Der Klinikarzt 2006; 35(2): 57-61
DOI: 10.1055/s-2006-933683
In diesem Monat

© Georg Thieme Verlag Stuttgart · New York

Nicht rein hormonell bedingt - Prämature Atherosklerose bei Männern - Was ist die Ursache?

Not Alone on Basis of Hormonal Status - Premature Atherosclerosis in Men: What is the Cause?D. Strödter1
  • 1Innere Medizin/Kardiologie, Medizinische Klinik I, Universitätsklinik Gießen (Direktor: Prof. Dr. H. Tillmanns)
Further Information

Publication History

Publication Date:
23 February 2006 (online)

Zusammenfassung

Die koronare Herzerkrankung (KHK) ist die Haupttodesursache bei Männern wie bei Frauen. Männer entwickeln sie aufgrund einer prämaturen Atherosklerose jedoch zehn Jahre früher als Frauen. Dies verkürzt die Lebenserwartung des Mannes um rund sechs Jahre. Bei gleichem Blutdruckwert oder Cholesterinwert haben jüngere und mittelalte Männer ein doppelt so hohes kardiovaskuläres Risiko wie Frauen - oder das gleiche Risiko wie um zehn Jahre ältere Frauen. Demnach ist das männliche Geschlecht neben dem Alter ein eigenständiger wesentlicher Risikofaktor. Die geschlechtsspezifische Hormonsituation (Sexualhormone) kann jedoch die beschriebene Geschlechterdifferenz bei atherosklerotischen Folgeerkrankungen nicht erklären. Die bisherige Datenlage erlaubt zurzeit keine definitive Erklärung der prämaturen Atherosklerose beim Mann.

Summary

Coronary artery disease (CAD) is the leading cause of death in men and women. But, compared to women men develop heart disease about ten years earlier, leading to an average life expectancy six years less than in women. What is the cause? The cause is premature atherosclerosis in men. Compared to women the same value of blood pressure or cholesterol results in a doubling of cardiovascular risk in men - or in the same risk as ten year older women - having the same risk factor value. Thus, besides age the most important cardiovascular risk factor is male sex, an irreversible one. But, the gender difference in coronary artery disease cannot be explained on the basis of endogenous sex hormone exposure. Till today, current evidence does not allow any definitive explanation of the premature atherosclerosis in men.

