Verhoef P
Wageningen Center for Food Sciences and Wageningen University, Division of Human Nutrition and Epidemiology, The Netherlands.
Semin Thromb Hemost. 2000;26(3):325-34. doi: 10.1055/s-2000-8474.
Plasma levels of total homocysteine (tHcy), a possible risk factor for vascular disease, are generally lower in women than in men and lower in premenopausal women than in postmenopausal women. This article reviews studies that have investigated associations of hyperhomocysteinemia with risk of vascular disease among women or that compared risk by stratum of gender or menopausal status. Seven out of 12 epidemiological studies that included both men and women found hyperhomocysteinemia to be a stronger risk factor in women than in men. However, the interaction effect was statistically significant for only 1 study. Three studies observed no risk difference between men and women, and 2 observed a weaker association in women. In addition, 3 studies that consisted (almost) entirely of women observed direct associations of hyperhomocysteinemia with vascular disease risk, comparable to associations observed in male populations. Hyperhomocysteinemia was associated with increased risk in populations of both young and elderly women, but only few studies have compared risks among premenopausal and postmenopausal women. However, the limited data indicate that hyperhomocysteinemia is also associated with elevation of vascular disease risk before the menopause. The stronger association among women in some studies may be explained by aspects of the study design, such as age at inclusion (i.e., women usually suffer from vascular diseases later in life than do men), or aspects of the data analysis, such as use of an overall instead of a gender-specific cutoff point. Of course, one cannot exclude the possibility that women are somehow more susceptible to detrimental effects of tHcy than men are, although there is evidence from other studies that estrogens have a "protective" effect on the vascular wall and a favorable effect on hemostasis. In conclusion, we should consider hyperhomocysteinemia as a potential risk factor for vascular disease in both men and women, before and after the menopause.
血浆总同型半胱氨酸（tHcy）水平是血管疾病的一个潜在风险因素，一般女性低于男性，绝经前女性低于绝经后女性。本文回顾了一些研究，这些研究调查了高同型半胱氨酸血症与女性血管疾病风险的关联，或按性别或绝经状态分层比较了风险。在12项纳入了男性和女性的流行病学研究中，有7项发现高同型半胱氨酸血症在女性中是比男性更强的风险因素。然而，只有1项研究的交互作用具有统计学意义。3项研究未观察到男性和女性之间的风险差异，2项研究观察到女性中的关联较弱。此外，3项（几乎）完全由女性组成的研究观察到高同型半胱氨酸血症与血管疾病风险之间存在直接关联，与在男性人群中观察到的关联相当。高同型半胱氨酸血症与年轻和老年女性人群的风险增加相关，但只有少数研究比较了绝经前和绝经后女性的风险。然而，有限的数据表明，高同型半胱氨酸血症在绝经前也与血管疾病风险升高相关。一些研究中女性之间更强的关联可能由研究设计方面的因素解释，如纳入时的年龄（即女性通常比男性在生命后期患血管疾病），或数据分析方面的因素，如使用总体而非性别特异性的截断点。当然，尽管其他研究有证据表明雌激素对血管壁有“保护”作用且对止血有有利影响，但不能排除女性在某种程度上比男性更容易受到tHcy有害影响的可能性。总之，我们应将高同型半胱氨酸血症视为绝经前后男性和女性血管疾病的潜在风险因素。
