de Kat A C, Verschuren W M M, Eijkemans M J C, van der Schouw Y T, Broekmans F J M
Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands.
Hum Reprod. 2016 Aug;31(8):1866-74. doi: 10.1093/humrep/dew159. Epub 2016 Jun 19.
Is there a relationship between serum anti-Müllerian hormone (AMH) level and cardiovascular disease (CVD) risk in premenopausal women?
There are indications that premenopausal women with very low ovarian reserve may have an unfavorable CVD risk profile.
Age at menopause is frequently linked to CVD occurrence. AMH is produced by ovarian antral follicles and provides a measure of remaining ovarian reserve Literature on whether AMH is related to CVD risk is still scarce and heterogeneous.
STUDY DESIGN, SIZE, DURATION: Cross-sectional study in 2338 women (age range of 20-57 years) from the general population, participating in the Doetinchem Cohort Study between 1993 and 1997.
PARTICIPANTS/MATERIALS, SETTING, METHODS: CVD risk was compared between 2338 premenopausal women in different AMH level-categories, with adjustment for confounders. CVD risk was assessed through levels of systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol and glucose, in addition to a summed score of CVD risk factors. Among other factors, analyses were corrected for smoking, oral contraceptive use and BMI.
The relationship of serum AMH levels with CVD risk factor outcomes was nonlinear. Women with AMH levels <0.16 µg/l had 0.11 (95% confidence intervals (CIs) 0.01; 0.21) more metabolic risk factors compared with women with AMH levels ≥0.16 µg/l. There was no association of individual risk factor levels with AMH levels, besides a tendency towards lower total cholesterol levels of 0.11 mmol/l (95% CI -0.23; 0.01) in women with AMH levels <0.002 µg/l compared with women with AMH levels ≥0.16 µg/l. Although not statistically significant, these effect sizes were larger in women below 40 years of age.
LIMITATIONS, REASONS FOR CAUTION: Causality and temporality of the studied association cannot be addressed here. Moreover, the clinical and statistical significance of the results of this exploratory study should be interpreted with caution due to the absence of adjustment for multiple statistical testing.
This population-based study supports previous findings that premenopausal women with very low AMH levels may have an increased CVD risk. It lays the groundwork for future research to focus on this group of women. Longitudinal studies with more sensitive AMH assays may furthermore help better understand the implications of these results.
STUDY FUNDING/COMPETING INTEREST: No financial support was received for this research or manuscript. The Doetinchem Cohort Study is conducted and funded by the Dutch National Institute for Public Health and the Environment F.J.M.B. has received fees and grant support from Merck Serono, Gedeon Richter, Ferring BV and Roche.
N/A.
绝经前女性血清抗苗勒管激素（AMH）水平与心血管疾病（CVD）风险之间是否存在关联？
有迹象表明，卵巢储备极低的绝经前女性可能具有不良的心血管疾病风险特征。
绝经年龄常与心血管疾病的发生有关。AMH由卵巢窦卵泡产生，可衡量剩余的卵巢储备。关于AMH是否与心血管疾病风险相关的文献仍然稀少且不一致。
研究设计、规模、持续时间：对2338名年龄在20 - 57岁之间、来自普通人群的女性进行横断面研究，这些女性于1993年至1997年参与了多廷赫姆队列研究。
参与者/材料、环境、方法：比较了2338名处于不同AMH水平类别的绝经前女性的心血管疾病风险，并对混杂因素进行了调整。通过收缩压和舒张压水平、总胆固醇、高密度脂蛋白胆固醇和血糖水平评估心血管疾病风险，此外还采用了心血管疾病风险因素综合评分。除其他因素外，分析还对吸烟、口服避孕药使用情况和体重指数进行了校正。
血清AMH水平与心血管疾病风险因素结果之间的关系是非线性的。与AMH水平≥0.16μg/l的女性相比，AMH水平<0.16μg/l的女性多0.11个（95%置信区间（CI）0.01；0.21）代谢风险因素。除了AMH水平<0.002μg/l的女性与AMH水平≥0.16μg/l的女性相比总胆固醇水平有降低0.11mmol/l（95%CI -0.23；0.01）的趋势外，个体风险因素水平与AMH水平之间无关联。尽管无统计学显著性，但这些效应大小在4０岁以下女性中更大。
局限性、谨慎原因：本研究中所探讨的关联的因果关系和时间顺序在此无法确定。此外，由于未对多重统计检验进行校正，本探索性研究结果的临床和统计学意义应谨慎解读。
这项基于人群的研究支持了先前的研究结果，即AMH水平极低的绝经前女性可能心血管疾病风险增加。它为未来针对这组女性的研究奠定了基础。采用更敏感的AMH检测方法的纵向研究可能有助于更好地理解这些结果的意义。
研究资金/利益冲突：本研究或稿件未获得资金支持。多廷赫姆队列研究由荷兰国家公共卫生与环境研究所开展并资助。F.J.M.B.已从默克雪兰诺、吉德昂·里奇特、辉凌制药和罗氏公司获得费用和资助支持。
无。
