Taechakraichana N, Holinka C F, Haines C J, Subramaniam R, Tian X W, Ausmanas M K
Chulalongkorn Hospital, Chulalongkorn University, Bangkok, Thailand.
Climacteric. 2007 Jun;10(3):225-37. doi: 10.1080/13697130701352375.
Lipid/lipoprotein profiles, among other factors, are associated with risk of cardiovascular disease. Because cardiovascular disease varies in Asian countries, we hypothesized that lipid profiles differ in ethnic groups of postmenopausal Asian women. To add to the limited body of information currently available, we also investigated the effects of estrogen/progestin therapy on lipid/lipoprotein profiles in postmenopausal Asian women.
The Pan-Asia Menopause (PAM) study was a prospective, randomized, double-blind clinical trial evaluating 1028 postmenopausal women at 22 investigational centers in 11 Asian countries/territories. Subjects were randomly assigned to one of three doses of continuous combined conjugated estrogens (CE)/medroxyprogesterone acetate (MPA): CE/MPA (in mg/day) = 0.625/2.5, 0.45/1.5 or 0.3/1.5. The treatment period, following baseline evaluations, consisted of six continuous 28-day cycles. Analysis of lipid profiles was a secondary objective of the PAM study. Total cholesterol, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), very low density cholesterol (VLDC-C), triglycerides and lipoprotein(a) were analyzed at a central laboratory by state-of-the-art methods.
Mean concentrations of total cholesterol, LDL-C, VLDL-C and triglycerides differed significantly among the nine ethnic groups of postmenopausal women. This difference was independent of body mass index and age, two factors that also influenced lipid/lipoprotein profiles. Mean HDL-C concentrations also differed, but this difference was influenced by body mass index in a weak interaction. All three doses of CE/MPA significantly lowered total cholesterol. Treatment with the high and middle doses significantly lowered LDL-C, and increased HDL-C, VLDL-C and triglycerides. The high dose produced a significant decrease in lipoprotein(a).
The different lipid/lipoprotein profiles in the nine ethnic groups of postmenopausal Asian women evaluated here suggest a relationship to differences in the prevalence of cardiovascular disease reported for different regions in Asia. However, the reported prevalence data on cardiovascular disease morbidity and mortality in the regions corresponding to the nine ethnic groups are insufficient to allow qualitative comparisons with the lipid profiles shown in our study. The lipid/lipoprotein changes in response to estrogen/progestin therapy observed here are consistent with those reported for Western women.
脂质/脂蛋白谱以及其他因素与心血管疾病风险相关。由于心血管疾病在亚洲国家存在差异，我们推测绝经后亚洲女性不同种族的脂质谱有所不同。为补充目前有限的可用信息，我们还研究了雌激素/孕激素疗法对绝经后亚洲女性脂质/脂蛋白谱的影响。
泛亚更年期（PAM）研究是一项前瞻性、随机、双盲临床试验，在11个亚洲国家/地区的22个研究中心评估了1028名绝经后女性。受试者被随机分配到三种剂量的连续联合共轭雌激素（CE）/醋酸甲羟孕酮（MPA）之一：CE/MPA（毫克/天）=0.625/2.5、0.45/1.5或0.3/1.5。在基线评估之后的治疗期包括六个连续的28天周期。脂质谱分析是PAM研究的次要目标。总胆固醇、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、极低密度胆固醇（VLDC-C）、甘油三酯和脂蛋白（a）在中心实验室采用先进方法进行分析。
绝经后女性的九个种族之间，总胆固醇、LDL-C、VLDC-C和甘油三酯的平均浓度存在显著差异。这种差异独立于体重指数和年龄，这两个因素也会影响脂质/脂蛋白谱。HDL-C的平均浓度也存在差异，但这种差异在较弱的相互作用中受体重指数影响。所有三种剂量的CE/MPA均显著降低了总胆固醇。高剂量和中剂量治疗显著降低了LDL-C，并升高了HDL-C、VLDC-C和甘油三酯。高剂量使脂蛋白（a）显著降低。
此处评估的绝经后亚洲女性的九个种族中不同的脂质/脂蛋白谱表明与亚洲不同地区报告的心血管疾病患病率差异有关。然而，对应于这九个种族的地区报告的心血管疾病发病率和死亡率的患病率数据不足以与我们研究中显示的脂质谱进行定性比较。此处观察到的雌激素/孕激素疗法引起的脂质/脂蛋白变化与西方女性报告的一致。
