Relationship between serum levels of sex hormones and progression of subclinical atherosclerosis in postmenopausal women
Relationship between serum levels of sex hormones and progression of subclinical atherosclerosis in postmenopausal women
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DOI：
10.1210/jc.2007-1738
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发表时间：
2008-01-01
影响因子：
5.8
通讯作者：
Mack, Wendy J.
中科院分区：
文献类型：
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作者：
Karim, Roksana;Hodis, Howard N.;Mack, Wendy J.
背景：绝经后激素治疗与心血管疾病的关系已得到广泛研究。然而，将血清性激素水平与心血管疾病联系起来的研究很少，而且结果尚无定论。 方法：在雌激素预防动脉粥样硬化试验中，我们测量了纵向收集的 180 名绝经后妇女样本中的性激素，其中 91 名随机服用 17 种 β-雌二醇，89 名随机服用安慰剂。重复测量性激素水平，测试其与颈动脉内膜中层厚度 (CIMT) 的关系，并在 2 年的时间里进行纵向评估。结果：在所有女性中，血清雌酮 (P = 0.02)、总雌二醇 (P = 0.01)、游离雌二醇 (P = 0.02) 和 SHBG (P = 0.005) 的变化与 CIMT 进展显着呈负相关。控制年龄和体重指数。所有雌激素化合物和SHBG均与低密度脂蛋白胆固醇呈显着负相关，与高密度脂蛋白胆固醇呈正相关（均P<0.0001），而游离睾酮与低密度脂蛋白胆固醇呈正相关，与高密度脂蛋白胆固醇呈负相关（P<0.003）。尽管雌二醇治疗后血清游离雌二醇有所增加，但 SHBG 和游离睾酮水平未改变的女性 CIMT 平均 (SE) 进展为 8.53 (4.72) mu m/年，而游离雌二醇和 SHBG 增加且游离睾酮水平降低的女性 CIMT 进展降低幅度最大 [-5.45 (2.77) mu m/年；趋势 P = 0.03]。结论：雌激素和 SHBG 与健康绝经后女性亚临床动脉粥样硬化进展的减少相关。这些关联部分是由它们对脂质的有益作用介导的。在服用雌二醇的女性中，对 CIMT 进展最有益的激素特征是游离雌二醇和 SHBG 增加，同时游离睾酮减少。
Background: Postmenopausal hormone therapy has been examined extensively in relation to cardiovascular disease. However, research relating serum levels of sex hormones to cardiovascular disease is sparse, and the results are inconclusive.Methods: We measured sex hormones in longitudinally collected samples of 180 postmenopausal women, 91 randomized to 17 beta-estradiol and 89 to placebo, in the Estrogen in the Prevention of Atherosclerosis Trial. Repeated measures of sex hormone levels were tested for an association with carotid artery intima-media thickness (CIMT), which was also assessed longitudinally over 2 yr.Results: in all women, changes in serum estrone (P = 0.02), total estradiol (P = 0.01), free estradiol (P = 0.02), and SHBG (P = 0.005) were significantly inversely associated with CIMT progression, controlling for age and body mass index. All the estrogen compounds and SHBG were significantly inversely related with low-density lipoprotein cholesterol and positively associated with high-density lipoprotein cholesterol (all P < 0.0001), whereas free testosterone was positively related with low-density lipoprotein cholesterol and inversely associated with high-density lipoprotein cholesterol (P < 0.003). Despite an increase in serum-free estradiol with estradiol therapy, women with unchanged SHBG and free testosterone levels had an average (SE) progression in CIMT of 8.53 (4.72) mu m/yr, whereas women with-increased free estradiol and SHBG and decreased free testosterone had the largest reduction in CIMT progression [-5.45 (2.77) mu m/yr; trend P = 0.03].Conclusion: Estrogen and SHBG are associated with reduced subclinical atherosclerosis progression in healthy postmenopausal women. These associations are partially mediated by their beneficial effects on lipids. Among women taking estradiol, the most beneficial hormone profile for CIMT progression was increased free estradiol and SHBG with concomitant decreased free testosterone.