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Baber RJ, Panay N, Fenton A. 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric 2016; 19:109-50. [DOI: 10.3109/13697137.2015.1129166] [Citation(s) in RCA: 520] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Värri M, Niskanen L, Tuomainen T, Honkanen R, Kröger H, Tuppurainen MT. Association of adipokines and estradiol with bone and carotid calcifications in postmenopausal women. Climacteric 2016; 19:204-11. [PMID: 26849745 DOI: 10.3109/13697137.2016.1139563] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Carotid artery calcifications (CAC) and high carotid artery intima-media thickness (cIMT) are associated with low bone mineral density (BMD) by unknown mechanisms in postmenopausal women. Leptin, adiponectin and estradiol may mediate these associations. Our aim was to study the relationships of the aforementioned factors to bone health (BMD) and carotid atherosclerosis (CAC and cIMT). METHOD Participants (n = 290, mean age 73.6 years) for this cross-sectional OSTPRE-BBA study (Kuopio Osteoporosis Risk Factor and Prevention - Bone, Brain and Atherosclerosis) were randomly selected from the OSTPRE cohort in 2009. Femoral neck and total body BMDs, trunk and total body fat mass were measured with dual-energy X-ray absorptiometry, and cIMT (mm) and CAC (no/yes) were measured with B-type ultrasound. Free estradiol, adiponectin and leptin were measured from serum samples. RESULTS Circulating estradiol levels were associated with leptin (β = 0.131, p < 0.001), but not with adiponectin (p > 0.05), when adjusted for total body fat mass. There were no associations between estradiol tertiles and BMDs, or with cIMT or CAC. Adiponectin levels were inversely associated with femoral neck BMD (p = 0.019, β = -0.138) and total body BMD (p = 0.009, β = -0.142), adjusted for total body fat mass, age, current smoking and estradiol, but showed no relationship with CAC or cIMT. Leptin levels were not associated with BMDs or cIMT; but the odds ratio was 1.5 between the CAC and leptin quartiles (p = 0.014), adjusted for total body fat mass, age, statin use and calcium intake. CONCLUSION The adipokines are associated with vascular calcification and low BMD. Moreover, estradiol was not independently associated with BMD or CAC.
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Affiliation(s)
- M Värri
- a Kuopio Musculoskeletal Research Unit, Surgery , Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland
| | - L Niskanen
- b Endocrinology , Helsinki University Hospital and University of Helsinki , Finland
| | - Tp Tuomainen
- c Institute of Public Health and Clinical Nutrition, University of Eastern Finland , Kuopio , Finland
| | - R Honkanen
- a Kuopio Musculoskeletal Research Unit, Surgery , Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland ;,d Lapland Hospital District , Rovaniemi , Finland
| | - H Kröger
- a Kuopio Musculoskeletal Research Unit, Surgery , Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland ;,e Department of Orthopaedics, Traumatology and Hand Surgery , Kuopio University Hospital , Kuopio , Finland
| | - M T Tuppurainen
- a Kuopio Musculoskeletal Research Unit, Surgery , Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland ;,f Department of Obstetrics and Gynaecology , Kuopio University Hospital , Kuopio , Finland
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Williams MS, Cushman M, Ouyang P, Heckbert SR, Kalyani RR, Vaidya D. Association of Serum Sex Hormones with Hemostatic Factors in Women On and Off Hormone Therapy: The Multiethnic Study of Atherosclerosis. J Womens Health (Larchmt) 2015; 25:166-72. [PMID: 26700933 DOI: 10.1089/jwh.2015.5465] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hormone therapy (HT) is associated with increased risk of both venous and arterial thrombosis, which are multifactorial in origin. OBJECTIVES Our objectives were twofold: first, we sought to examine associations between endogenous serum sex hormone levels and biomarkers of thrombosis and/or coagulation in postmenopausal hormone nonusers. Second, we separately studied the associations between serum sex hormone levels and biomarkers of thrombosis and/or coagulation in postmenopausal hormone users considering the fact that pattern of circulating hormones is different in women taking exogenous hormones. PATIENTS/METHODS We performed a cross-sectional analysis of postmenopausal women enrolled in a large multiethnic community-based cohort study, The Multiethnic Study of Atherosclerosis. We hypothesized that higher levels of estrogen-related sex hormones would be associated with biomarkers of thrombosis, suggesting mechanisms for differences in thrombotic risk from HT. Women (n = 2878) were included if they were postmenopausal and had thrombotic biomarkers (homocysteine, fibrinogen, C-reactive protein [CRP], factor VIII, and d-dimer) and sex hormone levels (total testosterone [T], bioavailable testosterone, sex hormone binding globulin [SHBG], estradiol [E2], and dehydroepiandrosterone [DHEA]) measured. A smaller random sample of 491 women also had von Willebrand factor (vWF), plasminogen activator inhibitor (PAI-1), and tissue factor pathway inhibitor (TFPI) levels measured. RESULTS AND CONCLUSIONS We found that elevated levels of estradiol and SHBG in HT users were associated with elevated levels of CRP and lower levels of TFPI, both of which may be related to a prothrombotic milieu in HT users. HT nonusers had far more prothrombotic associations between elevated serum sex hormone levels and thrombotic biomarkers when compared with HT users.
