El Khoudary Samar R
Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.
Curr Opin Lipidol. 2017 Aug;28(4):328-336. doi: 10.1097/MOL.0000000000000432.
To summarize recent provocative findings on conventional and novel metrics of HDL including HDL-C, HDL subclasses and HDL cholesterol efflux capacity as related to menopause.
Pattern of menopause-related changes in HDL-C are not consistent, suggesting a complex relationship between HDL and menopause. Growing body of literature indicates that higher levels of HDL-C may not be consistently cardio-protective in midlife women, suggesting a potential change in other metrics of HDL that could not be captured by the static metric HDL-C. It is also possible that higher HDL-C at certain conditions could be a marker of HDL metabolism dysfunctionality. Significant alterations in other metrics of HDL have been reported after menopause and found to be related to estradiol.
The impact of changes in novel metrics of HDL over the menopausal transition on cardiovascular disease (CVD) risk later in life is not clear in women. Much of our understanding of how the menopausal transition may impact HDL metrics comes from cross-sectional studies. Future longitudinal studies are needed to evaluate other metrics of HDL shown to better reflect the cardio-protective capacities of HDL, so that the complex association of menopause, HDL and CVD risk could be characterized.
总结近期关于高密度脂蛋白（HDL）的传统和新指标（包括HDL-C、HDL亚类和HDL胆固醇流出能力）与绝经相关的前沿研究结果。
HDL-C与绝经相关的变化模式并不一致，这表明HDL与绝经之间存在复杂关系。越来越多的文献表明，较高水平的HDL-C在中年女性中可能并非始终具有心脏保护作用，这表明HDL的其他指标可能发生了变化，而静态指标HDL-C无法捕捉到这些变化。在某些情况下，较高的HDL-C也可能是HDL代谢功能障碍的一个标志。绝经后已报道HDL的其他指标有显著改变，且发现与雌二醇有关。
HDL新指标在绝经过渡期的变化对女性后期心血管疾病（CVD）风险的影响尚不清楚。我们对绝经过渡期如何影响HDL指标的理解大多来自横断面研究。未来需要进行纵向研究，以评估其他能更好反映HDL心脏保护能力的HDL指标，从而明确绝经、HDL和CVD风险之间的复杂关联。
