Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, California 90502.
J Clin Endocrinol Metab. 2014 Nov;99(11):E2357-61. doi: 10.1210/jc.2014-2466. Epub 2014 Aug 20.
The gender gap in high-density lipoprotein cholesterol (HDL-C) is well documented in health and also maintained in diverse chronic conditions, including menopause and diabetes. The mechanism for this difference in HDL-C and its regulation is not well understood. We evaluated whether this gender gap is maintained during acute stress.
Diabetic patients with metabolic decompensation (n=179) were studied in the fasting state within 24 hours of admission to hospital, and again at outpatient follow-up. Fasting lipids and measures of glycemic control were evaluated on both occasions. The population was predominately minority, 78% Hispanic or African American.
During admission, fasting lipid concentrations were not different in women (W) (n = 88) and men (M) (n = 91); serum total cholesterol (total-C), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and HDL-C were similar. Glycemic control was also similar; hemoglobin A1c (A1C) and serum glucose at presentation to hospital were not different in men and women. Compared with a subset of patients with pre-admission data (W, 35; M, 24), a decline of HDL-C was observed, greater in women (P = .005). At outpatient follow-up after admission, median duration approximately 4 months in each group (P = .39), changes in TG, LDL-C, and total-C from baseline admission were not different in men and women. In contrast, whereas HDL-C increased in both groups, the increase (median [interquartile range]) was significantly greater in women, 11 (4, 23) vs 6 (-1, 15) mg/dL (P < .003). This larger increase restored the gender gap in fasting HDL-C, 48 (39, 61) and 41 (36, 49) mg/dL in women and men at follow-up (P < .002). A1C improved similarly in each group.
The sex difference in HDL-C levels is lost at time of admission to hospital in patients with diabetes, and returns when acute stress has resolved. These results raise the possibility that recurrent episodes of acute stress may lead to cumulative loss of the HDL-C advantage in women.
高密度脂蛋白胆固醇（HDL-C）的性别差异在健康和多种慢性疾病中都有记录，包括更年期和糖尿病。对于这种 HDL-C 差异及其调节机制尚不完全清楚。我们评估了这种性别差异是否在急性应激期间保持不变。
患有代谢失代偿的糖尿病患者（n=179）在入院后 24 小时内的禁食状态下进行研究，并在门诊随访时再次进行研究。两次都评估了禁食血脂和血糖控制措施。该人群主要是少数民族，78%为西班牙裔或非裔美国人。
入院期间，女性（n=88）和男性（n=91）的空腹血脂浓度没有差异；血清总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）和 HDL-C 相似。血糖控制也相似；入院时的血红蛋白 A1c（A1C）和血清葡萄糖在男性和女性之间没有差异。与具有入院前数据的患者亚组（女性 35 例，男性 24 例）相比，观察到 HDL-C 下降，女性更为明显（P=0.005）。入院后门诊随访时，两组的中位时间约为 4 个月（P=0.39），从入院时开始，男性和女性的 TG、LDL-C 和 TC 变化没有差异。相比之下，尽管两组的 HDL-C 均增加，但女性的增加幅度更大，中位数（四分位距）为 11（4，23）mg/dL 比 6（-1，15）mg/dL（P<0.003）。这种更大的增加恢复了女性空腹 HDL-C 的性别差异，女性为 48（39，61）mg/dL，男性为 41（36，49）mg/dL（P<0.002）。两组的 A1C 均有相似的改善。
糖尿病患者入院时 HDL-C 水平的性别差异消失，当急性应激得到缓解时恢复。这些结果提示反复发生急性应激可能导致女性 HDL-C 优势的逐渐丧失。