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Affiliation(s)
- Marlene S Williams
- 1 Department of Medicine, Johns Hopkins University , Baltimore, Maryland
| | - Mary Cushman
- 2 Department of Medicine, The University of Vermont , Colchester, Vermont
| | - Pamela Ouyang
- 1 Department of Medicine, Johns Hopkins University , Baltimore, Maryland
| | - Susan R Heckbert
- 3 Department of Epidemiology, University of Washington , Seattle, Washington
| | | | - Dhanajay Vaidya
- 1 Department of Medicine, Johns Hopkins University , Baltimore, Maryland
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Ventetuolo CE, Mitra N, Wan F, Manichaikul A, Barr RG, Johnson C, Bluemke DA, Lima JAC, Tandri H, Ouyang P, Kawut SM. Oestradiol metabolism and androgen receptor genotypes are associated with right ventricular function. Eur Respir J 2015; 47:553-63. [PMID: 26647441 DOI: 10.1183/13993003.01083-2015] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/09/2015] [Indexed: 11/05/2022]
Abstract
Sex hormones are linked to right ventricular (RV) function, but the relationship between genetic variation in these pathways and RV function is unknown.We performed a cross-sectional study of 2761 genotyped adults without cardiovascular disease. The relationships between RV measures and single nucleotide polymorphisms (SNPs) in 10 candidate genes were assessed. Urinary oestradiol (E2) metabolites produced by cytochrome P4501B1 (CYP1B1) and serum testosterone were measured in women and men respectively.In African-American (AA) women, the CYP1B1 SNP rs162561 was associated with RV ejection fraction (RVEF), such that each copy of the A allele was associated with a 2.0% increase in RVEF. Haplotype analysis revealed associations with RVEF in AA (global p<7.2×10(-6)) and white (global p=0.05) women. In white subjects, higher E2 metabolite levels were associated with significantly higher RVEF. In men, androgen receptors SNPs (rs1337080; rs5918764) were significantly associated with all RV measures and modified the relationship between testosterone and RVEF.Genetic variation in E2 metabolism and androgen signalling was associated with RV morphology in a sex-specific manner. The CYP1B1 SNP identified is in tight linkage disequilibrium with SNPs associated with pulmonary hypertension and oncogenesis, suggesting these pathways may underpin sexual dimorphism in RV failure.
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Affiliation(s)
- Corey E Ventetuolo
- Depts of Medicine and Health Services, Policy and Practice, Alpert Medical School of Brown University, Providence, RI, USA
| | - Nandita Mitra
- Dept of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Fei Wan
- Dept of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ani Manichaikul
- Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - R Graham Barr
- Dept of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Craig Johnson
- Dept of Biostatistics, University of Washington, Seattle, WA, USA
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health/Clinical Center, National Institute for Biomedical Imaging and Bioengineering, Bethesda, MD, USA
| | - Joao A C Lima
- Dept of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Hari Tandri
- Dept of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Pamela Ouyang
- Dept of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Steven M Kawut
- Dept of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA Dept of Medicine, University of Pennsylvania, Philadelphia, PA, USA Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Davis SR, Wahlin-Jacobsen S. Testosterone in women--the clinical significance. Lancet Diabetes Endocrinol 2015; 3:980-92. [PMID: 26358173 DOI: 10.1016/s2213-8587(15)00284-3] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 07/14/2015] [Accepted: 07/21/2015] [Indexed: 12/21/2022]
Abstract
Testosterone is an essential hormone for women, with physiological actions mediated directly or via aromatisation to oestradiol throughout the body. Despite the crucial role of testosterone and the high circulating concentrations of this hormone relative to oestradiol in women, studies of its action and the effects of testosterone deficiency and replacement in women are scarce. The primary indication for the prescription of testosterone for women is loss of sexual desire, which causes affected women substantial concern. That no formulation has been approved for this purpose has not impeded the widespread use of testosterone by women--either off-label or as compounded therapy. Observational studies indicate that testosterone has favourable cardiovascular effects measured by surrogate outcomes; however, associations between endogenous testosterone and the risk of cardiovascular disease and total mortality, particularly in older women, are yet to be established. Adverse cardiovascular effects have not been seen in studies of transdermal testosterone therapy in women. Clinical trials suggest that exogenous testosterone enhances cognitive performance and improves musculoskeletal health in postmenopausal women. Unmet needs include the availability of approved testosterone formulations for women and studies to elucidate the contribution of testosterone to cardiovascular, cognitive, and musculoskeletal health and the risk of cancer.
