Relationship Between Sex Hormones And Acute Coronary Syndrome,Morphology Of Coronary Lesion In Postmenopausal Women

Background Acute coronary syndrome (ACS) includes ST elevation and non-ST elevation acute myocardial infarction, unstable angina and cardiac sudden death. Acute coronary syndrome often shares a common pathogenesis based on plaque rupture, fissuring, or erosion and consequent thrombosis, which leads to total or untotal occlusion in coronary.Comparing with men in the same age group,the disease and death incidences of coronary heart disease in premenopausal women are low. The epidemiology indicated that the disease and death incidences of coronary heart disease in postmenopausal women increased by fourfold in comparision with premenopausal women. This phenomenon can not be elucidated by the increase of age completely. It possibly correlates that the changes of sex hormones in postmenopausal women resulted in dyslipidemia and so on. Some studies on the relationship between sex hormones and coronary artery disease have been done, but the relationship between sex hormones and acute coronary syndrome has been poorly studied.Objective To study the relationship between sex hormones and their ratios and acute coronary Syndrome,morphology of coronary lesion in postmenopausal women. Methods Ninety three postmenopausal women were included in this study. We studied 66 patients diagnosed coronary artery disease documented by coronary angiography, including 50 patients with acute coronery syndrome(ACS) and 16 patients with stable angina(SA). 27 control subjects were excluded coronary artery disease by coronary angiography. According to the results of coronary angiographies, Coronary lesion score and diseased vessel numbers were calculated. ischemic-related coronary lesions were classified as "simple lesion" and "complex lesion" according to the criteria proposed by Ambrose et al. Serum estrdiol(E2),testoserone(T) and prolaction(P) were measured, and blood sugar,lipid, apolipoprotein and so on were collected in the morning of procedure. Result (1) There were no significant difference in E2,T,P,T/ E2,P/E2,total cholesterol (TC) ,triglycerides (TG) ,high density lipoprotein cholesterol (HDL-C) ,apolipoproteinA (ApoA) and AapolipoproteinB (ApoB) between SA group and the control group (P >0.05). low density lipoprotein cholesterol (LDL-C)levels were higher (P <0.05). (2) There were no significant difference in P,P/E2,TC ,HDL-C and ApoB between SA group and the control group (P >0.05).LDL-C,T and T/ E2 were significantly higher (P <0.05). E2,TG,ApoA reduced apparently, and they were significantly different (P <0.05). (3) There were no significant difference between sex hormones and their ratios and coronary lesion score(P <0.05). (4) Sex hormones and their ratios showed little difference among different diseased vessel numbers. (5) Between simple lesion and complex lesion, E2 was lower; T,P,T/E2 and P/E2 were higher, though There were no significant difference (P >0.05). (6) Logistic regression analysis indicated a significant relationship between ACS in postmenopausal women and ApoA , LDL-C, and T/E2,LDL-C and DM were significantly independent risk factors of complex lesion ;correlation analysis showed there was a significant positive correlation between T/ E2 and TC,LDL-C,ApoB, while a negative correlation existed between T/ E2 and HDL-C,ApoA .Conclusion (1) sex hormones and their ratios in postmenopausal women were not independent risk factor of ACS. (2)The ratios of sex hormones correlated with the classification of coronary lesion in postmenopausal women,and did not correlate with diseased vessel numbers or severity of coronary artety lesions. (3) T/E2 was one of independent risk factors of complex lesion. (4) There was a close correlation between ratio imbalance of sex hormones in postmenopausal women and dyslipidemia, which resulted in the onset of atherosclerosis of coronary artery and unstable plaque and pathophisiological changes of ACS.