Association Between Sex Hormone Level And Coronary Atherosclerosis In Postmenopausal Women With Coronary Artery Disease

The Epidemiology survey shows that the incidence of CHD in women increase significantly after menopausal and can reach the level of men'rate soon, which indicates that disbalance of sex hormone play an important part in negative cardioascular incidences. Basic studies have demonstrated the protective role of estrogen, however, within the last decade, several large clinical studies have suggested that hormone replacement therapy (HRT) fails to prevent CHD in women. In recent years several studies have discovered that the risks of HRT may be associated with the age of a patient and inflammatory effect of sex hormone, but the ultimate conclusion have not obtained.Objective:To explore the relationship between sex hormone level and the severity of the coronary artery stenosis in postmenopausal women with CHD in order to provide the evidence of prevention of CHD and hormone replacement therapy. The thesis includes three parts:(1)To explore the association between sex hormone level and atherosclerotic severity in postmenopausal women with CHD.(2)To explore the sex hormone levels in different age groups.(3)To investigate the correlation between hs-CRP and sex hormone.Methods:A retrospective study was performed in 329 patients(menopause≥1 year) who had been treated in our Cardiovasology Department in 2008.12-2009.11. Sex hormone,lipids,hs-CRP were monitored, the BMI and blood pressure were also recorded.(1)The patients were divided into CHD and control groups according to the result of coronary angiography(CAG), then the relationship of sex hormone and risks of CHD were analysed.(2)The severity of the coronary artery stenosis was analyzed by means of coronary score system. The CHD group was divided through diagnosis and the extent of coronary lesions, then the correlation between severity artery lesions and sex hormone was analyzed. (3)A11 the cases were divided into three groups according to age:≤60 years old,61～70 years old and>70 years old, then the relationship of sex hormone and other factors among different groups were compared.Results:(1)Compared with the control group, E2 level was significant increased while T and hs-CRP levels were decreased in CHD group. Linear regression analysis showed that E2/T, E2 levels were negatively correlated with aging,lipid(a)and hs-CRP, T levels were positively correlated with BMI and hs-CRP (P<0.05, P<0.01).After adjusted by other factors, T and E2/T were correlated with hs-CRP (P<0.01).(2)E2/T in SAP group was significantly higher than those in UAP and AMI groups,E2/T in coronary score 0～5 group was significantly higher than those in>5 group.The score of coronary lesions were positively correlated with T,hs-CRP and LDL-C while negatively correlated with E2 level.(3)Compared with the normal cases of the same age group, significantly lower E2 level and higher T level were observed in CHD patients<60 years old, while the level of hs-CRP was significantly higher in CHD patients>60 years old (P<0.05,P<0.01)Conclusion:E2 level was decreased while T level were increased in postmenopausal women with CHD. E2/T was negatively correlated with hs-CRP and the severity of the coronary artery stenosis, it may be an important factor of prevention of CHD. The variation of sex hormone level had association with a patient's age, which suggested that the strategies of prevention and treatment in postmenopausal women of different age layers should be different.