Wang Haihui, Li Yuehua, Wang Xinlu, Bu Jianhong, Yan Guoliang, Lou Danfei
Department of Geriatrics, Shanghai Municipal Hospital of Traditional Chinese Medicine, China.
Eur J Prev Cardiol. 2017 Apr;24(6):600-611. doi: 10.1177/2047487317693133. Epub 2017 Jan 1.
Background Low testosterone levels have been associated with coronary heart disease (CHD) morbidity and mortality in men, but the influence of hormones in postmenopausal women is unclear. This meta-analysis aimed to examine whether there is an association between endogenous sex hormones and CHD risk in postmenopausal women. Methods A systematic search of the PubMed and EMBASE databases from 1966 to 30 November 2016 was performed for prospective studies that reported an association between endogenous sex hormones and CHD in postmenopausal women. Summary relative risks (RRs) and 95% confidence intervals (CIs) were combined by using a random-effects model. Results A total of 13 publications (12 studies, including six prospective cohort and six nested case-control studies) were included. The summary RRs for CHD were 1.01 (95% CI 0.77-1.31) comparing the highest versus lowest tertile of total testosterone, with evidence of high heterogeneity ( I= 80.7%). In subgroup and meta-regression analyses, none of the variables were identified as contributing to significant heterogeneity. Based on a comparison of the highest versus lowest tertile models, the summary RRs (95% CIs) for CHD were 0.88 (0.63-1.23, I= 48.7%) for free testosterone, 1.16 (0.82-1.63, I= 47.8%) for estradiol, 0.98 (0.90-1.07, I= 3.2%) for sex hormone-binding globulin and 1.19 (0.89-1.58, I= 0) for dehydroepiandrosterone. Conclusion There is limited evidence to suggest that endogenous levels of sex hormones are not significantly associated with CHD risk in postmenopausal women.
低睾酮水平与男性冠心病（CHD）的发病率和死亡率相关，但激素对绝经后女性的影响尚不清楚。本荟萃分析旨在研究内源性性激素与绝经后女性CHD风险之间是否存在关联。方法：对1966年至2016年11月30日的PubMed和EMBASE数据库进行系统检索，以查找报告内源性性激素与绝经后女性CHD之间关联的前瞻性研究。采用随机效应模型合并汇总相对风险（RRs）和95%置信区间（CIs）。结果：共纳入13篇文献（12项研究，包括6项前瞻性队列研究和6项巢式病例对照研究）。比较总睾酮最高三分位数与最低三分位数时，CHD的汇总RR为1.01（95%CI 0.77 - 1.31），存在高度异质性（I = 80.7%）。在亚组分析和Meta回归分析中，未发现任何变量导致显著异质性。基于最高三分位数模型与最低三分位数模型的比较，游离睾酮CHD的汇总RR（95%CI）为0.88（0.63 - 1.23，I = 48.7%），雌二醇为1.16（0.82 - 1.63，I = 47.8%），性激素结合球蛋白为0.98（0.90 - 1.07，I = 3.2%），脱氢表雄酮为1.19（0.89 - 1.58，I = 0）。结论：证据有限，提示内源性性激素水平与绝经后女性CHD风险无显著关联。
