| Objective:To explore the relationship between estrogen level and hyperhomocysteinemia,hypertension,H-type hypertension and carotid intima-media thickening in different physiological periods,so as to provide theoretical basis for estrogen replacement therapy in postmenopausal women.Methods:Randomly selected 1636 female patients who visited the department of cardiology and geriatrics of hunan provincial people’s hospital between October 2017 and September 2019.Collect the general demographic,physical examination,blood pressure measurement and laboratory examination data of the research subjects.Three models,unadjusted,finely adjusted and fully adjusted,are presented to analyze the independent effects of estradiol on H-type hypertension and c IMT thickening.The generalized additional model(GAM)was used to analyze the nonlinear relationship between estradiol and H-type hypertension and c IMT thickening,and the piecewise linear model was used to analyze the saturation threshold effect to find the inflection point of the action,as the prevention and treatment of H-type hypertension provides a theoretical basis.Results:1.Description of general demographic characteristics:this study randomly selected 1636 subjects,aged 18-88 years,with an average age of 63.36±12.04 years,including 1,400 menopausal women and 236non-menopausal women.The proportion of H-type hypertension in menopausal women was 38.86%,and the proportion of H-type hypertension in non-menopausal women was 23.31%.The difference between the two groups was statistically significant(χ~2=21.05,P<0.001).2.The relationship between estradiol and hyperhomocysteinemia:logistic regression analysis showed that after adjusting for confounding factors such as age,ethnicity,living situation,marital status,education level,smoking,drinking,drinking tea,menopause,BMI,TG,TC,UA,ALT and AST,the risk of H-type hypertension increased by 2%for every additional unit of estradiol,but it was not statistically significant(OR=1.02,95%CI=0.98,1.07;P=0.227).3.The relationship between estradiol and hypertension:logistic regression analysis showed that after adjusting for age,ethnicity,living status,marital status,education level,smoking,drinking,drinking tea,menopause,BMI,TG,TC,UA,ALT and AST,the risk of developing hypertension for every additional unit of estradiol decreased by 1%,but the difference was not statistically significant(OR=0.99,95%CI=0.97,1.01,P=0.245).4.The relationship between estradiol and H-type hypertension:after adjusting for confounding factors such as age,ethnicity,living status,marital status,education level,smoking,drinking,drinking tea and menopause,BMI,TG,ALT and AST,the risk of developing H-type hypertension for every additional unit of estradiol decreased by 1%,but it was not statistically significant(OR=0.99,95%CI=0.97,1.01;P=0.314).Through smooth curve fitting,it was found that the relationship between estradiol and H-type hypertension showed a curvilinear relationship in menopausal and non-menopausal women,and the risk of H-type hypertension decreased with the increase of estradiol levels,and the other as estradiol levels rise,the risk of H-type hypertension rises in a piecewise linear relationship.To further analyze the non-linear relationship between estradiol and H-type hypertension,when the estradiol level in menopausal women is less than 21.3 pg/ml,the risk of H-type hypertension decreases by 4%for every additional unit of estradiol and statistically significant(OR=0.96,95%CI=0.93,0.98;P<0.001);when the level of estradiol is greater than 21.3 pg/ml,the risk of H-type hypertension increases for every additional unit of estradiol 2%,but not statistically significant(OR=1.02,95%CI=0.99,1.04;P=0.134),the Wald test of the difference between the two regression coefficients P=0.001<0.05,the log-likelihood ratio test of the two models P=0.001.Similarly,when the estradiol level in non-menopausal women is less than 42.2 pg/ml,the risk of developing H-type hypertension for every additional unit of estradiol decreases by 5%and is statistically significant(OR=0.95,95%CI=0.91,0.99;P=0.017);when the level of estradiol is greater than 42.2 pg/ml,the risk of developing H-type hypertension for each additional unit of estradiol increases by 11%and is statistically significant(OR=1.11,95%CI=1.01,1.22;P=0.028),Wald test P=0.012<0.05 for the difference between the two regression coefficients,P=0.011<0.05 for the log-likelihood ratio test of the two models.5.The relationship between estrogen and c IMT:In the model after adjusting for confounding factors such as age,ethnicity,living status,marital status,education level,smoking,drinking,drinking tea,menopause,BMI,TG,ALT and AST,estradiol The risk of c IMT thickening decreased by 1 unit,but it was not statistically significant(OR=0.98,95%CI=0.96,1.00;P=0.051).In menopausal women,there is an inverted U-shaped curve between estrogen levels and c IMT thickening risk;in non-menopausal women,there is a linear relationship between estrogen levels and c IMT thickening risk.Further analysis of the saturation threshold effect of the risk of estrogen and c IMT thickening found that when the estradiol level of menopausal women was less than29.6 pg/ml,the risk of c IMT thickening decreased by 6%for each unit of estrogen level increased,and it was statistical Significance(OR=0.94,95%CI=0.92,0.96;P<0.001);when the level of estradiol is greater than29.6 pg/ml,for every unit increase in estrogen level,the risk of c IMT thickening increases by 5%.Statistical significance(OR=1.05,95%CI=1.00,1.10;P=0.046).The Wald test for the difference between the two regression coefficients P=0.001<0.05,the log-likelihood ratio test of the two models P=0.001.In non-menopausal women,the risk of thickening c IMT per unit of estrogen did not change significantly and was not statistically significant(OR=1.00,95%CI=0.95,1.05,P=0.937),and the log-likelihood of the two models Ratio test P=0.216.Conclusions:1.In this study,it was found that the proportion of H-type hypertension in postmenopausal women is greater than that in non-menopausal women,suggesting that estrogen may be a protective factor for H-type hypertension;2.There is a non-linear relationship between estrogen and H-type hypertension,and there is an inflection point for the role of saturation threshold,but the inflection point of menopause and non-menopausal women is different;3.In menopausal women,there is a non-linear relationship between estrogen and c IMT thickening,and there is an inflection point for the role of saturation threshold. |
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