Polotsky Alex J, Allshouse Amanda A, Crawford Sybil L, Harlow Sioban D, Khalil Naila, Kazlauskaite Rasa, Santoro Nanette, Legro Richard S
Department of Obstetrics and Gynecology (A.J.P., A.A.A., N.S.), University of Colorado Denver, and Department of Biostatistics and Informatics (A.A.A.), School of Public Health, University of Colorado Denver, Aurora, Colorado 80045; Department of Epidemiology, Preventive, and Behavioral Medicine (S.L.C.), University of Massachusetts Medical School, Worcester, Massachusetts 01655; School of Public Health (S.D.H.), University of Michigan, Ann Arbor, Michigan 48109; Department of Community Health (N.K.), Boonshoft School of Medicine, Wright State University, Dayton, Ohio 45420; Department of Endocrinology and Preventive Cardiology (R.K.), Rush University, Chicago, Illinois 60612; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033.
J Clin Endocrinol Metab. 2014 Jun;99(6):2120-7. doi: 10.1210/jc.2013-4170. Epub 2014 Feb 11.
Although there is evidence of metabolic risks in young women with irregular menses and androgen excess, persistence of risks after menopause is unclear.
The objective of the study was to determine the impact of menopause on the cardiometabolic profile in women with high androgens and a history of menstrual irregularity.
Study of Women's Health Across the Nation is a longitudinal cohort study. Data from 1929 women without metabolic syndrome (MetS) at baseline were analyzed for incidence of MetS, self-reported stroke, and myocardial infarction. Cox hazard ratios (HRs) were estimated, adjusting for age, ethnicity, body mass, smoking, menopausal status, and study site.
Among MetS-free women at baseline, 497 new cases were identified during 20 249 woman-years of follow-up over 12 years. Women with hyperandrogenemia (HA) and oligomenorrhea (Oligo) developed incident cases of MetS at a comparable rate compared with their counterparts: eumenorrheic, normoandrogenic women [HR 1.4 (0.9-2.2)], oligomenorrheic, normoandrogenic women [HR 1.3 (0.8-2.2)], and eumenorrheic hyperandrogenic women [HR 1.2 (0.7-1.8)]. Smoking and obesity were the strongest predictors of incident MetS. There was no significant difference in incidence of self-reported stroke or MI by HA/Oligo status.
Longitudinal evidence suggests that a history of androgen excess and menstrual irregularity is not associated with worsening of metabolic health after menopause. Our findings challenge the notion that a history of concurrent HA and Oligo reflects ongoing cardiometabolic risk in postmenopausal women.
尽管有证据表明月经不规律且雄激素过多的年轻女性存在代谢风险，但绝经后这些风险是否持续尚不清楚。
本研究的目的是确定绝经对雄激素水平高且有月经不规律病史的女性心脏代谢状况的影响。
全国女性健康研究是一项纵向队列研究。分析了1929名基线时无代谢综合征（MetS）的女性的数据，以确定MetS的发病率、自我报告的中风和心肌梗死情况。估计了Cox风险比（HRs），并对年龄、种族、体重、吸烟、绝经状态和研究地点进行了调整。
在基线时无MetS的女性中，在12年的20249人年随访期间确定了497例新病例。高雄激素血症（HA）和月经过少（Oligo）的女性发生MetS的发生率与对照组相当：月经正常、雄激素水平正常的女性[HR 1.4（0.9 - 2.2）]、月经过少、雄激素水平正常的女性[HR 1.3（0.8 - 2.2）]以及月经正常、高雄激素血症的女性[HR 1.2（0.7 - 1.8）]。吸烟和肥胖是MetS发生的最强预测因素。HA/Oligo状态与自我报告的中风或心肌梗死发生率之间无显著差异。
纵向证据表明，雄激素过多和月经不规律病史与绝经后代谢健康恶化无关。我们的研究结果挑战了同时存在HA和Oligo病史反映绝经后女性持续存在心脏代谢风险的观点。