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Affiliation(s)
- Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Sarah Wahlin-Jacobsen
- Department of Sexological Research, Sexological Clinic, Psychiatric Center Copenhagen, Copenhagen, Denmark
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Milman LW, Sammel MD, Barnhart KT, Freeman EW, Dokras A. Higher serum total testosterone levels correlate with increased risk of depressive symptoms in Caucasian women through the entire menopausal transition. Psychoneuroendocrinology 2015; 62:107-13. [PMID: 26280374 DOI: 10.1016/j.psyneuen.2015.07.612] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/10/2015] [Accepted: 07/28/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Despite the high prevalence of depressive symptoms in women, the precise role of sex hormones in mood changes during the menopausal transition is unclear. Previous studies have been inconsistent with regard to identifying the association of androgens, namely total testosterone, with depressive symptoms. OBJECTIVE The objectives of this study were to evaluate changes in serum total testosterone levels and depressive symptoms during the entire menopausal transition, and examine the impact of covariates on the association between concurrent serum total testosterone levels and depressive symptoms during this time period. METHODS A longitudinal cohort study (428 women at baseline with 3634 repeated measures) using data from the Penn Ovarian Aging Study, a population-based cohort of late reproductive-aged women, followed through the menopausal transition. Serum hormone parameters and depression scores using the Center for Epidemiological Studies of Depression scale (CES-D) were measured at each annual visit over a 14-year period. General linear (for testosterone) and a generalized negative-binomial model (for depressive symptoms) for repeated measures were used for analysis. RESULTS Serum total testosterone levels increased progressively over the study period and were significantly associated with older age and with current smoking (p<0.001, respectively). In the post menopause total testosterone levels were significantly higher in African Americans compared to Caucasians (p=0.012). The proportion of women with CES-D ≥16 significantly decreased with increasing age and in the post-menopausal period, and were higher in women with a history of depression and hot flashes (p<0.001). The association between concurrent testosterone levels and high depressive symptoms (CES-D ≥16) differed by race (p=0.008). In Caucasians, but not African Americans, higher serum testosterone levels were associated with increased depressive symptoms after controlling for several variables including age, obesity status, hot flashes and menopausal status (RR 1.09, 95% CI 1.00-1.17, p=0.042). CONCLUSION In our cohort, testosterone levels were low but progressively increased from premenopause through post menopause. In addition to age and history of depression, we identified race to have a significant interaction between the association of testosterone levels and depressive symptoms. This study further supports the associations between sex hormones and increased risk of having depressive symptoms, although the precise underlying mechanisms for this association remain unclear.
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Affiliation(s)
- Lauren W Milman
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Mary D Sammel
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Kurt T Barnhart
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Ellen W Freeman
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Anuja Dokras
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States.
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El Khoudary SR, Santoro N, Chen HY, Tepper PG, Brooks MM, Thurston RC, Janssen I, Harlow SD, Barinas-Mitchell E, Selzer F, Derby CA, Jackson EA, McConnell D, Matthews KA. Trajectories of estradiol and follicle-stimulating hormone over the menopause transition and early markers of atherosclerosis after menopause. Eur J Prev Cardiol 2015; 23:694-703. [PMID: 26385249 DOI: 10.1177/2047487315607044] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Indexed: 01/16/2023]
Abstract
AIM The purpose of this study was to assess associations between distinct patterns of circulating estradiol (E2) and follicle-stimulating hormone (FSH) over the menopause transition (MT) and subclinical measures of atherosclerosis after menopause. METHODS AND RESULTS Four temporal patterns of E2 decline (Low: low before and after final menstrual period (FMP); Medium: medium before and high after FMP; High-early decline: high prior to FMP and early decline thereafter; High-late decline: high prior to FMP and late decline thereafter) and three of FSH rise (Low, Medium, High) over 9.6 years across FMP were identified and linked to carotid intima-media-thickness (IMT), adventitial diameter (AD), and presence of carotid plaque (cPlaque) measured after menopause at the 12th annual visit (visit 12). Participants were 856 women (age at visit 12 = 59.5 ± 2.7 years) from the Study of Women's Health Across the Nation (SWAN), who never reported a stroke or a heart attack. In models adjusted for visit 12 or baseline cardiovascular disease (CVD) risk factors, odds of having any cPlaque were ∼43% lower among women with the High-early decline E2 trajectory compared to women with the Low E2 trajectory. In contrast, women with the Medium E2 trajectory had significantly higher IMT than those with the Low E2 trajectory adjusting for visit 12 CVD risk factors. Interestingly, adjusting for baseline CVD risk factors attenuated this association. The Low FSH group had lower IMT than the Medium and High FSH groups (p ≤ 0.05) in all models. CONCLUSION During MT, women are subjected to hormonal alterations that could potentially increase their risk of developing CVD after menopause.
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Affiliation(s)
| | | | - Hsiang-Yu Chen
- Department of Epidemiology, University of Pittsburgh, USA
| | - Ping G Tepper
- Department of Epidemiology, University of Pittsburgh, USA
| | - Maria M Brooks
- Department of Epidemiology, University of Pittsburgh, USA
| | - Rebecca C Thurston
- Department of Epidemiology, University of Pittsburgh, USA Department of Psychiatry, University of Pittsburgh, USA
| | | | | | | | - Faith Selzer
- Department of Epidemiology, University of Pittsburgh, USA
| | - Carol A Derby
- Department of Neurology and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, USA
| | | | | | - Karen A Matthews
- Department of Epidemiology, University of Pittsburgh, USA Department of Psychiatry, University of Pittsburgh, USA
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Kim C, Cushman M, Kleindorfer D, Lisabeth L, Redberg RF, Safford MM. A review of the relationships between endogenous sex steroids and incident ischemic stroke and coronary heart disease events. Curr Cardiol Rev 2015; 11:252-60. [PMID: 25563292 PMCID: PMC4558357 DOI: 10.2174/1573403x1103150515110749] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 12/22/2014] [Accepted: 12/25/2014] [Indexed: 12/22/2022] Open
Abstract
For decades, it has been recognized that men have a higher age-adjusted risk of ischemic cardiovascular (CVD) events compared to women, thus generating hypotheses that sex steroids contribute to CVD risk. Potential mechanisms include genomic and non-genomic effects of sex steroids as well as mediation through classic CVD risk factors and obesity. However, results from randomized studies suggest that sex steroid supplementation in men and women do not result in improved CVD outcomes and may increase CVD risk. In contrast, prospective observations from endogenous sex steroid studies, i.e. among participants not using sex steroids, have suggested the opposite relationship. We reviewed the findings of prospective observational studies in men (17 studies) and women (8 studies) that examined endogenous sex steroids and CVD risk. These studies suggested a lack of association or that lower levels of testosterone or dihydrotestosterone are associated with higher CVD risk in both men and women. Higher, rather than lower, estradiol levels were associated with higher CVD risk in women. There were several significant gaps in the literature. First, it is unclear whether more sensitive measures of sex steroid levels might detect significant differences. Second, there are few prospective studies in women. Similarly, no studies report outcomes for high-risk groups such as African-Americans and Hispanics. Finally, few studies report upon ischemic coronary disease as opposed to ischemic stroke separately, although relationships between sex steroids and CVD may vary by vascular bed. Future investigations need to examine high risk groups and to distinguish between subtypes of CVD.