Literatur

  • 1 1999 World Health Organization - International Society of Hypertension Guidelines for the management of hypertension. . Guidelines Subcommittee.  J Hypertens. 1999;  17 151-183
  • 2 Alexandersen P, Haarbo J, Christiansen C. The relationship of natural androgens to coronary heart disease in males: a review.  Atherosclerosis. 1996;  125 1-13
  • 3 Assmann G, Cullen P, Jossa F. et al. . Coronary heart disease: reducing the risk. The scientific background to primary and secondary prevention of coronary heart disease. A worldwide view. International Task Force for the Prevention of Coronary Heart Disease.  Arterioscler Thromb Vasc Biol. 1999;  19 1819-1824
  • 4 Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the Prospective Cardiovascular Münster (PROCAM) Study.  Circulation. 2002;  105 310-315
  • 5 Barrett-Connor E, Khaw KT. Endogenous sex hormones and cardiovascular disease in men. A prospective population based study.  Circulation. 1988;  78 539-545
  • 6 Barrett-Connor E. Sex differences in coronary heart disease. Why are women so superior? The 1995 Ancel Keys lecture.  Circulation. 1997;  95 252-264
  • 7 Burt VL, Whelton P, Rocella EJ. et al. . 1995 prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988-1991.  Hypertension. 1995;  25 305-313
  • 8 Collins P, Stevenson JC, Mosca L. Spotlight on gender.  Cardiovasc Res. 2002;  53 535-537
  • 9 Conroy RM, Pyörälä K, Fitzgerald AP. et al. . Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project.  Eur Heart J. 2003;  24 987-1003
  • 10 Coronary Drug Project Research Group . The Coronary Drug Project. Findings leading to discontinuation of the 2,5 mg day estrogen group.  JAMA. 1973;  226 652-657
  • 11 Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults . Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III).  JAMA. 2001;  285 2486-2497
  • 12 Feldman HA, Johannes CB, Araujo AB. et al. . Low dehydroepiandrosterone and ischemic heart disease in middle-aged men: prospective results from the Massachusetts Male Aging Study.  Am J Epidemiol. 2001;  153 79-89
  • 13 Freedman S, Srinivasan DS, Webber LS. Black-white differences in serum lipoproteins during sexual maturation: The Bogalusa Heart Study.  J Chron Dis. 1987;  40 309-318
  • 14 Gibbons RJ, Chatterjee K, Daley J. et al. . ACC/AHA/ACP-ASIM Guidelines for the management of patients with chronic stable angina.  J Am Coll Cardiol. 1999;  33 2092-2190
  • 15 Hak AE, Witteman JCM, de Jong FH. et al. . Low levels of endogenous androgens increase the risk of atherosclerosis in elderly men: The Rotterdam Study.  J Clin Endocrinol Metab. 2002;  87 3632-3639
  • 16 Hamilton JB, Mestler GE. Mortality and survival: comparison of eunuchs with intact men and women in a mentally retarded population.  J Gerontol. 1969;  24 395-411
  • 17 Harman SM, Metter EJ, Tobin JD. et al. . Longitudinal effects of aging on serum total and free testosterone levels in healthy men.  J Clin Endocrinol Metab. 2001;  86 724-731
  • 18 Hatakeyama N, Nishizawa M, Nakagawa A. et al. . Testosterone inhibits tumor necrosis factor-alpha-induced vascular cell adhesion molecule-1 expression in human aortic endothelial cells.  FEBS Lett. 2002;  530 129-132
  • 19 Herbst KL, Amory JK, Brunzell JD. et al. . Testosterone administration to men increases hepatic lipase activity and decreases HDL and LDL size in 3 wk.  Am J Physiol Endocrinol Metab. 2003;  284 E1112-E1118
  • 20 Jenkins JS. The voice of the castrato.  Lancet. 1998;  3521 1877-1880
  • 21 Kalin MF, Zumoff B. Sex hormones and coronary disease: a review of the clinical studies.  Steroids. 1990;  55 330-352
  • 22 Kanaya AM, Grady D, Barrett-Connor E. Explaining the sex difference in coronary heart disease mortality among patients with type 2 diabetes mellitus.  Arch Intern Med. 2002;  162 1737-1745
  • 23 Kaplan NM. Clinical hypertension (7th edition). Baltimore, Maryland: Williams & Wilkins 1998
  • 24 Keil U, Fitzgerald AP, Wellmann J, Hense HW. Risikoabschätzung tödlicher Herz-Kreislauf-Erkrankungen.  Dtsch Ärzteblatt. 2005;  102 A1808-A1812
