Association of endogenous sex hormone levels with coronary artery calcium progression among post-menopausal women in the Multi-Ethnic Study of Atherosclerosis (MESA).
Association of endogenous sex hormone levels with coronary artery calcium progression among post-menopausal women in the Multi-Ethnic Study of Atherosclerosis (MESA).
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DOI：
10.1016/j.jcct.2018.09.010
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发表时间：
2019-01
影响因子：
5.4
通讯作者：
Michos ED
中科院分区：
文献类型：
--
作者：
Subramanya V;Zhao D;Ouyang P;Ying W;Vaidya D;Ndumele CE;Heckbert SR;Budoff MJ;Post WS;Michos ED
心血管疾病（CVD）发病率和表现的性别差异表明性激素参与疾病的发病机制。冠状动脉钙（CAC）及其进展，通过非造影心脏计算机断层扫描测量，是亚临床动脉粥样硬化的标志物，并预测心血管疾病，即使在低风险的妇女。我们假设性激素水平与动脉粥样硬化多种族研究中女性CAC进展相关。我们研究了2，759名绝经后女性（年龄65±9岁），她们没有基线CVD，在检查1（2000-2002）时测量了基线血清性激素和CAC。在该样本中，2，427例患者在检查5（2010-2012）中进行了≥1次随访CAC测量。使用混合效应线性回归方法，我们通过log[性激素]水平测试log[CAC+1]评分的变化（连续，比较第90个与第10个样本）。模型经人口统计学、生活方式因素、心血管危险因素、激素治疗和绝经后年限调整。在基线时，我们发现性激素和普遍的CAC之间没有联系。在中位4.7年的时间里，在完全校正的模型中，游离睾酮水平较高的女性具有较大的相对CAC进展率（95% CI）[1.26（1.011.56）]，而性激素结合球蛋白（SHBG）较高与较低的进展风险相关[0.80（0.64-0.99）。总睾酮、雌二醇或脱氢表雄酮均无相关性。在绝经后妇女中，更高的游离睾酮和更低的SHBG的雄激素水平与更大的CAC进展（长达10年）相关。性激素水平可能有助于识别CVD风险增加的女性，这些女性可能从额外的降低风险策略中受益。
Sex differences in the incidence and manifestation of cardiovascular disease (CVD) suggest the involvement of sex hormones in disease pathogenesis. Coronary artery calcium (CAC) and its progression, measured by non-contrast cardiac computed tomography, are markers of subclinical atherosclerosis and predict CVD, even among low-risk women. We hypothesized that sex hormone levels were associated with CAC progression among women in the Multi-Ethnic Study of Atherosclerosis. We studied 2,759 post-menopausal women (age 65±9 years), free of baseline CVD, with baseline serum sex hormones and CAC measured at Exam 1 (2000–2002). Of this sample, 2,427 had ≥1 follow-up CAC measurement through Exam 5 (2010–2012). Using mixed effects linear regression methods, we tested change in log[CAC+1] score by log[sex hormone] levels (continuous, comparing the 90th versus 10th percentiles). Models adjusted for demographics, lifestyle factors, cardiovascular risk factors, hormone therapy, and years since menopause. At baseline, we found no associations between sex hormones and prevalent CAC. Over a median of 4.7 years, in fully-adjusted models, women with higher free testosterone levels had a greater relative CAC progression ratio (95% CI) [1.26 (1.011.56)], whereas higher sex hormone binding globulin (SHBG) was associated with lower progression risk [0.80 (0.64–0.99). No associations were seen for total testosterone, estradiol, or dehydroepiandrosterone. A more androgenic hormone profile of higher free testosterone and lower SHBG is associated with a greater CAC progression up to 10-years in post-menopausal women. Sex hormone levels may help identify women at increased risk for CVD who may benefit from additional risk-reducing strategies.
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影响因子：
5.8
作者：
DUNN, JF;NISULA, BC;RODBARD, D
通讯作者：
RODBARD, D
影响因子：
5.4
作者：
Gassett AJ;Sheppard L;McClelland RL;Olives C;Kronmal R;Blaha MJ;Budoff M;Kaufman JD
通讯作者：
Kaufman JD
DOI：
10.1016/0735-1097(90)90282-t
发表时间：
1990-03-15
影响因子：
24
作者：
AGATSTON, AS;JANOWITZ, WR;DETRANO, R
通讯作者：
DETRANO, R
影响因子：
3.5
作者：
Budoff, MJ;Chen, GPW;Mao, SS
通讯作者：
Mao, SS
影响因子：
5
作者：
Bild, DE;Bluemke, DA;Tracy, RP
通讯作者：
Tracy, RP