Celermajer D S, Sorensen K E, Spiegelhalter D J, Georgakopoulos D, Robinson J, Deanfield J E
Cardiothoracic Unit, Hospital for Sick Children, London.
J Am Coll Cardiol. 1994 Aug;24(2):471-6. doi: 10.1016/0735-1097(94)90305-0.
This study assessed whether aging is associated with progressive endothelial dysfunction, whether the pattern of any age-related decline in vascular health is different in men and women and whether any gender difference is consistent with known changes in hormonal status.
Coronary and cerebrovascular disease are much less common in young and middle-aged women compared with men, although the gender difference in death from atherosclerosis is less marked after the menopause. Endothelial dysfunction is an early event in atherogenesis and is important in dynamic plaque stenosis in later life. The effect of aging on endothelial function in men and women, however, is not well known.
We used high resolution ultrasound to study endothelium-dependent and endothelium-independent vascular responses. Brachial artery physiology was investigated in 238 subjects (103 men, 135 women; mean [+/- SD] age 38 +/- 17 years, range 15 to 72) with no known risk factors for atherosclerosis. The responses to reactive hyperemia (flow-mediated dilation, which is endothelium dependent) and to glyceryl trinitrate (an endothelium-independent dilator) were assessed for all the subjects and then for men and women separately.
On multivariate analysis for the whole group, reduced flow-mediated dilation was related to older age (r = -0.34, p < 0.0001). In men, flow-mediated dilation was preserved in subjects aged < or = 40 years but declined thereafter at 0.21%/year. In women, flow-mediated dilation was stable until the early 50s, after which it declined at 0.49%/year (p = 0.002 compared with men). In contrast, there was no significant change in the glyceryl trinitrate response with aging in either gender.
Aging is associated with progressive endothelial dysfunction in normal humans, and this appears to occur earlier in men than in women. In women, however, a steep decline commences at around the time of the menopause. This is consistent with a protective effect of estrogens on the arterial wall.
本研究评估衰老是否与进行性内皮功能障碍相关，血管健康方面与年龄相关的下降模式在男性和女性中是否不同，以及任何性别差异是否与已知的激素状态变化一致。
与男性相比，冠状动脉疾病和脑血管疾病在年轻和中年女性中要少见得多，尽管绝经后动脉粥样硬化导致的死亡中的性别差异不太明显。内皮功能障碍是动脉粥样硬化发生的早期事件，并且在后期的动态斑块狭窄中很重要。然而，衰老对男性和女性内皮功能的影响尚不清楚。
我们使用高分辨率超声研究内皮依赖性和非内皮依赖性血管反应。对238名无已知动脉粥样硬化危险因素的受试者（103名男性，135名女性；平均[±标准差]年龄38±17岁，范围15至72岁）的肱动脉生理学进行了研究。评估了所有受试者以及男性和女性分别对反应性充血（血流介导的舒张，其为内皮依赖性）和硝酸甘油（一种非内皮依赖性扩张剂）的反应。
在对整个组的多变量分析中，血流介导的舒张降低与年龄较大相关（r = -0.34，p < 0.0001）。在男性中，年龄≤40岁的受试者血流介导的舒张得以保留，但此后以每年0.21%的速度下降。在女性中，血流介导的舒张在50岁出头之前保持稳定，此后以每年0.49%的速度下降（与男性相比，p = 0.002）。相比之下，硝酸甘油反应在两性中均未随衰老发生显著变化。
衰老与正常人体内进行性内皮功能障碍相关，并且这似乎在男性中比在女性中出现得更早。然而，在女性中，在绝经前后开始出现急剧下降。这与雌激素对动脉壁的保护作用一致。
