Ouyang Pamela, Vaidya Dhananjay, Dobs Adrian, Golden Sherita Hill, Szklo Moyses, Heckbert Susan R, Kopp Peter, Gapstur Susan M
Johns Hopkins University, Baltimore, MD 21224, USA.
Atherosclerosis. 2009 May;204(1):255-61. doi: 10.1016/j.atherosclerosis.2008.08.037. Epub 2008 Sep 6.
We examined cross-sectional associations between sex hormones and carotid artery intimal-medial thickness (cIMT) and coronary artery calcium in women in the Multi-Ethnic Study of Atherosclerosis. Serum testosterone, estradiol, sex hormone binding globulin (SHBG), and dehydroepiandrosterone levels were measured in 1947 postmenopausal women aged 45-84 years (30% White, 14% Chinese-American, 31% Black, and 25% Hispanic) and not on hormone therapy. Using multiple linear regression we evaluated associations between log(sex hormone) levels and log(cIMT) adjusted for age, ethnicity, body mass index (BMI) and cardiac risk factors. Associations between sex hormone levels and the presence and extent of coronary calcium were evaluated. Total and bioavailable testosterone were positively associated with common cIMT independent of age, BMI, hypertension, smoking, HDL-cholesterol, LDL-cholesterol and insulin sensitivity (p=0.009 and p=0.002, respectively). SHBG was negatively associated with common cIMT (p=0.001) but further adjustment for BMI, cardiovascular risk factors, and LDL- and HDL-cholesterol removed significance. Estradiol and dehydroepiandrosterone were not associated with common cIMT. Sex hormones were not associated with presence of coronary calcium. Among women with measurable coronary calcium, higher SHBG (p=0.012) and lower bioavailable testosterone (p=0.007) were associated with greater coronary calcium score. No heterogeneity by ethnicity was found. In postmenopausal women, testosterone is independently associated with greater common cIMT. SHBG is negatively associated and this may be mediated by LDL- and HDL-cholesterol. In contrast, SHBG and testosterone were associated with extent of coronary calcium but in the opposite direction compared to carotid intimal-medial thickness. These differences warrant further evaluation.
在动脉粥样硬化多族裔研究中，我们研究了绝经后女性性激素与颈动脉内膜中层厚度（cIMT）及冠状动脉钙化之间的横断面关联。对1947名年龄在45 - 84岁之间（30%为白人、14%为华裔美国人、31%为黑人、25%为西班牙裔）且未接受激素治疗的绝经后女性，测定了血清睾酮、雌二醇、性激素结合球蛋白（SHBG）和脱氢表雄酮水平。使用多元线性回归，我们评估了经年龄、种族、体重指数（BMI）和心脏危险因素校正后的log（性激素）水平与log（cIMT）之间的关联。评估了性激素水平与冠状动脉钙化的存在及程度之间的关联。总睾酮和生物可利用睾酮与颈总动脉内膜中层厚度呈正相关，独立于年龄、BMI、高血压、吸烟、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇和胰岛素敏感性（分别为p = 0.009和p = 0.002）。SHBG与颈总动脉内膜中层厚度呈负相关（p = 0.001），但进一步校正BMI、心血管危险因素以及低密度脂蛋白和高密度脂蛋白胆固醇后，这种相关性不再显著。雌二醇和脱氢表雄酮与颈总动脉内膜中层厚度无关。性激素与冠状动脉钙化的存在无关。在有可测量冠状动脉钙化的女性中，较高的SHBG（p = 0.012）和较低的生物可利用睾酮（p = 0.007）与更高的冠状动脉钙化评分相关。未发现种族异质性。在绝经后女性中，睾酮与更大的颈总动脉内膜中层厚度独立相关。SHBG与之呈负相关，这可能由低密度脂蛋白和高密度脂蛋白胆固醇介导。相比之下，SHBG和睾酮与冠状动脉钙化程度相关，但与颈动脉内膜中层厚度的关联方向相反。这些差异值得进一步评估。
