70 岁女性和男性体内更高的内源性雌激素水平：一种对抗动脉粥样硬化形成的内源性反应？

Higher endogenous estrogen levels in 70-year-old women and men: an endogenous response to counteract developing atherosclerosis?

机构信息

Department of Women’s and Children’s Health, Section for Obstetrics and Gynecology, Uppsala University, Uppsala, SE-751 85 Sweden.

出版信息

Menopause. 2012 Dec;19(12):1322-8. doi: 10.1097/gme.0b013e31825ea8c1.

DOI:10.1097/gme.0b013e31825ea8c1

PMID:22990754

Abstract

OBJECTIVE

Reported associations between endogenous steroid hormone levels and cardiovascular disease in the older population have been contradictory. We evaluated plasma steroid concentrations in terms of the dimensions of the common carotid artery wall layers as a measure of the extent of atherosclerosis.

METHODS

A subgroup of 70-year-old participants (32 women and 50 men) from the Prospective Investigation of the Vasculature in Uppsala Seniors study was investigated. All participants had assessments of common carotid artery wall layer parameters (intima thickness, media thickness, and intima-media thickness [IMT] ratio; measured by high-frequency ultrasound at 22 MHz) and endogenous steroid hormone concentrations (measured by liquid chromatography-tandem mass spectrometry).

RESULTS

Low androgen levels, high aromatase enzyme activity (estrone [E1]/androstenedione and estradiol [E2]/testosterone), high E2/E1 ratio, and high estrogen levels (E1, E2, estriol, and E2/sex hormone-binding globulin) were consistently associated (often significantly) with a more unhealthy artery wall (thick intima, thin media, and high IMT ratio) in both sexes. Consistently strong associations were found between the aromatase index E2/testosterone and intima, media, and the IMT ratio. For IMT ratio, in both men (rs = 0.52) and women (rs = 0.58), P was <0.001 for both and remained significant after adjustment for cardiovascular disease risk factors and the Framingham risk score (both P < 0.01).

CONCLUSIONS

Low androgens, high aromatase enzyme activity, and high estrogen levels are often significantly associated with an unhealthy artery wall on ultrasound. We suggest that the steroid hormone profile of older individuals with higher estrogens most probably reflects an endogenous response to developing atherosclerosis, rather than a cause-and-effect relationship. However, the reverse causality cannot be excluded.

摘要

目的

在老年人群中，内源性类固醇激素水平与心血管疾病之间的关联报道存在矛盾。我们评估了血浆类固醇浓度与颈总动脉壁层各层维度的关系，作为动脉粥样硬化程度的衡量指标。

方法

我们对前瞻性血管研究中 Uppsala 老年人研究的一个亚组（70 岁的参与者，32 名女性和 50 名男性）进行了调查。所有参与者都进行了颈总动脉壁层参数（内膜厚度、中膜厚度和内-中膜厚度比；通过 22MHz 高频超声测量）和内源性类固醇激素浓度（通过液相色谱-串联质谱法测量）的评估。

结果

低雄激素水平、高芳香化酶活性（雌酮[E1]/雄烯二酮和雌二醇[E2]/睾酮）、高 E2/E1 比值和高雌激素水平（E1、E2、雌三醇和 E2/性激素结合球蛋白）与两性不健康的动脉壁（厚内膜、薄中膜和高 IMT 比值）均呈一致（通常显著）相关。芳香化酶指数 E2/睾酮与内膜、中膜和 IMT 比值之间存在一致的强关联。对于 IMT 比值，男性（rs = 0.52）和女性（rs = 0.58）中，P 值均 <0.001，且在调整心血管疾病危险因素和 Framingham 风险评分后仍具有显著意义（均 P < 0.01）。