Endogenous Sex Hormones and Incident Cardiovascular Disease in Post-Menopausal Women (original) (raw)
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Sex Hormone Levels and Risk of Cardiovascular Events in Postmenopausal Women
Circulation, 2003
Background-Despite diffuse effects of sex hormones on the cardiovascular system, few prospective studies have examined the relationship of plasma androgens and estrogens with risk of cardiovascular disease (CVD) in postmenopausal women. Methods and Results-A nested case-control study was performed among women in the Women's Health Study. Two hundred women who developed CVD were matched 1:1 by age, smoking, and postmenopausal hormone therapy (HT) to controls who remained free of CVD. We measured testosterone, estradiol, and sex hormone binding globulin (SHBG) levels and calculated free androgen index (FAI), free estradiol index, and the FAI/free estradiol index ratio. Results were stratified by HT use. Among HT nonusers, cases had significantly higher androgen profiles (higher median FAI and lower SHBG levels) than controls. After adjustment for age, smoking, use of aspirin, vitamin E, and alcohol, family history of myocardial infarction, and physical activity, nonusers in the lowest SHBG quartile had an OR of 2.25 (95% CI, 1.03 to 4.91) for CVD, and there were significant trends across FAI quartiles (P for trendϭ0.03). Additional adjustment for body mass index, hypertension, diabetes, and elevated cholesterol eliminated associations with SHBG and FAI. Among women using HT, no significant differences in hormones or SHBG were observed among women who developed CVD and controls. Conclusions-Among HT nonusers, lower SHBG and higher FAI levels were noted among postmenopausal women who developed CVD events, but this was not independent of body mass index and other cardiovascular risk factors. Estradiol levels were not associated with risk of CVD in HT users or nonusers.
Journal of endocrinological investigation, 2013
Our aim was to understand the relationship between endogenous sex hormones and cardiovascular disease (CVD) risk factors in post-menopausal women. Eighty-three post-menopausal women from a previous prospectively designed study were included. We analyzed endogenous sex hormones and biochemical parameters. Levels of estradiol and free testosterone were higher in patients with metabolic syndrome. Estradiol correlated positively with interleukin-6 (IL-6), weight, body mass index (BMI), insulin, homocysteine, and homeostasis model assessment of insulin resistance (HOMA-IR). Free testosterone correlated positively with weight, waist circumference (WC), BMI, insulin, HOMA-IR and negatively with HDL and SHBG. DHEAS correlated only with HDL. FSH correlated negatively with age, weight, WC, hip circumference, BMI, systolic blood pressure, diastolic blood pressure, duration of menopause, fasting glucose, HDL, C-reactive protein, and insulin. LH correlated negatively with IL-6, age, WC, duration...
Extreme concentrations of endogenous sex hormones, ischemic heart disease, and death in women
Arteriosclerosis, thrombosis, and vascular biology, 2015
Sex hormones may be critical determinants of ischemic heart disease and death in women, but results from previous studies are conflicting. To clarify this, we tested the hypothesis that extreme plasma concentrations of endogenous estradiol and testosterone are associated with risk of ischemic heart disease and death in women. In a nested prospective cohort study, we measured plasma estradiol in 4600 and total testosterone in 4716 women not receiving oral contraceptives or hormonal replacement therapy from the 1981 to 1983 examination of the Copenhagen City Heart Study. During ≤30 years of follow-up, 1013 women developed ischemic heart disease and 2716 died. In women with a plasma estradiol below the fifth percentile compared with between the 10th and 89th percentiles, multifactorially adjusted risk of ischemic heart disease was 44% (95% confidence interval, 14%-81%) higher; however, plasma estradiol concentrations did not associate with death. Also, in women with a plasma testostero...
Severity of cardiovascular disease in women: Relation with exposure to endogenous estrogen
Maturitas, 2006
Objectives: Coronary artery disease (CAD) is more common in men than in women. Endogenous sex steroids may be the main factor responsible, as long-term estrogen action appears to be protective. The aim of the study was to investigate the predisposing factors responsible for the severity of CAD in women. Methods: One hundred and eight women (100 menopausal) undergoing coronary angiography were studied. Reproductive function was recorded. The severity of CAD was assessed by the number of arteries with severe stenosis, the presence of angina and myocardial infarctions (MI). Results: The time since menopause (TSM) was significantly longer in women with angina and with MIs compared to those without (20.3 ± 8.7 years versus 15.8 ± 8.7 years and 22.6 ± 8.6 years versus 18.1 ± 8.9 years, p < 0.05), independently of chronological age. The age at menopause was significantly younger in women who had 2 MIs compared to those with 1 or 0 MI (41.5 ± 3.5, 47.5 ± 5.3 and 48.4 ± 5.4 years, respectively; p = 0.04); the total duration of menstrual cyclicity was inversely related to the number of MIs (35.6 ± 5.8, 34.2 ± 5.3 and 28.3 ± 3.3 years, 0, 1 and 2 MIs, respectively; p = 0.03). Conclusions: The severity of CAD in women referred for coronary angiography is correlated with measures of exposure to endogenous estrogen. Both the TSM and the age at menopause are aggravating factors for MI, independently of age. There is an independent protective effect of the duration of estrogen exposure on the number of MIs; this has not been reported before and supports the protective role of the length of exposure to endogenous estrogen, especially for the occurrence of MI in this selected group of women.
