Framingham Heart Study, Framingham, Massachusetts, USA.
J Am Coll Cardiol. 2011 Aug 2;58(6):618-26. doi: 10.1016/j.jacc.2011.03.042.
The aim of this study was to assess the relationship between sex hormones and natriuretic peptide levels in community-based adults.
Women have higher circulating natriuretic peptide concentrations than men, but the mechanisms for these sex-related differences and the impact of hormone therapy are unclear. Experimental studies suggest that androgens may suppress natriuretic peptide secretion.
We measured N-terminal pro-B-type natriuretic peptide (NT-proBNP), total testosterone, and sex hormone-binding globulin plasma levels in 4,056 men and women (mean age 40 ± 9 years) from the Framingham Heart Study Third-Generation cohort. Sex/hormone status was grouped as: 1) men; 2) post-menopausal women not receiving hormone replacement therapy; 3) pre-menopausal women not receiving hormonal contraceptives; 4) post-menopausal women receiving hormone replacement therapy; and 5) pre-menopausal women receiving hormonal contraceptives.
Circulating NT-proBNP levels were associated with sex/hormone status (overall p < 0.0001). Men had lower NT-proBNP levels than women of all menopause or hormone groups, and women receiving hormonal contraceptives had higher NT-proBNP levels than women who were not receiving hormone therapy (all p < 0.0001). These relationships remained significant after adjusting for age, body mass index, and cardiovascular risk factors. Across sex/hormone status groups, free testosterone (FT) levels decreased and sex hormone-binding globulin levels increased in tandem with increasing NT-proBNP levels. In sex-specific analyses, NT-proBNP levels decreased across increasing quartiles of FT in men (p for trend <0.01) and women (p for trend <0.0001). Adjustment for FT markedly attenuated the association between sex/hormone status and NT-proBNP concentrations.
These findings suggest that lower levels of circulating androgens and the potentiating effect of exogenous female hormone therapy contribute to the higher circulating NT-proBNP concentrations in women.
本研究旨在评估社区成年人中性激素与利钠肽水平之间的关系。
女性的循环利钠肽浓度高于男性，但这些性别相关差异的机制以及激素治疗的影响尚不清楚。实验研究表明，雄激素可能抑制利钠肽的分泌。
我们测量了来自弗雷明汉心脏研究第三代队列的 4056 名男性和女性（平均年龄 40±9 岁）的 N 末端 B 型利钠肽前体（NT-proBNP）、总睾酮和性激素结合球蛋白的血浆水平。将性别/激素状态分为：1）男性；2）未接受激素替代疗法的绝经后妇女；3）未服用激素避孕药的绝经前妇女；4）接受激素替代疗法的绝经后妇女；5）服用激素避孕药的绝经前妇女。
循环 NT-proBNP 水平与性别/激素状态相关（总体 p<0.0001）。与所有绝经或激素组的女性相比，男性的 NT-proBNP 水平较低，服用激素避孕药的女性的 NT-proBNP 水平高于未接受激素治疗的女性（均 p<0.0001）。调整年龄、体重指数和心血管危险因素后，这些关系仍然显著。在跨性别/激素状态组中，随着 NT-proBNP 水平的升高，游离睾酮（FT）水平降低，性激素结合球蛋白水平升高。在性别特异性分析中，NT-proBNP 水平随着男性（趋势 p<0.01）和女性（趋势 p<0.0001）FT 四分位数的增加而降低。FT 的调整显著减弱了性别/激素状态与 NT-proBNP 浓度之间的关联。
这些发现表明，循环雄激素水平较低以及外源性女性激素治疗的增强作用导致女性循环 NT-proBNP 浓度升高。