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Affiliation(s)
- Catherine Kim
- 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109, USA.
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Daan NMP, Jaspers L, Koster MPH, Broekmans FJM, de Rijke YB, Franco OH, Laven JSE, Kavousi M, Fauser BCJM. Androgen levels in women with various forms of ovarian dysfunction: associations with cardiometabolic features. Hum Reprod 2015; 30:2376-86. [PMID: 26269538 DOI: 10.1093/humrep/dev195] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/23/2015] [Indexed: 01/28/2023] Open
Abstract
STUDY QUESTION Are differences in androgen levels among women with various forms of ovarian dysfunction associated with cardiometabolic abnormalities? SUMMARY ANSWER Androgen levels differed substantially between women with and without ovarian dysfunction, and increased androgen levels were associated with impaired cardiometabolic features in all women irrespective of their clinical condition. WHAT IS KNOWN ALREADY Sex steroid hormones play important roles in the development of cardiovascular diseases (CVD). Extremes of low as well as high androgen levels have been associated with increased CVD risk in both men and women. STUDY DESIGN, SIZE, DURATION This cross-sectional study included 680 women with polycystic ovary syndrome (PCOS), premature ovarian insufficiency (POI), natural post-menopausal women (NM), or regular menstrual cycles (RC) (170 women per group). PARTICIPANTS/MATERIALS, SETTING, METHODS Measurements of serum testosterone, androstenedione and dehydroepiandrosterone sulfate were performed using liquid chromatography-tandem mass spectrometry. Assessments were taken of body mass index (BMI), blood pressure, lipid profiles, glucose, insulin and SHBG, and the bioactive fraction of circulating testosterone was calculated using the free androgen index (FAI). MAIN RESULTS AND THE ROLE OF CHANCE PCOS women were hyperandrogenic [median FAI = 4.9 (IQR 3.6-7.4)], and POI women were hypoandrogenic [FAI = 1.2 (0.8-1.7)], compared with RC women [FAI = 1.7 (1.1-2.8)], after adjustment for age, ethnicity, smoking and BMI (P < 0.001). After adjustment for age, there were no significant differences in androgens between POI and NM (P = 0.15) women and between NM and RC (P = 0.27) women, the latter indicating that chronological aging rather than ovarian aging influences the differences between pre- and post-menopausal women. A high FAI was associated with elevated triglycerides (β log FAI for PCOS: 0.45, P < 0.001, POI: 0.25, P < 0.001, NM: 0.20, P = 0.002), insulin (β log FAI for PCOS: 0.77, POI: 0.44, NM: 0.40, all P < 0.001), HOMA-IR (β log FAI for PCOS: 0.82, POI: 0.46, NM: 0.47, all P < 0.001) and mean arterial pressure (β log FAI for PCOS: 0.05, P = 0.002, POI: 0.07, P < 0.001, NM: 0.04, P = 0.04) in all women; with increased glucose (β log FAI for PCOS: 0.05, P = 0.003, NM: 0.07, P < 0.001) and decreased high-density lipoprotein (β log FAI for PCOS: -0.23, P < 0.001, NM: -0.09, P = 0.03) in PCOS and NM women; and with increased low-density lipoprotein (β log FAI for POI: 0.083, P = 0.041) in POI women. Adjustment for BMI attenuated the observed associations. Associations between FAI and cardiometabolic features were the strongest in PCOS women, even after adjustment for BMI. LIMITATIONS, REASONS FOR CAUTION Associations between androgen levels and cardiometabolic features were assessed in PCOS, POI and NM women only, due to a lack of available data in RC women. Due to the cross-sectional design of the current study, the potential associations between androgen levels and actual future cardiovascular events could not be assessed. WIDER IMPLICATIONS OF THE FINDINGS This study affirms the potent effect of androgens on cardiometabolic features, indicating that androgens should indeed be regarded as important denominators of women's health. Future research regarding the role of androgens in the development of CVD and potential modulatory effects of BMI is required. STUDY FUNDING/COMPETING INTERESTS N.M.P.D. is supported by the Dutch Heart Foundation (grant number 2013T083). L.J. and O.H.F. work in ErasmusAGE, a center for aging research across the life course, funded by Nestlé Nutrition (Nestec Ltd), Metagenics Inc. and AXA. M.K. is supported by the AXA Research Fund. Nestlé Nutrition (Nestec Ltd), Metagenics Inc. and AXA had no role in the design and conduct of the study; the collection, management, analysis and interpretation of the data; or the preparation, review or approval of the manuscript. J.S.E.L. has received fees and grant support from the following companies (in alphabetical order): Ferring, Merck-Serono, Merck Sharpe & Dome, Organon, Schering Plough and Serono. In the last 5 years, B.C.J.M.F. has received fees and grant support from the following companies (in alphabetic order); Actavis, COGI, Euroscreen, Ferring, Finox, Genovum, Gedeon-Richter, Merck-Serono, OvaScience, Pantharei Bioscience, PregLem, Roche, Uteron and Watson laboratories. With regard to potential conflicts of interest, there is nothing further to disclose.
