Kang In Sook, Shin Mi-Seung, Lee Hye Ah, Kim Mi-Na, Kim Hack-Lyoung, Yoon Hyun-Ju, Park Seong-Mi, Hong Kyung-Soon, Kim Myung-A
Division of Cardiology, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon, Korea.
Coron Artery Dis. 2024 Jun 1;35(4):314-321. doi: 10.1097/MCA.0000000000001339. Epub 2024 Feb 20.
Despite the significant increase in cardiovascular events in women after menopause, studies comparing postmenopausal women and men are scarce.
We analyzed data from a nationwide, multicenter, prospective registry and enrolled 2412 patients with stable chest pain who underwent elective coronary angiography. Binary coronary artery disease (b-CAD) was defined as the ≥50% stenosis of epicardial coronary arteries, including the left main coronary artery.
Compared with the men, postmenopausal women were older (66.6 ± 8.5 vs. 59.5 ± 11.4 years) and had higher high-density lipoprotein cholesterol levels (49.0 ± 12.8 vs. 43.6 ± 11.6 mg/dl, P < 0.01). The prevalence of diabetes did not differ significantly ( P = 0.40), and smoking was more common in men than in postmenopausal women ( P ≤ 0.01). At enrollment, b-CAD and revascularization were more common in men than in postmenopausal women (50.3% vs. 41.0% and 14.4% vs. 9.7%, respectively; both P < 0.01). However, multivariate analyses revealed that revascularization [odds ratio (OR): 0.72; 95% confidence interval (CI): 0.49-1.08] was not significantly related to sex and a similar result was found in age propensity-matched population (OR: 0.80; 95% CI: 0.52-1.24). During the follow-up period, the secondary composite cardiovascular outcomes were lower in postmenopausal women than in men (OR: 0.55; 95% CI: 0.31-0.98), also consistent with the result using the age propensity-mated population (OR: 0.33; 95% CI: 0.13-0.85).
Postmenopausal women experienced coronary revascularization comparable to those in men at enrollment, despite the average age of postmenopausal women was 7 years older than that of men.Postmenopausal women exhibit better clinical outcomes than those of men if optimal treatment is provided.
尽管绝经后女性心血管事件显著增加，但比较绝经后女性和男性的研究却很少。
我们分析了一项全国性、多中心、前瞻性登记研究的数据，纳入了2412例接受择期冠状动脉造影的稳定型胸痛患者。二元冠状动脉疾病（b-CAD）定义为心外膜冠状动脉（包括左主干冠状动脉）狭窄≥50%。
与男性相比，绝经后女性年龄更大（66.6±8.5岁 vs. 59.5±11.4岁），高密度脂蛋白胆固醇水平更高（49.0±12.8 vs. 43.6±11.6mg/dl，P<0.01）。糖尿病患病率无显著差异（P = 0.40），男性吸烟比绝经后女性更常见（P≤0.01）。入选时，b-CAD和血运重建在男性中比绝经后女性更常见（分别为50.3% vs. 41.0%和14.4% vs. 9.7%；P均<0.01）。然而，多变量分析显示血运重建[比值比（OR）：0.72；95%置信区间（CI）：0.49-1.08]与性别无显著相关性，在年龄倾向匹配人群中也得到了类似结果（OR：0.80；95%CI：0.52-1.24）。在随访期间，绝经后女性的次要复合心血管结局低于男性（OR：0.55；95%CI：0.31-0.98），这也与年龄倾向匹配人群的结果一致（OR：0.33；95%CI：0.13-0.85）。
尽管绝经后女性的平均年龄比男性大7岁，但入选时绝经后女性接受冠状动脉血运重建的情况与男性相当。如果提供最佳治疗，绝经后女性的临床结局优于男性。
