Dallongeville J, Marecaux N, Isorez D, Zylbergberg G, Fruchart J C, Amouyel P
SERLIA et Unité INSERM 325, Institut Pasteur de Lille, France.
Atherosclerosis. 1995 Nov;118(1):123-33. doi: 10.1016/0021-9150(95)05599-r.
The relationship between menopause and cardiovascular risk factors of progestin alone or in combination with estrogen were analysed in a sample of French women. Three thousand four hundred and forty consecutive women, between 45 and 65 years of age, who received a systematic check-up between January 1991 and April 1993 were enrolled in this study. All biological measurements were performed at a central laboratory. Women were classified as premenopausal (n = 1233), postmenopausal (n = 1774) if they had not menstruated in the 12 months before examination, and perimenopausal (n = 433) if they met at least two of the following criteria: elevated levels of serum follicle-stimulating hormone (FSH), irregular menses, amenorrhea for less than 12 months, hot flushes. The effect of menopause on cardiovascular risk factors was determined in 2167 women between 45 and 65 years of age (premenopausal n = 790, postmenopausal n = 1377), none of whom were presently treated with hormonal replacement therapy (HRT). In addition, the effect of progestin was assessed in a group or 397 perimenopausal women, and the effect of combined estrogen and progestin replacement therapy in another group of 1746 postmenopausal women. Menopause was associated with higher levels of serum cholesterol (6.4 vs. 5.9 mmol/l), triglycerides (1.2 vs. 1.0 mmol/l), apolipoprotein (apo) B (1.3 vs. 1.1 g/l), apo A-I (1.9 vs. 1.8 g/l), as well as with elevated diastolic blood pressure (79.7 vs. 77.0 mmHg). Multivariate analysis indicated that these effects were independent of age, body mass index (BMI), glycemia, smoking, alcohol intake, exercise and parity. Perimenopausal women treated with progestin alone (n = 95) were compared to perimenopausal women not using HRT (n = 302). There were no statistically significant differences in the levels of cholesterol, triglycerides, apo B, apo A-I, glycemia and blood pressure between the two groups. Postmenopausal women using a combination of estrogen and progestin (n = 369) had significantly lower levels of serum cholesterol (6.1 vs 6.4 mmol/l), triglycerides (1.0 vs. 1.2 mmol/l), apo B (1.2 vs. 1.3 g/l), systolic (131.9 vs. 137.9 mmHg) and diastolic (76.9 vs. 79.7 mmHg) blood pressure than postmenopausal women without hormonal therapy (n = 1377), taking into account confounding variables. In contrast, serum apo A-I levels were not altered by the combined hormonal therapy. We conclude that menopause is associated with the aggravation of multiple cardiovascular risk factors. These deleterious factors are affected by a treatment of combining estrogen and progestin.
在一组法国女性样本中，分析了单独使用孕激素或孕激素与雌激素联合使用与绝经和心血管危险因素之间的关系。1991年1月至1993年4月期间接受系统体检的3440名年龄在45至65岁之间的连续女性参与了本研究。所有生物学测量均在中央实验室进行。如果女性在检查前12个月内没有月经，则被分类为绝经前（n = 1233）、绝经后（n = 1774）；如果她们符合以下至少两条标准，则被分类为围绝经期（n = 433）：血清促卵泡激素（FSH）水平升高、月经不规律、闭经少于12个月、潮热。在2167名年龄在45至65岁之间的女性（绝经前n = 790，绝经后n = 1377）中确定了绝经对心血管危险因素的影响，这些女性目前均未接受激素替代疗法（HRT）。此外，在一组397名围绝经期女性中评估了孕激素的作用，在另一组1746名绝经后女性中评估了雌激素和孕激素联合替代疗法的作用。绝经与较高的血清胆固醇水平（6.4 vs. 5.9 mmol/l）、甘油三酯（1.2 vs. 1.0 mmol/l）、载脂蛋白（apo）B（1.3 vs. 1.1 g/l）、apo A-I（1.9 vs. 1.8 g/l）以及舒张压升高（79.7 vs. 77.0 mmHg）相关。多变量分析表明，这些影响独立于年龄、体重指数（BMI）、血糖、吸烟、饮酒、运动和生育情况。将单独使用孕激素治疗的围绝经期女性（n = 95）与未使用HRT的围绝经期女性（n = 302）进行比较。两组之间的胆固醇、甘油三酯、apo B、apo A-I、血糖和血压水平没有统计学上的显著差异。考虑到混杂变量，使用雌激素和孕激素联合治疗的绝经后女性（n = 369）的血清胆固醇（6.1 vs 6.4 mmol/l）、甘油三酯（1.0 vs. 1.2 mmol/l）、apo B（1.2 vs. 1.3 g/l）、收缩压（131.9 vs. 137.9 mmHg）和舒张压（76.9 vs. 79.7 mmHg）水平显著低于未接受激素治疗的绝经后女性（n = 1377）。相比之下，联合激素治疗并未改变血清apo A-I水平。我们得出结论，绝经与多种心血管危险因素的加重相关。这些有害因素会受到雌激素和孕激素联合治疗的影响。
