健康希腊绝经后女性体内内源性性激素与动脉粥样硬化风险因素

Endogenous sex hormones and risk factors for atherosclerosis in healthy Greek postmenopausal women.

作者信息

Lambrinoudaki Irene, Christodoulakos George, Rizos Demetrios, Economou Emmanuel, Argeitis John, Vlachou Sofia, Creatsa Maria, Kouskouni Evangelia, Botsis Dimitrios

机构信息

2nd Department of Obstetrics and Gynecology, University of Athens, Greece.

出版信息

Eur J Endocrinol. 2006 Jun;154(6):907-16. doi: 10.1530/eje.1.02167.

DOI:10.1530/eje.1.02167

PMID:16728552

Abstract

OBJECTIVE

To assess the association between endogenous sex hormones and risk factors for atherosclerosis in healthy postmenopausal women.

DESIGN

Cross-sectional study in a university menopause clinic.

METHODS

Serum sex hormones and lipid-lipoprotein profile, arterial pressure, homocysteine and insulin resistance, measured by the homeostasis model assessment of insulin resistance (HOMA-IR), were assessed in 598 healthy postmenopausal women not on hormone therapy.

RESULTS

Compared with women in the lowest testosterone quartile (Q), women in the highest testosterone quartile had higher total cholesterol (Q1: 225.2 +/- 41.3 vs Q4: 246.2 +/- 38.4 mg/dl, P < 0.01), low-density lipoprotein (LDL)-cholesterol (Q1: 146.9 +/- 37.2 vs Q4: 171.8 +/- 35.3 mg/dl, P < 0.001), atherogenic index of plasma (AIP) (Q1: -0.224 +/- 0.238 vs Q4: -0.087 +/- 0.254, P < 0.01), apolipoprotein B (ApoB) (Q1: 100.7 +/- 23.1 vs Q4: 113.9 +/- 23.8 mg/dl, P < 0.001) and higher high-density lipoprotein (HDL)-cholesterol (Q1: 60.7 +/- 14.5 vs Q4: 52.9 +/- 13.0 mg/dl, P < 0.01). Accordingly, women in the highest free androgen index (FAI) quartile had higher AIP (Q1: -0.232 +/- 0.254 vs Q4: -0.078 +/- 0.243, P < 0.001) and ApoB (Q1: 102.4 +/- 25.5 vs Q4: 114.2 +/- 25.8 mg/dl, P < 0.01) and lower HDL-cholesterol (Q1: 62.0 +/- 15.7 vs Q4: 51.9 +/- 11.6 mg/dl, P < 0.001) and apolipoprotein A (Q1: 159.6 +/- 25.6 vs Q4: 147.9 +/- 24.1 mg/dl, P < 0.01) compared with women in the lowest FAI quartile. These differences remained significant after adjustment for age, body mass index (BMI), insulin resistance and social habits. The free estrogen index (FEI) exhibited similar associations to the FAI. HOMA-IR showed an independent positive association with total testosterone (Q1: 2.00 +/- 1.36 vs Q4: 2.66 +/- 1.60, P < 0.01), FAI (Q1: 1.70 +/- 1.12 vs Q4: 3.04 +/- 1.66, P < 0.001) and FEI (Q1: 1.70 +/- 0.91 vs Q4: 3.08 +/- 1.77, P < 0.001).

CONCLUSIONS

Increased androgenicity in healthy postmenopausal women is associated with an unfavorable cardiovascular risk profile. High endogenous estradiol is related to a pro-atherogenic lipid profile, an association which may, in part, be mediated by insulin resistance.

摘要

目的

评估健康绝经后女性内源性性激素与动脉粥样硬化危险因素之间的关联。

设计

在大学更年期诊所进行的横断面研究。

方法

对598名未接受激素治疗的健康绝经后女性测定血清性激素、脂质 - 脂蛋白谱、动脉压、同型半胱氨酸以及通过胰岛素抵抗稳态模型评估（HOMA - IR）测定的胰岛素抵抗。

结果

与睾酮水平处于最低四分位数（Q）的女性相比，睾酮水平处于最高四分位数的女性总胆固醇水平更高（Q1：225.2±41.3 vs Q4：246.2±38.4mg/dl，P<0.01），低密度脂蛋白（LDL）胆固醇水平更高（Q1：146.9±37.2 vs Q4：171.8±35.3mg/dl，P<0.001），血浆致动脉粥样硬化指数（AIP）更高（Q1： - 0.224±0.238 vs Q4： - 0.087±0.254，P<0.01），载脂蛋白B（ApoB）水平更高（Q1：100.7±23.1 vs Q4：113.9±23.8mg/dl，P<0.001），高密度脂蛋白（HDL）胆固醇水平更高（Q1：60.7±14.5 vs Q4：52.9±13.0mg/dl，P<0.01）。相应地，游离雄激素指数（FAI）处于最高四分位数的女性与FAI处于最低四分位数的女性相比，AIP更高（Q1： - 0.232±0.254 vs Q4： - 0.078±0.243，P<0.001），ApoB更高（Q1：102.4±25.5 vs Q4：114.2±25.8mg/dl，P<0.01），HDL胆固醇水平更低（Q1：62.0±15.7 vs Q4：51.9±11.6mg/dl，P<0.001），载脂蛋白A水平更低（Q1：159.6±25.6 vs Q4：147.9±24.1mg/dl，P<0.01）。在对年龄、体重指数（BMI）、胰岛素抵抗和社会习惯进行调整后，这些差异仍然显著。游离雌激素指数（FEI）表现出与FAI相似的关联。HOMA - IR与总睾酮（Q1：2.00±1.36 vs Q4：2.66±1.60，P<0.01）、FAI（Q1：1.70±1.12 vs Q4：3.04±1.