JAHA：更年期后雌激素和心血管疾病的关联

妇女不太容易像男性那样出现心血管疾病，但绝经后，两性之间的在罹患心血管疾病上的差异变得越来越不明显。其中原因就是雌激素对心脏和血管的有益作用。现在，一项新的研究数据质疑上述这些观点。Pierre-Yves Scarabin带领的INSERM的研究团队进行了一项募集6000名65岁以上的妇女的研究证实，血液雌二醇水平高的妇女面临的心肌梗死或中风的风险更大。

研究结果发表在Journal of the American Heart Association杂志上。

雌激素对妇女性发育和生殖发挥关键作用。雌二醇是最活跃的激素之一。在生殖期，血液中雌二醇浓度特别高。绝经后，卵巢功能停止，导致其血液中的雌激素水平显著下降。然而，这些低浓度的激素仍可能会对机体发挥一定作用。

终其一生，女性比男性存在较少的心血管疾病风险。多年来认为雌激素介导的免疫力在预防动脉粥样硬化及其并发症方面起到“保护者”的角色。然而，最近的研究证实这种假设是不成立的，新研究认为更年期妇女雌激素不会防止缺血性血管疾病，甚至对于最高的年龄段的妇女存在有害影响

到现在为止，还没有研究已经能够清楚地证实内源性性激素对绝经后妇女心血管疾病风险有何影响。

该研究募集6000名妇女参与研究，研究人员进行为期四年的血液中的雌二醇水平测量，结果发现有150例心血管疾病的新病例出现。结果表明，心肌梗死或中风的风险增加的人血液中oestrodial雌性激素水平也高。但这种关系不存在于其他已知的心血管疾病如糖尿病和肥胖中。这项新的研究数据证实雌激素对心脏和血管是有益的。

doi:10.1161/JAHA.112.001388
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High Level of Plasma Estradiol as a New Predictor of Ischemic Arterial Disease in Older Postmenopausal Women: The Three-City Cohort Study

Valérie Scarabin-Carré, MD*; Marianne Canonico, PhD*; Sylvie Brailly-Tabard, MD; Séverine Trabado, MD; et al.

Background Despite evidence that estrogens may be involved in atherothrombosis, the role of endogenous sex steroid hormones in ischemic arterial disease among postmenopausal women remains uncertain.

Methods and Results In the Three-City prospective cohort study of subjects (n=9294) >65 years of age, we investigated the association of total 17β-estradiol, bioavailable 17β-estradiol, and total testosterone with the 4-year incidence of ischemic arterial disease among postmenopausal women who did not use any hormone therapy. We designed a case–cohort study including a random sample of 537 subjects and 106 incident cases of first cardiovascular events. Weighted Cox proportional-hazards models with age as the time scale were used to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) for ischemic arterial disease by a 1–standard deviation increase in sex steroid hormones. In univariate analysis, HR of ischemic arterial disease was positively and significantly associated with both total and bioavailable estradiol levels. These associations remained significant after adjustment for traditional cardiovascular risk factors, including body mass index, diabetes, hypercholesterolemia, hypertension, and smoking status (HR: 1.42, 95% CI: 1.12–1.79, P<0.01; and HR: 1.42, 95% CI: 1.12–1.78, P<0.01, respectively). Separate analysis for coronary heart disease yielded similar results (adjusted HR: 1.49, 95% CI: 1.10–2.02, P=0.01; and adjusted HR: 1.50, 95% CI: 1.11–2.04, P<0.01, respectively), and a borderline significant trend was observed for ischemic stroke (HR: 1.34, 95% CI: 0.95–1.89, P=0.08; and HR: 1.32, 95% CI: 0.94–1.84, P=0.11, respectively). By contrast, no significant association was found between total testosterone and ischemic arterial disease in both univariate and adjusted analyses.

Conclusions High plasma level of endogenous estradiol emerges as a new predictor of ischemic arterial disease in older postmenopausal women.