Rozenberg S, Liebens I, Vandromme J, Hotimsky A, Van Rijsselberge M
Department of Gynecology, St. Pieter University Hospital, Free University of Brussels (VUB-ULB), Belgium.
Int J Fertil Menopausal Stud. 1994;39 Suppl 1:36-42.
Cardiovascular risk is higher in men than in women, and also more prevalent in postmenopausal than in premenopausal women, especially if not treated by estrogens. These differences may be due, in part, to a cardioprotective action of sex hormones, mainly estrogens. However, only a limited part of this protection may be attributed to metabolic modifications induced by replacement therapy with estrogen. Therefore, it remains to be determined which other cardioprotective mechanisms influenced by sex steroids might be involved. It has been demonstrated that the menopause is associated with an increase in uterine arterial pulsatility index, reflecting increased peripheral resistance, while the administration of estrogens has an opposite effect at this level. In Doppler studies, estrogen replacement therapy was also associated with an increase in stroke volume and flow acceleration in the aorta. This suggests a positive inotropic effect of estrogens. Using technetium scanning, it was found that women at an early phase of menopause have a stronger myocardial contractility than women of a similar age whose menopause is of longer duration. These effects of estrogens on hemodynamic characteristics might be controlled by vasoregulatory hormones such as endothelin(s) or endothelial-derived relaxing factor (EDRF), now identified as nitric oxide (NO). Indeed, sex-associated differences in endothelin have been observed. Such are some of the mechanisms by which estrogen administration might effect a cardiovascular protection. At the present time, however, conclusive data are not available.
心血管疾病风险在男性中高于女性，在绝经后女性中也比绝经前女性更为普遍，尤其是在未接受雌激素治疗的情况下。这些差异可能部分归因于性激素，主要是雌激素的心脏保护作用。然而，这种保护作用中只有有限的一部分可归因于雌激素替代疗法引起的代谢改变。因此，仍有待确定性激素影响的其他心脏保护机制可能是什么。已经证明，绝经与子宫动脉搏动指数增加有关，这反映了外周阻力增加，而在这个水平上给予雌激素则有相反的效果。在多普勒研究中，雌激素替代疗法还与主动脉搏出量增加和血流加速有关。这表明雌激素具有正性肌力作用。通过锝扫描发现，处于绝经早期的女性比绝经时间较长的同龄女性具有更强的心肌收缩力。雌激素对血流动力学特征的这些影响可能受血管调节激素如内皮素或内皮衍生舒张因子（现确定为一氧化氮）控制。确实，已观察到内皮素存在性别相关差异。雌激素给药可能实现心血管保护的机制就是这些。然而，目前尚无确凿数据。