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Affiliation(s)
- N M P Daan
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, HP F05.126, PO Box 85500, 3584 CX Utrecht, The Netherlands
| | - L Jaspers
- Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M P H Koster
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, HP F05.126, PO Box 85500, 3584 CX Utrecht, The Netherlands
| | - F J M Broekmans
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, HP F05.126, PO Box 85500, 3584 CX Utrecht, The Netherlands
| | - Y B de Rijke
- Department of Clinical Chemistry, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - O H Franco
- Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J S E Laven
- Department of Obstetrics and Gynecology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Kavousi
- Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - B C J M Fauser
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, HP F05.126, PO Box 85500, 3584 CX Utrecht, The Netherlands
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Gabrielli L, Almeida MDCCD, Aquino EM. Proposed criteria for the identification of polycystic ovary syndrome following menopause: An ancillary study of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Maturitas 2015; 81:398-405. [DOI: 10.1016/j.maturitas.2015.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 03/12/2015] [Accepted: 04/25/2015] [Indexed: 10/23/2022]
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Maturana MA, Franz RF, Metzdorf M, da Silva TR, Spritzer PM. Subclinical cardiovascular disease in postmenopausal women with low/medium cardiovascular risk by the Framingham risk score. Maturitas 2015; 81:311-6. [DOI: 10.1016/j.maturitas.2015.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 03/03/2015] [Accepted: 03/13/2015] [Indexed: 10/23/2022]
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Glueck CJ, Woo JG, Khoury PR, Morrison JA, Daniels SR, Wang P. Adolescent oligomenorrhea (age 14-19) tracks into the third decade of life (age 20-28) and predicts increased cardiovascular risk factors and metabolic syndrome. Metabolism 2015; 64:539-53. [PMID: 25633270 DOI: 10.1016/j.metabol.2015.01.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 12/22/2014] [Accepted: 01/06/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Assess whether adolescent oligomenorrhea (age 14-19) tracks into young adulthood (age 20-28) and predicts increased cardiometabolic risk factors, metabolic syndrome (MetS), and impaired fasting glucose-type II diabetes mellitus (IFG+T2DM). MATERIALS AND METHODS Prospective study of menstrual cyclicity and its metabolic effects in 865 black and white schoolgirls from age 9 to 19, and 605 of these 865 girls from age 20 to 28. MAIN FINDINGS Patterns of menstrual delays (oligomenorrhea) during ages 14-19 and ages 20-28 were closely related (p<.0001). Adolescent menses delay (ages 14-19, p<.0001), mean insulin (ages 20-28, p=.0003), and self-identified polycystic ovary syndrome (PCOS, p=.049) predicted ages 20-28 menses delay. Menses delays during ages 14-19 and 20-28, and, their interaction product were correlated with IFG+T2DM and MetS at ages 20-28. Waist circumference (ages 20-28, p<.0001), mean triglyceride (ages 20-28, p=.005), and the number of average menstrual cycles≥42 days (ages 20-28, p=.04) predicted IFG+T2DM (ages 20-28). MetS (ages 9-19, p<.0001), mean insulin (ages 20-28, p=.0002), the number of ≥42 day gaps between menstrual periods (ages 20-28, p=.02), and cigarette smoking at age 18-19 (p=.04) were significant explanatory variables for MetS at ages 27-28. As MetS status category changed from age 14-19 to 27-28 from best to worst: (no → no), (yes → no), (yes → yes), (no → yes), the number of women with ≥2 menses delays during ages 20-28 rose from 3% to 4% to 15% to 17%, p=.0001. MetS status change from age 9-19 to 27-28 was positively associated with mean insulin (age 20-28, p<.0001), cigarette smoking (age 24-25, p=.01) and the number of menses delays during ages 20-28 (p=.04). PRINCIPAL CONCLUSIONS Menstrual patterns track from adolescence to young adulthood, and oligomenorrhea predicts MetS and IFG+T2DM. Patterns of menses delays in adolescence should be considered as a significant risk factor for future development of young adult IFG+T2DM, MetS, oligomenorrhea, and polycystic ovary syndrome.