Circulation, 2005
Background-Recent clinical trials have shifted attention away from estrogens and toward androgens and sex hormone-binding globulin (SHBG) as potential mediators of increasing cardiovascular (CV) risk in women at midlife. Methods and Results-The correlation between reproductive hormones and CV risk factors was evaluated in a multiethnic (white, black, Hispanic, Chinese, and Japanese) sample of 3297 premenopausal and perimenopausal women. Testosterone and estradiol (E 2 ) were evaluated along with SHBG and the free androgen index (FAI), the amount of testosterone not bound by SHBG. Low SHBG and high FAI were strongly and consistently related to elevated CV risk factors (higher insulin, glucose, and hemostatic and inflammatory markers and adverse lipids) even after controlling for body mass index (PϽ0.001 for all). Low levels of E 2 were associated with elevated CV risk factors to a lesser degree.
IP Innovative Publication Pvt. Ltd., 2017
Introduction: Women continue to have a high cardiovascular mortality than men in the past 20 years which is underestimated. Cardiovascular disease is clearly polyfactorial, and data on endogenous hormones may improve our prediction of risk. The endocrine environment in women is complex and changes with chronology. So this study becomes a need in women of middle age with objectives-1. To analyse the level and association of serum Estradiol, Testosterone, SHBG, DHEA with lipid profile. 2. To assess the cardiovascular risk in adult women with respect to their androgenic status. Materials and Method: A cross-sectional study from 120 volunteered adult women of age between 20-40years selected and blood collected for biochemical assay of serum Estradiol, Testosterone, Steroid Hormone Binding Globulin, Dehydroepiandrosterone and lipid profile by standard methods. All quantitative data obtained were analysed with a set statistical significance at p<0.05. Results: In our study mean age of adult women was 29.05 ± 5.8 years. The mean of sex hormone profile were in normal range. Testosterone levels even in normal range showed a positive association with LDL-C (r=0.392, p<0.05), Atherogenic Index of Plasma (r=452, p<0.05) and negative association with HDL-C(r=-0.114, p=0.21). Conclusion: The study shows in adult women as the age advances the androgen levels influences dyslipidemia and cardiovascular risk.
Endogenous estrogen exposure and cardiovascular mortality risk in postmenopausal women
American journal of …, 2002
In this study, the authors investigated whether combined information on reproductive factors has additive value to the single reproductive factor age at menopause for assessing endogenous estrogen exposure and cardiovascular mortality risk in postmenopausal women. They conducted a population-based cohort study that included 9,450 postmenopausal women from Nijmegen, the Netherlands, who were aged 35-65 years at enrollment in 1975, with a median follow-up of 20.5 years. A Cox proportional hazards model and Receiver Operating Curves were used to analyze the data. Women aged 52 years or more at menopause had an 18% reduction in cardiovascular mortality (hazard ratio = 0.82, 95% confidence interval (CI): 0.69, 0.98) compared with those aged 44 years or less. Women with more than 18 years of exposure to endogenous estrogen had a statistically significant 20% reduction in cardiovascular mortality (hazard ratio = 0.80, 95 percent CI: 0.67, 0.96) compared with those who had 13 years of exposure or less. The area under the curve of the Receiver Operating Curves for the two models was identical (area under the curve = 0.67, 95 percent CI: 0.66, 0.68). This study shows that age at menopause is related to cardiovascular disease mortality and that a newly developed composite measure of endogenous estrogen exposure does not add to the predictive value of age at menopause for cardiovascular mortality. Am J Epidemiol 2002;155:339-45.
Clinical Chemistry, 2013
BACKGROUNDMenopausal hormone therapy (HT) continues to have a clinical role in symptom management, but identifying women for whom benefits will outweigh the risks remains a challenge. Although hormone therapy (HT) is the most effective strategy for ameliorating vasomotor and other symptoms, randomized clinical trials show an unfavorable balance of benefits and risks for many women. However, closer examination of data from these trials suggests that it may be possible to classify women as better or worse candidates for HT by using individual risk stratification.CONTENTData from 2 landmark trials—the Women's Health Initiative (WHI) and the Heart and Estrogen/progestin Replacement Study (HERS)—suggest an important role for clinical characteristics, serum biomarkers, genomic markers, and gene–environment interactions in developing a personalized approach to the prediction of risk for cardiovascular disease (CVD) events for women while on HT. The available data suggest several charac...