Fontaine Coralie, Gosset Anna, Davezac Morgane, Buscato Mélissa, Grouthier Virginie, Renault Marie-Ange, Henrion Daniel, Trémollières Florence, Schumacher Michael, Lenfant Françoise, Arnal Jean-François
Institut National de la Santé et de la Recherche Médicale (Inserm) U1297, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), University of Toulouse, Toulouse CHU, 1 avenue Jean Poulhès, 31 400 Toulouse, France.
University of Bordeaux, Inserm, Biology of CV Diseases, UMR 1034 Pessac F-33600, France.
Cardiovasc Res. 2025 Aug 28;121(10):1551-1565. doi: 10.1093/cvr/cvaf086.
Ageing plays a critical role in the deterioration of artery function and structure, and clearly represents the first cardiovascular (CV) risk factor in men but also in women. Coronary and cerebral arteries are particularly prone to atheroma, and the tissues they perfuse are particularly vulnerable to ischaemia. In both sexes, the age-related decrease in sex hormones (menopause and andropause) has deleterious effects on CV health. The extent to which hormonal supplementation can limit the CV risks increased by ageing remains controversial. The Women Health Initiative study, the main clinical intervention designed to evaluate the benefit/risk ratio of hormone treatment after menopause, revealed in 2002 an unexpected increase in CV events in aged women (>70 years) given estrogens plus a peculiar synthetic progestin medroxyprogesterone acetate, whereas estrogens alone were not harmful but even protective in younger women (<60 years). This pointed out the double problem of the progestin (now natural progesterone is preferred) and of the age. The clinical situation is not yet clear for testosterone and CV disease in men. Related to these questions, we will analyse and summarize: (i) the importance of the doses and concentrations of estrogens and testosterone, both in humans and in experimental models, allowing to define relevant/physiological or pharmacological actions of sex hormones in respect to their medical modulations in practice; (ii) the main clinical studies conducted with estrogens or androgens, in terms of CV protection and the impact of age on these effects; (iii) the mechanisms underlying these actions; (iv) the gender-affirming hormone therapy, as these sex hormones are the cornerstone of gender transition care management.
衰老在动脉功能和结构的恶化中起着关键作用，显然是男性和女性的首要心血管（CV）危险因素。冠状动脉和脑动脉特别容易发生动脉粥样硬化，它们所灌注的组织特别容易受到缺血的影响。在两性中，与年龄相关的性激素减少（绝经和男性更年期）对心血管健康都有有害影响。激素补充能在多大程度上限制因衰老而增加的心血管风险仍存在争议。妇女健康倡议研究是旨在评估绝经后激素治疗的益处/风险比的主要临床干预研究，2002年发现，给予雌激素加一种特殊的合成孕激素醋酸甲羟孕酮的老年女性（>70岁）心血管事件意外增加，而单独使用雌激素对年轻女性（<60岁）无害甚至有保护作用。这指出了孕激素（现在首选天然孕酮）和年龄的双重问题。男性睾酮与心血管疾病的临床情况尚不清楚。关于这些问题，我们将分析和总结：（i）雌激素和睾酮的剂量和浓度在人类和实验模型中的重要性，以便在实际医疗调节方面确定性激素的相关/生理或药理作用；（ii）就心血管保护以及年龄对这些作用的影响而言，用雌激素或雄激素进行的主要临床研究；（iii）这些作用的潜在机制；（iv）性别确认激素疗法，因为这些性激素是性别过渡护理管理的基石。