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Affiliation(s)
- Charles J Glueck
- Cholesterol Metabolism Thrombosis Center Jewish Hospital of Cincinnati, Cincinnati, OH.
| | - Jessica G Woo
- Heart Institute the Division of Biostatistics Epidemiology Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Philip R Khoury
- Heart Institute the Division of Biostatistics Epidemiology Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - John A Morrison
- Heart Institute the Division of Biostatistics Epidemiology Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Ping Wang
- Cholesterol Metabolism Thrombosis Center Jewish Hospital of Cincinnati, Cincinnati, OH
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Raman SV, Sharkey-Toppen TP, Tran T, Liu JX, McCarthy B, He X, Smart S, Gulati M, Wexler R, Simonetti OP, Jackson RD. Iron, inflammation and atherosclerosis risk in men vs. perimenopausal women. Atherosclerosis 2015; 241:249-54. [PMID: 25817132 DOI: 10.1016/j.atherosclerosis.2015.03.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 02/15/2015] [Accepted: 03/16/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Age at first atherosclerotic event is typically older for women vs. men; monthly iron loss has been postulated to contribute to this advantage. We investigated the relationship between an MRI-based arterial wall biomarker and the serum inflammatory biomarker high-sensitivity C-reactive protein (hsCRP) in perimenopausal women vs. men. METHODS AND RESULTS Women without evident atherosclerotic disease were prospectively enrolled and observed over 24 months of menopause transition, indicated by hormone levels and reduction in median number of menstrual cycles from 4 [3-6] per year to 0 [0-1] per year (P < 0.01). Higher hsCRP predicted shorter carotid artery wall T2* in women entering the menopause transition (r = -0.3139, P = 0.0014); this relationship weakened after 24 months of perimenopause in women (r = -0.1718, P = 0.0859) and was not significant in a cohort of men matched for age and cardiovascular risk category (r = -0.0310, P = 0.8362). Serum ferritin increased from baseline to 24-month follow-up during women's menopause transition (37 [20-79] to 67 [36-97] ng/mL, P < 0.01), but still remained lower compared to men (111 [45-220] ng/mL, P < 0.01). Circulating ferritin levels correlated with arterial wall T2* values in women at baseline (r = -0.3163, P = 0.0013) but not in women after 24 months (r = -0.0730, P = 0.4684) of menopause transition nor in men (r = 0.0862, P = 0.5644). CONCLUSIONS An arterial wall iron-based imaging biomarker reflects degree of systemic inflammation in younger women, whereas this relationship is lost as women transition through menopause to become more similar to men. Iron homeostasis and inflammation in the arterial wall microenvironment warrants further investigation as a potential early target for interventions that mitigate atherosclerosis risk.
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Affiliation(s)
- Subha V Raman
- Ohio State University (OSU), Davis Heart and Lung Research Institute, 473 W. 12th Ave, Suite 200, Columbus, OH 43210, USA.
| | - Travis P Sharkey-Toppen
- Ohio State University (OSU), Davis Heart and Lung Research Institute, 473 W. 12th Ave, Suite 200, Columbus, OH 43210, USA
| | - Tam Tran
- Ohio State University (OSU), Davis Heart and Lung Research Institute, 473 W. 12th Ave, Suite 200, Columbus, OH 43210, USA
| | - Jim X Liu
- Ohio State University (OSU), Davis Heart and Lung Research Institute, 473 W. 12th Ave, Suite 200, Columbus, OH 43210, USA
| | - Beth McCarthy
- Ohio State University (OSU), Davis Heart and Lung Research Institute, 473 W. 12th Ave, Suite 200, Columbus, OH 43210, USA
| | - Xin He
- University of Maryland, Department of Epidemiology and Biostatistics, 2234H SPH Building, College Park, MD 20742, USA
| | - Suzanne Smart
- Ohio State University (OSU), Davis Heart and Lung Research Institute, 473 W. 12th Ave, Suite 200, Columbus, OH 43210, USA
| | - Martha Gulati
- Ohio State University (OSU), Davis Heart and Lung Research Institute, 473 W. 12th Ave, Suite 200, Columbus, OH 43210, USA
| | - Randell Wexler
- OSU, Department of Family Medicine, 2231 N. High St, Columbus, OH 43210, USA
| | - Orlando P Simonetti
- Ohio State University (OSU), Davis Heart and Lung Research Institute, 473 W. 12th Ave, Suite 200, Columbus, OH 43210, USA
| | - Rebecca D Jackson
- OSU, Division of Endocrinology, Diabetes and Metabolism, 1581 Dodd Drive, Columbus, OH 43210, USA
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Macut D, Antić IB, Bjekić-Macut J. Cardiovascular risk factors and events in women with androgen excess. J Endocrinol Invest 2015; 38:295-301. [PMID: 25432327 DOI: 10.1007/s40618-014-0215-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/14/2014] [Indexed: 10/24/2022]
Abstract
Androgen excess (AE) was approximated to be present in 7% of the adult population of women. Polycystic ovary syndrome (PCOS) is the most prevalent among them, followed by idiopathic hirsutism (IH), congenital adrenal hyperplasia (CAH), hyperandrogenic insulin-resistant acanthosis nigricans (HAIRAN) syndrome, and androgen-secreting neoplasms (ASNs). Increased cardiovascular risk was implicated in women with AE. Serum testosterone independently increases risk for cardiovascular disease (CVD), and correlates even with indices of subclinical atherosclerosis in various populations of postmenopausal women. Hyperandrogenism in PCOS is closely related to the aggravation of abdominal obesity, and together with insulin resistance forming the metabolic core for the development of CVD. However, phenotypic variability of PCOS generates significant influence on the cardiometabolic risks. Numerous risk factors in PCOS lead to 5-7 times higher risk for CVD and over 2-fold higher risk for coronary heart disease and stroke. However, issue on the cardiometabolic risk in postmenopausal women with hyperandrogenic history is still challenging. There is a significant overlapping in the CVD characteristics of women with PCOS and variants of CAH. Relevant clinical data on the prevalence and cardiometabolic risk and events in women with IH, HAIRAN syndrome or ASNs are scarce. The effects of various oral contraceptives (OCs) and antiandrogenic compounds on metabolic profile are varying, and could be related to the selected populations and different therapy regiments mainly conducted in women with PCOS. It is assumed relation of OCs containing antiandrogenic progestins to the increased risk of cardiovascular and thromboembolic events.
