Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Am Coll Cardiol. 2018 Jun 5;71(22):2555-2566. doi: 10.1016/j.jacc.2018.01.083.
Higher androgen and lower estrogen levels are associated with cardiovascular disease (CVD) risk factors in women. However, studies on sex hormones and incident CVD events in women have yielded conflicting results.
The authors assessed the associations of sex hormone levels with incident CVD, coronary heart disease (CHD), and heart failure (HF) events among women without CVD at baseline.
The authors studied 2,834 post-menopausal women participating in the MESA (Multi-Ethnic Study of Atherosclerosis) with testosterone, estradiol, dehydroepiandrosterone, and sex hormone binding globulin (SHBG) levels measured at baseline (2000 to 2002). They used Cox hazard models to evaluate associations of sex hormones with each outcome, adjusting for demographics, CVD risk factors, and hormone therapy use.
The mean age was 64.9 ± 8.9 years. During 12.1 years of follow-up, 283 CVD, 171 CHD, and 103 HF incident events occurred. In multivariable-adjusted models, the hazard ratio (95% confidence interval [CI]) associated with 1 SD greater log-transformed sex hormone level for the respective outcomes of CVD, CHD, and HF were as follows: total testosterone: 1.14 (95% CI: 1.01 to 1.29), 1.20 (95% CI: 1.03 to 1.40), 1.09 (95% CI: 0.90 to 1.34); estradiol: 0.94 (95% CI: 0.80 to 1.11), 0.77 (95% CI: 0.63 to 0.95), 0.78 (95% CI: 0.60 to 1.02); and testosterone/estradiol ratio: 1.19 (95% CI: 1.02 to 1.40), 1.45 (95% CI: 1.19 to 1.78), 1.31 (95% CI: 1.01 to 1.70). Dehydroepiandrosterone and SHBG levels were not associated with these outcomes.
Among post-menopausal women, a higher testosterone/estradiol ratio was associated with an elevated risk for incident CVD, CHD, and HF events, higher levels of testosterone associated with increased CVD and CHD, whereas higher estradiol levels were associated with a lower CHD risk. Sex hormone levels after menopause are associated with women's increased CVD risk later in life.
较高的雄激素和较低的雌激素水平与女性心血管疾病（CVD）风险因素有关。然而，关于女性性激素与 CVD 事件发生的研究结果存在矛盾。
作者评估了基线时无 CVD 的女性性激素水平与 CVD、冠心病（CHD）和心力衰竭（HF）事件发生的相关性。
作者研究了 2834 名参加 MESA（动脉粥样硬化多民族研究）的绝经后女性，基线时（2000 年至 2002 年）测量了睾酮、雌二醇、脱氢表雄酮和性激素结合球蛋白（SHBG）水平。作者使用 Cox 风险模型评估了性激素与每种结局的相关性，调整了人口统计学、CVD 风险因素和激素治疗的使用情况。
平均年龄为 64.9±8.9 岁。在 12.1 年的随访期间，发生了 283 例 CVD、171 例 CHD 和 103 例 HF 事件。在多变量调整模型中，与相应的 CVD、CHD 和 HF 结局的 1 SD 更大对数转换性激素水平相关的风险比（95%置信区间[CI]）如下：总睾酮：1.14（95%CI：1.01 至 1.29）、1.20（95%CI：1.03 至 1.40）、1.09（95%CI：0.90 至 1.34）；雌二醇：0.94（95%CI：0.80 至 1.11）、0.77（95%CI：0.63 至 0.95）、0.78（95%CI：0.60 至 1.02）；以及睾酮/雌二醇比值：1.19（95%CI：1.02 至 1.40）、1.45（95%CI：1.19 至 1.78）、1.31（95%CI：1.01 至 1.70）。脱氢表雄酮和 SHBG 水平与这些结局无关。
在绝经后女性中，较高的睾酮/雌二醇比值与 CVD、CHD 和 HF 事件的发生风险增加有关，较高的睾酮水平与 CVD 和 CHD 风险增加有关，而较高的雌二醇水平与 CHD 风险降低有关。绝经后女性的性激素水平与她们以后的 CVD 风险增加有关。
