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Perimenopause vasomotor symptoms coronary atherosclerosis and risk of myocardial infarction during menopause: the cardiologist’s perspective

机译:围绝经期血管舒缩症状冠状动脉粥样硬化和绝经期间发生心肌梗塞的风险:心脏病专家的观点

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摘要

Myocardial infarction (MI) is rare in pre-menopausal women, and in most cases has a gender-specific pathogenesis. After menopause, MI incidence increases gradually to equalize men’s rate in the eighth decade of age, with similar pathogenesis. This epidemiological observation has raised a number of hypotheses on the protective effect of estrogen against atherosclerosis and its related diseases. However, MI has a multifactorial pathogenesis with variable contributions of inflammation, eroded or ruptured atherosclerotic plaques, vasoconstriction and thrombosis. Whether perimenopausal vasomotor symptoms are associated with a better, worse or neutral effect on the risk of myocardial infarction has long been disputed. The recent finding of the LADIES ACS study that women reporting transitional vasomotor symptoms have earlier onset myocardial infarction, as compared to women without symptoms, despite similar risk factors and extent of coronary angiographic disease, supports the hypothesis that endothelial dysfunction, or other vasoconstrictive mechanisms, may play a key role in precipitating an acute coronary syndrome at an earlier age. These factors, rather than other atherosclerotic markers, should be specifically investigated in order to elucidate the so far elusive link between vasomotor symptoms and risk of MI.
机译:绝经前女性很少发生心肌梗塞(MI),多数情况下具有特定于性别的发病机制。绝经后,MI发病率逐渐增加,以达到与男性发病率相同的第八个十年的发病率。这种流行病学观察结果提出了许多关于雌激素对动脉粥样硬化及其相关疾病的保护作用的假设。但是,MI具有多种因素的发病机制,其炎症反应,动脉粥样硬化斑块侵蚀或破裂,血管收缩和血栓形成的影响多种多样。长期以来,围绝经期血管舒缩症状是否与对心肌梗塞风险的更好,更差或中性作用有关。 LADIES ACS研究的最新发现是,尽管没有类似症状的女性,尽管有类似的危险因素和冠状动脉造影疾病,但报告有过渡性血管舒缩症状的女性与没有症状的女性相比,更早发作心肌梗死,支持以下假设:内皮功能障碍或其他血管收缩机制,可能在早期引发急性冠状动脉综合征中起关键作用。这些因素,而不是其他动脉粥样硬化标志物,应予以专门研究,以阐明到目前为止,血管舒缩症状与MI风险之间难以捉摸的联系。

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