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Affiliation(s)
- D Macut
- Clinic of Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr Subotića 13, 11000, Belgrade, Serbia.
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| | - I B Antić
- Clinic of Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr Subotića 13, 11000, Belgrade, Serbia
| | - J Bjekić-Macut
- Department of Endocrinology, CHC Bežanijska kosa, Belgrade, Serbia
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Calderon-Margalit R, Siscovick D, Merkin SS, Wang E, Daviglus ML, Schreiner PJ, Sternfeld B, Williams OD, Lewis CE, Azziz R, Schwartz SM, Wellons MF. Prospective association of polycystic ovary syndrome with coronary artery calcification and carotid-intima-media thickness: the Coronary Artery Risk Development in Young Adults Women's study. Arterioscler Thromb Vasc Biol 2014; 34:2688-94. [PMID: 25359859 DOI: 10.1161/atvbaha.114.304136] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To study the independent associations of polycystic ovary syndrome (PCOS), and its 2 components, hyperandrogenism and anovulation, with coronary artery calcification (CAC) and carotid artery intima-media thickness (IMT). APPROACH AND RESULTS At the year 20 of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based multicenter cohort of young adults, women (mean age, 45 years) with information on menses and hirsutism in their twenties were assessed for CAC (n=982) and IMT (n=988). We defined PCOS as women who had both irregular menses and hyperandrogenism (n=55); isolated oligomenorrhea (n=103) as women who only had irregular menses; and isolated hyperandrogenism (n=156) as women who had either hirsutism or increased testosterone levels. Logistic regressions and general linear models were used to estimate the associations between components of PCOS and subclinical CVD. The prevalence of CAC was 10.3% overall. Women with PCOS had a multivariable adjusted odds ratio of 2.70 (95% confidence interval, 1.31-5.60) for CAC. Women with either isolated oligomenorrhea or isolated hyperandrogenism had no increased risk of CAC when compared with unexposed women. Women with PCOS had significantly increased bulb and internal carotid-IMT measurements; however, no significant differences were noted in bulb or internal carotid artery IMT among women with either isolated oligomenorrhea or isolated hyperandrogenism when compared with unexposed women. There were no differences in common carotid-IMT among the 4 study groups. CONCLUSIONS In this study, women with PCOS, manifested as both anovulation and hyperandrogenism, but not women with one of these manifestations alone, were at increased risk for the development of subclinical CVD.
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Affiliation(s)
- Ronit Calderon-Margalit
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.).
| | - David Siscovick
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Sharon S Merkin
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Erica Wang
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Martha L Daviglus
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Pamela J Schreiner
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Barbara Sternfeld
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - O Dale Williams
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Cora E Lewis
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Ricardo Azziz
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Stephen M Schwartz
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Melissa F Wellons
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
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Värri M, Tuomainen TP, Honkanen R, Rikkonen T, Niskanen L, Kröger H, Tuppurainen MT. Carotid intima-media thickness and calcification in relation to bone mineral density in postmenopausal women—The OSTPRE-BBA study. Maturitas 2014; 78:304-9. [DOI: 10.1016/j.maturitas.2014.05.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 05/17/2014] [Accepted: 05/21/2014] [Indexed: 10/25/2022]
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Polotsky AJ, Allshouse AA, Crawford SL, Harlow SD, Khalil N, Kazlauskaite R, Santoro N, Legro RS. Hyperandrogenic oligomenorrhea and metabolic risks across menopausal transition. J Clin Endocrinol Metab 2014; 99:2120-7. [PMID: 24517154 PMCID: PMC4037727 DOI: 10.1210/jc.2013-4170] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Although there is evidence of metabolic risks in young women with irregular menses and androgen excess, persistence of risks after menopause is unclear. OBJECTIVE The objective of the study was to determine the impact of menopause on the cardiometabolic profile in women with high androgens and a history of menstrual irregularity. METHODS Study of Women's Health Across the Nation is a longitudinal cohort study. Data from 1929 women without metabolic syndrome (MetS) at baseline were analyzed for incidence of MetS, self-reported stroke, and myocardial infarction. Cox hazard ratios (HRs) were estimated, adjusting for age, ethnicity, body mass, smoking, menopausal status, and study site. RESULTS Among MetS-free women at baseline, 497 new cases were identified during 20 249 woman-years of follow-up over 12 years. Women with hyperandrogenemia (HA) and oligomenorrhea (Oligo) developed incident cases of MetS at a comparable rate compared with their counterparts: eumenorrheic, normoandrogenic women [HR 1.4 (0.9-2.2)], oligomenorrheic, normoandrogenic women [HR 1.3 (0.8-2.2)], and eumenorrheic hyperandrogenic women [HR 1.2 (0.7-1.8)]. Smoking and obesity were the strongest predictors of incident MetS. There was no significant difference in incidence of self-reported stroke or MI by HA/Oligo status. CONCLUSIONS Longitudinal evidence suggests that a history of androgen excess and menstrual irregularity is not associated with worsening of metabolic health after menopause. Our findings challenge the notion that a history of concurrent HA and Oligo reflects ongoing cardiometabolic risk in postmenopausal women.
