Endocrine Unit, Department of Medical Therapeutics, Athens University School of Medicine, Alexandra Hospital, 80 Vassilissis Sofias Avenue, 11528 Athens, Greece.
Eur J Endocrinol. 2012 Aug;167(2):145-56. doi: 10.1530/EJE-12-0215. Epub 2012 May 18.
Cardio- and cerebro-vascular diseases are two leading causes of death and long-term disability in postmenopausal women. The acute fall of estrogen in menopause is associated with increased cardiovascular risk. The relative contribution of androgen to this risk is also being recognized. The use of more sensitive assays for estradiol measurement and the study of receptor and carrier protein gene polymorphisms have provided some new information on the clinical relevance of endogenous sex steroids. We provide an update on the role of endogenous sex steroids on cardio- and cerebro-vascular disease in the postmenopausal period.
We performed a PubMed search using the terms 'endogenous estrogen', 'androgen', 'cardiovascular disease', 'cerebro-vascular disease', 'stroke', 'carotid artery disease', and 'subclinical atherosclerosis'.
The majority of studies show a beneficial effect of endogenous estrogen on the vasculature; however, there are a few studies reporting the contrary. A significant body of literature has reported associations of endogenous estrogen and androgen with early markers of atherosclerosis and metabolic parameters. Data on the relevance of endogenous sex steroids in heart disease and stroke are inconclusive.
Most studies support a beneficial role of endogenous estrogens and, probably, an adverse effect of androgens in the vasculature in postmenopausal women. However, the described associations may not always be considered as causal. It is possible that circulating estrogen might represent a marker of general health status or alternatively reflect the sum of endogenous androgens aromatized in the periphery. Elucidating the role of sex steroids in cardio- and cerebro-vascular disease remains an interesting field of future research.
心脑血管疾病是绝经后女性死亡和长期残疾的两个主要原因。绝经后雌激素的急剧下降与心血管风险增加有关。雄激素对这种风险的相对贡献也得到了认可。更敏感的雌二醇测量方法的应用以及受体和载体蛋白基因多态性的研究，为内源性性激素的临床相关性提供了一些新信息。我们提供了绝经后内源性性激素在心脑血管疾病中的作用的最新信息。
我们使用了术语“内源性雌激素”、“雄激素”、“心血管疾病”、“脑血管疾病”、“中风”、“颈动脉疾病”和“亚临床动脉粥样硬化”，在 PubMed 上进行了搜索。
大多数研究表明内源性雌激素对血管有有益的影响；然而，也有一些研究报告了相反的结果。大量文献报道了内源性雌激素和雄激素与动脉粥样硬化的早期标志物和代谢参数之间的关联。关于内源性性激素在心脑血管疾病中的相关性的数据尚无定论。
大多数研究支持内源性雌激素的有益作用，以及可能的雄激素对绝经后女性血管的不利影响。然而，所描述的关联并不总是被认为是因果关系。循环中的雌激素可能代表一般健康状况的标志物，或者反映外周组织中芳香化的内源性雄激素的总和。阐明性激素在心脑血管疾病中的作用仍然是未来研究的一个有趣领域。
