폐경으로 인한 대사증후군
Metabolic Syndrome Emerging from Menopause
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초록
대사증후군이란 복부비만, 인슐린 저항성증가, 지질 대사이상으로 인한 고지혈증 등의 특징을 가지며 심혈관 질환 발생 및 당뇨 발생의 주요한 위험인자로 알려지고 있다. 폐경은 그 자체로 대사증후군 발생과 관련이 있고, 복부비만, 지방대사 변화, 응고인자증가 등과 연관되어 향후 심혈관 질환 발생을 증가시킨다고 한다. 그러나 이런 위험인자들의 발생이 폐경에 따른 직접적인 결과라는 견해도 있고, 다른 한편으로는 에스트로겐 분비 결핍에 따른 간접적인 영향이라는 견해도 있다. 더구나 여성들은 전 생애에 걸쳐 대사증후군 발생 위험에 노출되게 되는데, 임신성 체중 증가, 호르몬성 피임제 복용, 다낭성 난소 증후군 등이 그것이다. 따라서 폐경 자체가 대사증후군의 직접적인 원인으로 간주하기는 어려울 것으로 생각된다. 대사증후군에 대한 대표적인 관리법은 생활 습관 개선과 지질감소제 사용을 들 수 있다. 본 종설에서는 대사증후군 발생과 폐경의 관계에 관한 여러 문헌들을 고찰하여 폐경과 관련한 대사 변화에 대한 이해를 통해 향후 심혈관 질환 발생 위험군에 대한 적극적인 관리를 도모하고자 한다.
Abstract
Metabolic syndrome (MS) in women, which is characterized with central obesity, insulin resistance, and dyslipidemia, is associated with high risk of cardiovascular disease (CVD) and diabetes. Menopause may be related with the prevalence of MS and increased CVD risk through effects on central obesity, lipid metabolism, and prothrombotic state. The emergence of these risk factors may be a direct result from the failure of estrogen production. Alternatively, metabolic changes with estrogen deficiency may be the indirect cause of those risks. Additionally, most women may have a few chances of developing MS during their life, such as pregnancy-related weight gain, hormonal contraceptive use and polycystic ovary syndrome. Therefore, it is difficult to conclude that menopause itself can be the cause of MS. Representative managements of MS are life style modification and use of lipid lowering medication. This article will review the relationship between the development of MS and menopause. A better understanding on the metabolic changes with menopause will help identify women with risk factors of CVD and provide appropriate interventions (J Korean Soc Menopause 2011;17:127-135)
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