摘要
背景:代谢综合征(MetS)是发展心血管疾病(CVD)和2型糖尿病(T2DM)的一系列危险因素。 根据几项细致分析,已经表明,与男性相比,MetS赋予的心血管(CV)风险高于女性。 有许多可能的原因可以解释MetS患者的CV风险更高:最重要的差异可归因于中枢性肥胖,脂质分布和激素的分布,但血小板生物学和生物化学的差异也起着重要的作用。方法:在本文中,我们使用PubMed数据库进行了一项研究,该数据库检查文献中的证据(特别是临床试验和荟萃分析),或缺乏关于MetS成分性别分布和相关CV风险的证据/偏见信息,我们打算 为治疗MetS和CV风险提供相应的性别观点。 结果:评估了二十三篇论文,寻找MetS和CV风险患病率中的性别差异。 我们还确定了五十六篇关于肥胖,胰岛素抵抗和激素调节性别差异的论文。 关于慢性疾病中MetS的性别特异性表达,我们分析了重点关注非酒精性脂肪性肝病,多囊卵巢综合征,妊娠糖尿病,类风湿性关节炎和艾滋病毒感染的三十一篇论文。我们还评估了二十篇关于血小板生物学/反应性性别差异的论文,以及三十三篇关于MetS治疗性别方法的论文。 MetS授予的CV风险根据性别而不同;性别之间的差异可能取决于MetS组分的不同表现,性别特异性遗传,获得性代谢和激素环境,最后是已知危险因素与性别特异性之间的差异相互作用,导致不同程度的病理生理事件最终导致动脉粥样硬化血栓形成。关于潜在的性别相关治疗方法,即使药物药物动力学中的性别相关差异存在于身体组成,血浆蛋白结合,代谢酶和排泄特征差异中,我们也必须承认,妇女的代谢不足临床试验,从而防止在这种性别中充分挑战药物的功效和安全性。结论:虽然对于MetS组分患病率以及相关的心脏代谢风险,临床试验中的妇女人数不足,指导治疗未充分利用,例如缺血性心脏病的妇女,存在着关于性别差异的知识存在,但主要缺陷 解释流行病学和临床证据。 应该努力打击所谓的“Yentl综合症”,并促进针对性别的药物试验,或者至少在预先规定了按性别分组分析的研究。
关键词: 代谢综合征,性别,心血管风险,肥胖,糖尿病,动脉粥样硬化血栓形成,血小板。
Current Medicinal Chemistry
Title:Metabolic Syndrome: Sex-Related Cardiovascular Risk and Therapeutic Approach
Volume: 24 Issue: 24
关键词: 代谢综合征,性别,心血管风险,肥胖,糖尿病,动脉粥样硬化血栓形成,血小板。
摘要: Background: The metabolic syndrome (MetS) is a cluster of risk factors for the development of cardiovascular diseases (CVD) and type 2 diabetes (T2DM). According to several meta-analyses, it has been shown that the cardiovascular (CV) risk conferred by the MetS is higher in women in comparison with men. There are many possible reasons to explain a higher CV risk in women with MetS: the most important differences can be attributed to distribution of central adiposity, lipid profile and hormones, but also differences in platelet biology and biochemistry play an important role.
Methods: In this article we performed a research using PubMed database reviewing the evidence in literature (in particular clinical trials and meta-analyses) or lack of evidence/ biased information regarding the distribution by gender of MetS components and associated CV risk and we intended to provide a consequent gender perspective to the treatment of MetS and CV risk. Results: Twenty-three papers were evaluated searching for sex differences in the prevalence of MetS and CV risk. We also identified fifty-six papers dealing with sex differences in adiposity, insulin resistance and hormonal regulation. In terms of gender-specific expression of MetS in chronic disease we analyzed thirty-one papers focusing the attention on non-alcoholic fatty liver disease, polycystic ovarian syndrome, gestational diabetes mellitus, rheumatoid arthritis and HIV infection. We also evaluated twenty papers focusing on gender differences in platelet biology/reactivity and thirty-three papers on the gender approach in the treatment of MetS. The CV risk conferred by MetS segregates differently according to gender; differences between sexes may depend on the different representation of MetS components, gender-specific genetic, acquired metabolic and hormonal milieu and finally on a differential interaction between known risk factors and genderspecific properties, resulting in different degrees of pathophysiological events eventually leading to atherothrombosis. Regarding a potential sex-related therapeutic approach, even if gender-related differences exist in the pharmacokinetics of drugs for differences in body composition, plasma protein binding, metabolizing enzymes and difference in excretion characteristics, we have to acknowledge that women are under-represented in clinical trials, thus preventing from adequately challenging the efficacy and safety of drugs in this gender. Conclusion: While ncreasing knowledge exists regarding pathophysiological differences between genders in the prevalence of MetS components as well as in the associated cardiometabolic risk, underrepresentation of women in clinical trials and underutilization of guideline therapy, for instance in women with ischemic heart disease, largely flaw the interpretation of epidemiological and clinical evidence. Efforts should be undertaken to fight the so-called “Yentl syndrome” and to promote gender-specific drug trials, or at least studies where subgroup analyses by gender are pre-specified.Export Options
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Cite this article as:
Metabolic Syndrome: Sex-Related Cardiovascular Risk and Therapeutic Approach, Current Medicinal Chemistry 2017; 24 (24) . https://dx.doi.org/10.2174/0929867324666170710121145
DOI https://dx.doi.org/10.2174/0929867324666170710121145 |
Print ISSN 0929-8673 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-533X |
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