El Khoudary Samar R, Santoro Nanette, Chen Hsiang-Yu, Tepper Ping G, Brooks Maria M, Thurston Rebecca C, Janssen Imke, Harlow Sioban D, Barinas-Mitchell Emma, Selzer Faith, Derby Carol A, Jackson Elizabeth A, McConnell Daniel, Matthews Karen A
Department of Epidemiology, University of Pittsburgh, USA
School of Medicine, University of Colorado, USA.
Eur J Prev Cardiol. 2016 May;23(7):694-703. doi: 10.1177/2047487315607044. Epub 2015 Sep 18.
The purpose of this study was to assess associations between distinct patterns of circulating estradiol (E2) and follicle-stimulating hormone (FSH) over the menopause transition (MT) and subclinical measures of atherosclerosis after menopause.
Four temporal patterns of E2 decline (Low: low before and after final menstrual period (FMP); Medium: medium before and high after FMP; High-early decline: high prior to FMP and early decline thereafter; High-late decline: high prior to FMP and late decline thereafter) and three of FSH rise (Low, Medium, High) over 9.6 years across FMP were identified and linked to carotid intima-media-thickness (IMT), adventitial diameter (AD), and presence of carotid plaque (cPlaque) measured after menopause at the 12th annual visit (visit 12). Participants were 856 women (age at visit 12 = 59.5 ± 2.7 years) from the Study of Women's Health Across the Nation (SWAN), who never reported a stroke or a heart attack. In models adjusted for visit 12 or baseline cardiovascular disease (CVD) risk factors, odds of having any cPlaque were ∼43% lower among women with the High-early decline E2 trajectory compared to women with the Low E2 trajectory. In contrast, women with the Medium E2 trajectory had significantly higher IMT than those with the Low E2 trajectory adjusting for visit 12 CVD risk factors. Interestingly, adjusting for baseline CVD risk factors attenuated this association. The Low FSH group had lower IMT than the Medium and High FSH groups (p ≤ 0.05) in all models.
During MT, women are subjected to hormonal alterations that could potentially increase their risk of developing CVD after menopause.
本研究旨在评估绝经过渡（MT）期间循环雌二醇（E2）和促卵泡生成素（FSH）的不同变化模式与绝经后动脉粥样硬化亚临床指标之间的关联。
确定了在整个绝经过程中9.6年里E2下降的四种时间模式（低：末次月经（FMP）前后均低；中：FMP前中等水平且FMP后高；高-早期下降：FMP前高且此后早期下降；高-晚期下降：FMP前高且此后晚期下降）以及FSH上升的三种模式（低、中、高），并将其与在第12次年度随访（随访12）绝经后测量的颈动脉内膜中层厚度（IMT）、外膜直径（AD）和颈动脉斑块（cPlaque）的存在情况相关联。参与者为来自全国女性健康研究（SWAN）的856名女性（随访12时年龄 = 59.5 ± 2.7岁），她们从未报告过中风或心脏病发作。在针对随访12或基线心血管疾病（CVD）风险因素进行调整的模型中，与E2轨迹为低的女性相比，E2轨迹为高-早期下降的女性出现任何cPlaque的几率低约43%。相比之下，在针对随访12的CVD风险因素进行调整后，E2轨迹为中的女性的IMT显著高于E2轨迹为低的女性。有趣的是，在针对基线CVD风险因素进行调整后，这种关联减弱。在所有模型中，低FSH组的IMT均低于中FSH组和高FSH组（p≤0.05）。
在MT期间，女性会经历激素变化，这可能会增加她们绝经后发生CVD的风险。
