Evolahti A, Hultcrantz M, Collins A
Karolinska Institute, Department of Clinical Neuroscience, Stockholm, Sweden.
Climacteric. 2009 Apr;12(2):131-45. doi: 10.1080/13697130802521290.
The aim of the study was to characterize lipid profiles of perimenopausal women and to relate these to the psychosocial work environment and lifestyle using a longitudinal design.
A population-based sample of 107 women, aged 47-53 years, participated in a baseline study and in a follow-up 2 years later. Psychosocial work stress was measured using the Job Content Questionnaire. The women also completed a health questionnaire and participated in a psychological interview. Fasting blood samples were analyzed for concentrations of total cholesterol, high and low density lipoprotein (HDL, LDL) cholesterol and triglycerides.
Multiple regression analyses showed that work control was a significant predictor of higher HDL cholesterol (p<0.05), lower LDL cholesterol/HDL cholesterol ratio (p<0.01) and lower total cholesterol/HDL cholesterol ratio (p<0.01). Job strain predicted a higher LDL cholesterol/HDL cholesterol ratio (p<0.01) and higher total cholesterol/HDL cholesterol ratio (p<0.05). Lifestyle variables smoking, body mass index and waist/hip ratio predicted an unfavorable lipid profile, whereas alcohol consumption predicted a favorable lipid profile. Age but not menopausal status was associated with lipid levels at baseline and on follow-up. Use of hormone replacement therapy was a significant predictor of lower cholesterol levels in the multivariate analyses.
Our results demonstrated a significant association between the psychosocial work environment and women's cardiovascular health at menopause. Job strain was a significant contributor to an atherogenic lipid profile, whereas work control predicted a favorable profile. Hence, the argument is now compelling that psychosocial factors should be included in the risk profiles for cardiovascular disease in women.
本研究旨在通过纵向设计描述围绝经期女性的血脂谱特征，并将其与社会心理工作环境及生活方式相关联。
以人群为基础，选取107名年龄在47 - 53岁的女性参与基线研究，并于2年后进行随访。使用工作内容问卷测量社会心理工作压力。这些女性还完成了一份健康问卷并参与了一次心理访谈。对空腹血样进行总胆固醇、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）胆固醇以及甘油三酯浓度分析。
多元回归分析表明，工作控制是较高HDL胆固醇水平（p<0.05）、较低LDL胆固醇/HDL胆固醇比值（p<0.01）以及较低总胆固醇/HDL胆固醇比值（p<0.01）的显著预测因素。工作紧张度预示着较高的LDL胆固醇/HDL胆固醇比值（p<0.01）和较高的总胆固醇/HDL胆固醇比值（p<0.05）。生活方式变量吸烟、体重指数和腰臀比预示着不良血脂谱，而饮酒预示着良好血脂谱。年龄而非绝经状态与基线及随访时的血脂水平相关。在多变量分析中，使用激素替代疗法是较低胆固醇水平的显著预测因素。
我们的结果表明围绝经期女性的社会心理工作环境与心血管健康之间存在显著关联。工作紧张度是致动脉粥样硬化血脂谱的重要促成因素，而工作控制预示着良好的血脂谱。因此，现在有令人信服的理由表明，社会心理因素应纳入女性心血管疾病的风险评估中。