  • 25 Lerner DJ, Kannel WB. Patterns of coronary heart disease morbidity and mortality in the sexes: a 26-year follow-up of the Framingham Population.  Am J Cardiol. 1986;  111 383-390
  • 26 Levy D, Kannel WB. Cardiovascular risks: new insights from Framingham.  Am Heart J. 1988;  116 266-272
  • 27 Levy D, Kannel WB. Searching for answers to ethnic disparities in cardiovascular risk.  Lancet. 2000;  356 266-267
  • 28 Liu PY, Death AK, Handelsman DJ. Androgens and cardiovascular death.  Endocrin Rev. 2003;  24 313-340
  • 29 Lloyd-Jones DM, Larson MG, Beiser A, Levy D. Lifetime risk of developing coronary heart disease.  Lancet. 1999;  353 89-92
  • 30 Mäkinen J, Järvisalo MJ, Pöllänen P. et al. . Increased carotid atherosclerosis in andropausal middle-aged men.  J Am Coll Cardiol. 2005;  45 1603-1608
  • 31 Morrison JA, Laskarzewski PM, Rauh JL. Lipids, lipoproteins, and sexual maturation during adolescence: The Princeton Maturation Study.  Metabolism. 1979;  28 641-649
  • 32 Morrison JA, Sprecher DL, Biro FM. et al. . Serum testosterone associates with lower high density lipoprotein cholesterol in black and white males, 10-15 years of age, through lowered apolipoproten AI and AII concentrations.  Metabolism. 2002;  51 432-437
  • 33 Mosca L, Manson JE, Sutherland SE. et al. . Cardiovascular disease in women. A statement for healthcare professionals from the American Heart Association.  Circulation. 1997;  96 2468-2482
  • 34 Muller M, van den Beld AW, Bots ML. et al. . Endogenous sex hormones and progression of carotid atherosclerosis in elderly men.  Circulation. 2004;  109 2074-2079
  • 35 Natarajan S, Liao Y, Cao G. et al. . Sex differences in risk for coronary heart disease mortality associated with diabetes and established coronary heart disease.  Arch Intern Med. 2003;  163 1735-1740
  • 36 Nieschlag E, Nieschlag S, Behre HM. Lifespan and testosterone.  Nature. 1993;  366 1011-1017
  • 37 Reinecke H, Bogdanski J, Woltering A. et al. . Relation of serum levels of sex hormone binding globulin to coronary heart disease in postmenopausal women.  Am J Cardiol. 2002;  90 364-368
  • 38 Rich-Edwards JW, Manson JA, Hennekens CH, Buring JE. The primary prevention of coronary heart disease in women.  N Engl J Med. 1995;  332 1758-1766
  • 39 Rossouw JE. Women and coronary heart disease. In: DJ Betteridge (ed). Lipids and vascular disease - current issues. London: Martin Dunitz Ltd, UK 2000
  • 40 The Veterans Administration Co-operative Urological Research Group. . Treatment and survival of patients with cancer of the prostate.  Surg Gynecol Obstet. 1967;  124 1011-1017
  • 41 The World Health Report. Geneva: World Health Organization 2002
  • 42 Van Kesteren PJ, Ascheman H, Megens JA. et al. . Mortality and Morbidity in transsexual subjects treated with cross-sex hormones.  Clin Endocrinol (Oxf). 1997;  47 337-342
  • 43 Vasan RS, Larson MG, Leip EP. et al. . Impact of high-normal blood pressure on the risk of cardiovascular disease.  N Engl J Med. 2002;  345 1291-1297
  • 44 Weidemann W, Hanke H. Cardiovascular effects of androgens.  Cardiovasc Drug Rev. 2002;  20 175-198
  • 45 Wilson JD, Roehrborn C. Long-term consequence of castration in men: lessons from the Skoptzy and the eunuchs of the Chinese and Ottoman courts.  J Clin Endocrinol Metab. 1999;  84 4324-4331
  • 46 Wu FCW, von Eckardstein A. Androgens and coronary artery disease.  Endocr Rev. 2003;  24 183-187
  • 47 Yarnell JWG, Beswick AD, Sweetnam PM, Riad-Fahmy D. Endogenous sex hormones and ischemic heart disease in men. The Caerphilly prospective study.  Arterioscler Thromb. 1993;  13 517-520
  • 48 Zitzman M, Nieschlag E. Testosterone levels in healthy men and their relation to behavioural and physical characteristics: facts and constructs.  Eur J Endocrinol. 2001;  144 183-187

1 National Cholesterol Education Program

2 PROspective CArdiovascular Münster Studie

3 Lipid Research Clinics Coronary Primary Prevention Trial

Anschrift des Verfassers

Prof. Dr. Dietrich Strödter

Innere Medizin/Kardiologie

Medizinische Klinik I, Universität Gießen

Klinikstr. 36, 35385 Gießen