Tremollieres F A, Cigagna F, Alquier C, Cauneille C, Pouilles J, Ribot C
Menopause and Metabolic Bone Diseases Unit, Department of Endocrinology, CHU Rangueil, 1, avenue Jean Poulhes, 31403 Cedex 4, Toulouse, France.
Atherosclerosis. 2000 Nov;153(1):81-8. doi: 10.1016/s0021-9150(00)00372-5.
The aim of this study was to determine the changes in carotid artery intima-media thickness as measured by B-mode ultrasound in postmenopausal women receiving hormone replacement therapy (HRT) or not. One hundred and fifty-nine healthy postmenopausal women aged 45-65 years were recruited from our menopause clinic. All the selected women were free of cardio-vascular diseases and had no cardio-vascular risk factors. None of the women were receiving lipid-lowering or antihypertensive drugs. Because carotid artery intima-media thickness was shown to be strongly and positively correlated with age in women aged 55 years and older but not before, women were divided into four groups according to age (<55 vs. > or =55 years) and use of HRT (current users vs. never users). All the treated women received non-oral 17beta-estradiol with a non-androgenic progestin and had started HRT within the first year after menopause. Scanning of the right common carotid artery was performed with a B-mode ultrasound imager and thickness of the intima-media complex as well as luminal diameter of the artery were determined using an automated computerized procedure. Within each age group (i.e. <55 or > or =55 years), women had comparable demographic characteristics and only differed by HRT use. Long-term treated women had significantly lower total cholesterol levels than untreated women (P=0.005). Triglycerides, low-density lipids (LDL)-cholesterol and high-density lipids (HDL)-cholesterol levels, systolic and diastolic blood pressure were not significantly different between users and non-users. In women <55 years, no significant difference in carotid intima-media thickness was found between current users (mean 2.5+/-1.4 years) and non users. In older women, the mean values of carotid intima-media thickness were significantly smaller in current users (mean 6.9+/-3.3 years) than in never treated women: 0.50+/-0.05 versus 0.56+/-0.07 mm, P<0.0001. Carotid artery intima-media thickness was significantly correlated to age in never users (r=0.5, P<0.0001) but not in women who were currently receiving HRT (r=0.2, ns). These findings suggest an apparent protective effect of long-term HRT on age-related thickening of the intima-media of the right common carotid artery. This may contribute to explain the apparent cardio-protective effect of HRT after the menopause.
本研究的目的是确定接受或未接受激素替代疗法（HRT）的绝经后女性经B超测量的颈动脉内膜中层厚度的变化。从我们的更年期诊所招募了159名年龄在45 - 65岁之间的健康绝经后女性。所有入选女性均无心血管疾病且无心血管危险因素。这些女性均未服用降脂药或降压药。由于55岁及以上女性的颈动脉内膜中层厚度与年龄呈强正相关，而55岁之前并非如此，因此根据年龄（<55岁与≥55岁）和HRT使用情况（当前使用者与从未使用者）将女性分为四组。所有接受治疗的女性均接受非口服17β - 雌二醇与非雄激素孕激素联合治疗，并在绝经后第一年内开始HRT。使用B超成像仪对右侧颈总动脉进行扫描，并通过自动化计算机程序确定内膜中层复合体的厚度以及动脉管腔直径。在每个年龄组（即<55岁或≥55岁）内，女性具有可比的人口统计学特征，仅在HRT使用情况上有所不同。长期接受治疗的女性总胆固醇水平显著低于未接受治疗的女性（P = 0.005）。使用者与非使用者之间的甘油三酯、低密度脂蛋白（LDL） - 胆固醇和高密度脂蛋白（HDL） - 胆固醇水平、收缩压和舒张压无显著差异。在<55岁的女性中，当前使用者（平均2.5±1.4岁）与非使用者之间的颈动脉内膜中层厚度无显著差异。在年龄较大的女性中，当前使用者的颈动脉内膜中层厚度平均值（平均6.9±3.3岁）显著小于从未接受治疗的女性：分别为0.50±0.05与0.56±0.07mm，P < 0.0001。在从未使用者中，颈动脉内膜中层厚度与年龄显著相关（r = 0.5，P < 0.0001），而在当前接受HRT的女性中则无相关性（r = 0.2，无统计学意义）。这些发现表明长期HRT对右侧颈总动脉内膜中层与年龄相关的增厚具有明显的保护作用。这可能有助于解释绝经后HRT明显的心脏保护作用。
