Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis, Davis, CA 95616, USA.
Clin Sci (Lond). 2010 Dec;119(12):493-513. doi: 10.1042/CS20100248.
CVD (cardiovascular disease) is the leading cause of death for women. Considerable progress has been made in both our understanding of the complexities governing menopausal hormone therapy and our understanding of the cellular and molecular mechanisms underlying hormone and hormone receptor function. Understanding the interplay of atherosclerosis and sex steroid hormones and their cognate receptors at the level of the vessel wall has important ramifications for clinical practice. In the present review, we discuss the epidemiology of CVD in men and women, the clinical impact of sex hormones on CVD, and summarize our current understanding of the pathogenesis of atherosclerosis with a focus on gender differences in CVD, its clinical presentation and course, and pathobiology. The critical animal and human data that pertain to the role of oestrogens, androgens and progestins on the vessel wall is also reviewed, with particular attention to the actions of sex hormones on each of the three key cell types involved in atherogenesis: the endothelium, smooth muscle cells and macrophages. Where relevant, the systemic (metabolic) effects of sex hormones that influence atherogenesis, such as those involving vascular reactivity, inflammation and lipoprotein metabolism, are discussed. In addition, four key current concepts in the field are explored: (i) total hormone exposure time and coronary heart disease risk; (ii) the importance of tissue specificity of sex steroid hormones, critical timing and the stage of atherosclerosis in hormone action; (iii) biomarkers for atherosclerosis with regard to hormone therapy; and (iv) the complex role of sex steroids in inflammation. Future studies in this field will contribute to guiding clinical treatment recommendations for women and help define research priorities.
心血管疾病（CVD）是女性死亡的主要原因。我们在理解绝经激素治疗的复杂性以及激素和激素受体功能的细胞和分子机制方面都取得了相当大的进展。了解动脉粥样硬化和性激素及其同源受体在血管壁水平的相互作用对临床实践具有重要意义。在本综述中，我们讨论了 CVD 在男性和女性中的流行病学、性激素对 CVD 的临床影响，并总结了我们目前对动脉粥样硬化发病机制的理解，重点是 CVD 的性别差异及其临床表现和病程以及病理生物学。还回顾了与雌激素、雄激素和孕激素对血管壁的作用相关的关键动物和人体数据，并特别关注性激素对动脉粥样硬化形成中涉及的三种关键细胞类型（内皮细胞、平滑肌细胞和巨噬细胞）的作用。在相关情况下，讨论了影响动脉粥样硬化形成的性激素的全身（代谢）作用，如涉及血管反应性、炎症和脂蛋白代谢的作用。此外，还探讨了该领域的四个关键现有概念：（i）总激素暴露时间与冠心病风险；（ii）性激素组织特异性、关键时间和动脉粥样硬化阶段在激素作用中的重要性；（iii）关于激素治疗的动脉粥样硬化生物标志物；（iv）性激素在炎症中的复杂作用。该领域的未来研究将有助于指导女性的临床治疗建议，并有助于确定研究重点。
