Torosyan Nare, Visrodia Parth, Torbati Tina, Minissian Margo B, Shufelt Chrisandra L
Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA.
Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA; Geri and Richard Brawerman Nursing Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Maturitas. 2022 Dec;166:14-20. doi: 10.1016/j.maturitas.2022.08.001. Epub 2022 Aug 11.
Dyslipidemia is an established risk factor for cardiovascular disease (CVD), which remains the leading cause of morbidity and mortality in women globally. The incidence of dyslipidemia increases over a woman's lifespan, with adverse changes around the time of menopause. Menopause, and the years leading up to the final menstrual period, is a time of estrogen fluctuation and ultimately estrogen deficiency, which has been associated with proatherogenic changes in the lipid profile. Independent of aging, menopausal status is associated with elevations in serum total cholesterol, LDL cholesterol, apolipoproteins, and triglycerides, and decreases in HDL cholesterol (HDL-C). Emerging research also suggests that after menopause there is a loss of functional HDL cardioprotective properties. Early initiation of menopausal hormone therapy (MHT) confers a favorable effect on lipid profile, though this does not translate into improved CVD outcomes and therefore guidelines do not indicate it for primary or secondary prevention of CVD. At the time of menopause, special consideration should be given to women with conditions more associated with CVD, including polycystic ovarian syndrome, premature menopause, early menopause, premature ovarian insufficiency, and familial hypercholesterolemia. Statins remain the mainstay of dyslipidemia therapy, though novel lipid-lowering agents are emerging. This review provides an overview of lipid alterations observed during the menopausal transition, summarizes the current evidence on the role of estrogen and progestogen on lipids, identifies special populations of women at especially high risk for lipid dysregulation at menopause, and describes approaches to the screening and treatment of midlife women.
血脂异常是心血管疾病（CVD）公认的危险因素，而心血管疾病仍是全球女性发病和死亡的主要原因。血脂异常的发生率在女性一生中会增加，在绝经前后会出现不良变化。绝经以及绝经前的数年，是雌激素波动并最终导致雌激素缺乏的时期，这与血脂谱中促动脉粥样硬化的变化有关。独立于衰老因素，绝经状态与血清总胆固醇、低密度脂蛋白胆固醇、载脂蛋白和甘油三酯升高以及高密度脂蛋白胆固醇（HDL-C）降低有关。新出现的研究还表明，绝经后功能性HDL的心脏保护特性会丧失。早期开始绝经激素治疗（MHT）对血脂谱有有利影响，尽管这并未转化为改善的心血管疾病结局，因此指南未将其用于心血管疾病的一级或二级预防。在绝经时，应特别关注患有与心血管疾病关联更大疾病的女性，包括多囊卵巢综合征、过早绝经、早发性绝经、卵巢早衰和家族性高胆固醇血症。他汀类药物仍然是血脂异常治疗的主要药物，不过新型降脂药物也在不断涌现。本综述概述了绝经过渡期观察到的血脂变化，总结了雌激素和孕激素对血脂作用的现有证据，确定了绝经时血脂失调风险特别高的特殊女性群体，并描述了中年女性的筛查和治疗方法。
