenous estradiol is associated with stroke risk in older postmenopausal women. Stroke incidence increases after menopause, when endogenous estrogen levels fall, yet exogenous estrogen increases strokes in older postmenopausal women. The relation between endogenous estrogen and stroke is unclear. Prospective case-control study. Study of Osteoporotic Fractures. Women at least age 65 years (99% follow-up) who were not taking estrogen at baseline. Free estradiol index (FEI) was calculated by dividing total estradiol by sex hormone–binding globulin concentrations measured in banked baseline serum. Using logistic regression, odds ratios were estimated for a first-ever atherothrombotic stroke associated with endogenous FEI in 196 women who had a subsequent validated stroke (median follow-up, 8 years) compared with 219 randomly selected women who did not. Potential mediators were assessed in multivariable models. The age-adjusted odds of atherothrombotic stroke increased with increasing FEI quartiles (Ptrend=.007). Women in the highest FEI quartile had an age-adjusted 2.31-fold (odds ratio, 2.31; 95% confidence interval, 1.28–4.17) higher odds than women in the lowest quartile. Women with greater central adiposity had a suggestively stronger association (P =.08). Atherogenic dyslipidemia, type 2 diabetes mellitus, and C-reactive protein level were potential mediators of this relation. Endogenous estradiol level is an indicator of stroke risk in older postmenopausal women, especially in those with greater central adiposity. Potential mediators, including atherogenic dyslipidemia, insulin resistance, and inflammation, might underlie this association. Whether estradiol, independent of atherogenic adiposity, influences such mediators and stroke risk needs to be determined. Estrogen-altering agents might be harmful or beneficial depending on endogenous estradiol levels, especially in women with greater central adiposity.
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