Khaw K T, Barrett-Connor E
Department of Community Medicine, University of Cambridge Medical School, Addenbrooke's Hospital, England.
Arterioscler Thromb. 1991 May-Jun;11(3):489-94. doi: 10.1161/01.atv.11.3.489.
At least some of the large preponderance for coronary heart disease in men has been attributed to differences in lipid and lipoprotein levels; notably, high density lipoprotein cholesterol (HDL-C), a protective factor, is higher in women. The sex differences in lipid levels have been postulated to be related to differences in sex hormones. In a southern California cohort of 391 men aged 30-79 years, HDL-C levels were positively correlated and very low density lipoprotein cholesterol (VLDL-C) levels were inversely correlated with testosterone levels independently of age, body mass index, physical exercise, smoking, and alcohol intake. Mean HDL-C levels were 12% higher and VLDL-C levels were 40% lower in the highest compared with the lowest quartile of testosterone level. Low density lipoprotein cholesterol levels were positively related to estrone, estradiol, and androstenedione levels. It is premature to attribute the sex differential in lipid cardiovascular risk profiles to higher levels of testosterone per se in men, since testosterone levels are favorably associated with cardiovascular risk while estrogen levels have the converse relation in men. The differing effects and interactions of specific endogenous sex hormones in men and women require further elucidation.
男性冠心病发病率显著高于女性，至少部分原因可归结于脂质和脂蛋白水平的差异；值得注意的是，高密度脂蛋白胆固醇（HDL-C）作为一种保护因子，女性体内的水平更高。脂质水平的性别差异被认为与性激素差异有关。在南加州一个由391名年龄在30 - 79岁之间的男性组成的队列中，HDL-C水平与睾酮水平呈正相关，极低密度脂蛋白胆固醇（VLDL-C）水平与睾酮水平呈负相关，且不受年龄、体重指数、体育锻炼、吸烟和饮酒量的影响。与睾酮水平最低的四分位数相比，最高四分位数的平均HDL-C水平高12%，VLDL-C水平低40%。低密度脂蛋白胆固醇水平与雌酮、雌二醇和雄烯二酮水平呈正相关。将脂质心血管风险特征的性别差异归因于男性本身较高的睾酮水平还为时过早，因为在男性中，睾酮水平与心血管风险呈正相关，而雌激素水平则相反。特定内源性性激素在男性和女性中的不同作用及相互作用需要进一步阐明。
