Tchernof A, Calles-Escandon J, Sites C K, Poehlman E T
Clinical Pharmacology and Metabolic Research Unit, University of Vermont, Burlington 05405, USA.
Coron Artery Dis. 1998;9(8):503-11. doi: 10.1097/00019501-199809080-00006.
In addition to being associated with termination of reproductive life in women, the menopause coincides with an increase in several comorbidities including cardiovascular disease. This increase in the prevalence of cardiovascular disease in the postmenopausal years has been partially attributed to adverse effects of estrogen deficiency on plasma lipid-lipoprotein levels and on the cardiovascular system, although other factors are contributing. Central body fatness and insulin resistance are components of a cluster of metabolic abnormalities which also increases the risk of cardiovascular disease. This review summarizes studies that have examined the effects of the menopause transition and of estrogen-replacement therapy on central body fatness and insulin resistance. Review of cross-sectional studies suggests that the menopause transition is associated with an increase in abdominal and visceral adipose tissue accumulation, as measured either with dual X-ray absorptiometry or computed tomography. These results appear to be independent of the aging process and total body fatness. In general, cross-sectional studies using circumference measurements did not find any significant effect of the menopause. Longitudinal studies also support that accumulation of central body fatness accelerates with menopause. The effects of the menopause on insulin resistance appear to be moderate, if any, although available studies are clearly insufficient to draw firm conclusions. The majority of interventional studies support the notion that hormone-replacement therapy attenuates the accumulation of central fat in postmenopausal women, compared with control or placebo-treated women. Retrospective comparisons of hormone users and nonusers also support a protective effect of hormone replacement on fat distribution. Moderate effects of estrogen therapy were found on insulin resistance in postmenopausal women, although long-term, controlled trials using accurate measurements of insulin sensitivity are lacking. Treatment with progestins exerts moderate deleterious effects on insulin sensitivity, which may be attributable to the partial androgenicity of progestins used. It is concluded that part of the increased incidence of cardiovascular disease in postmenopausal women may be attributable to increased central body fatness. Therapies aiming at preventing these changes in fat distribution such as hormone-replacement therapy, diet or exercise are likely to provide long-term cardiovascular and metabolic benefits for women's health.
除了与女性生殖生命的终止相关外，更年期还与包括心血管疾病在内的多种合并症的增加同时出现。绝经后心血管疾病患病率的增加部分归因于雌激素缺乏对血浆脂质 - 脂蛋白水平和心血管系统的不良影响，尽管还有其他因素在起作用。中心性肥胖和胰岛素抵抗是一组代谢异常的组成部分，这也增加了心血管疾病的风险。本综述总结了研究更年期过渡和雌激素替代疗法对中心性肥胖和胰岛素抵抗影响的研究。横断面研究的综述表明，更年期过渡与腹部和内脏脂肪组织堆积的增加有关，这是通过双能X线吸收法或计算机断层扫描测量的。这些结果似乎独立于衰老过程和全身肥胖。一般来说，使用周长测量的横断面研究未发现更年期有任何显著影响。纵向研究也支持随着更年期中心性肥胖的堆积加速。更年期对胰岛素抵抗的影响似乎适中（如果有的话），尽管现有研究显然不足以得出确凿结论。大多数干预性研究支持这样的观点，即与对照或安慰剂治疗的女性相比，激素替代疗法可减轻绝经后女性中心脂肪的堆积。激素使用者和非使用者的回顾性比较也支持激素替代对脂肪分布的保护作用。在绝经后女性中发现雌激素疗法对胰岛素抵抗有中等影响，尽管缺乏使用准确胰岛素敏感性测量的长期对照试验。孕激素治疗对胰岛素敏感性有中等程度的有害影响，这可能归因于所用孕激素的部分雄激素性。结论是绝经后女性心血管疾病发病率增加的部分原因可能是中心性肥胖增加。旨在预防脂肪分布这些变化（如激素替代疗法、饮食或运动）的治疗方法可能会为女性健康带来长期的心血管和代谢益处。