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Affiliation(s)
- Alex J Polotsky
- Department of Obstetrics and Gynecology (A.J.P., A.A.A., N.S.), University of Colorado Denver, and Department of Biostatistics and Informatics (A.A.A.), School of Public Health, University of Colorado Denver, Aurora, Colorado 80045; Department of Epidemiology, Preventive, and Behavioral Medicine (S.L.C.), University of Massachusetts Medical School, Worcester, Massachusetts 01655; School of Public Health (S.D.H.), University of Michigan, Ann Arbor, Michigan 48109; Department of Community Health (N.K.), Boonshoft School of Medicine, Wright State University, Dayton, Ohio 45420; Department of Endocrinology and Preventive Cardiology (R.K.), Rush University, Chicago, Illinois 60612; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
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Yavropoulou MP, Pikilidou M, Yovos JG. Anti-osteoporotic drugs and vascular calcification: the bidirectional calcium traffic. J Vasc Res 2013; 51:37-49. [PMID: 24280985 DOI: 10.1159/000355204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 08/19/2013] [Indexed: 11/19/2022] Open
Abstract
During the last years, numerous epidemiological studies have demonstrated a direct relationship between vascular calcification and low bone mineral density. This observation is in line with experimental data demonstrating the osteogenic characteristics of calcified arteries. Various common risk factors have been suggested to link vascular calcification and bone loss, including aging, estrogen deficiency, vitamin D and K deficiency, diabetes mellitus, renal failure, smoking, chronic inflammation and oxidative stress. Although the underlying pathogenetic mechanisms are not yet clear, current research is focusing on anti-osteoporotic agents that could potentially affect the deposition of calcium in the arterial wall and thus provide an additional therapeutic strategy in elderly osteoporotic women prone to calcific cardiovascular disease.
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Affiliation(s)
- Maria P Yavropoulou
- Division of Endocrinology and Metabolism, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Jung SK, Kim MK, Lee YH, Shin DH, Shin MH, Chun BY, Choi BY. Lower zinc bioavailability may be related to higher risk of subclinical atherosclerosis in Korean adults. PLoS One 2013; 8:e80115. [PMID: 24223217 PMCID: PMC3819296 DOI: 10.1371/journal.pone.0080115] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/07/2013] [Indexed: 12/13/2022] Open
Abstract
Background There is a proposed link between dietary zinc intake and atherosclerosis, but this relationship remains unclear. Phytate may contribute to this relationship by influencing zinc bioavailability. Objective The aim of this study is to examine the relationship between zinc bioavailability and subclinical atherosclerosis in healthy Korean adults. Materials and Methods The present cross-sectional analysis used baseline data from the Korean multi-Rural Communities Cohort Study (MRCohort), which is a part of The Korean Genome Epidemiology Study (KoGES). A total of 5,532 subjects (2,116 men and 3,416 women) aged 40 years and older were recruited from rural communities in South Korea between 2005 and 2010. Phytate:zinc molar ratio, estimated from a food-based food frequency questionnaire (FFQ) of 106 food items, was used to determine zinc bioavailability, and carotid intima media thickness (cIMT) and pulse wave velocity (PWV) were measured to calculate the subclinical atherosclerotic index. Results We found that phytate:zinc molar ratio is positively related to cIMT in men. A higher phytate:zinc molar ratio was significantly related to an increased risk of atherosclerosis in men, defined as the 80th percentile value of cIMT (5th vs. 1st quintile, OR = 2.11, 95% CI 1.42-3.15, P for trend = 0.0009), and especially in elderly men (5th vs. 1st quintile, OR = 2.58, 95% CI 1.52-4.37, P for trend = 0.0021). We found a positive relationship between phytate:zinc molar ratio and atherosclerosis risk among women aged 65 years or younger. Phytate:zinc molar ratio was not found to be related to PWV. Conclusions Lower zinc bioavailability may be related to higher atherosclerosis risk.
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Affiliation(s)
- Su Kyoung Jung
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, South Korea
- Institute for Health and Society, Hanyang University, Seoul, South Korea
| | - Mi-Kyung Kim
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, South Korea
- Institute for Health and Society, Hanyang University, Seoul, South Korea
- * E-mail:
| | - Young-Hoon Lee
- Department of Preventive Medicine & Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, Iksan, South Korea
| | - Dong Hoon Shin
- Department of Preventive Medicine, School of Medicine Keimyung University, Daegu, South Korea
| | - Min-Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Byung-Yeol Chun
- Department of Preventive Medicine, School of Medicine, and Health Promotion Research Center, Kyungpook National University, Daegu, South Korea
| | - Bo Youl Choi
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, South Korea
- Institute for Health and Society, Hanyang University, Seoul, South Korea
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Staimez LR, Weber MB, Narayan KMV, Oza-Frank R. A systematic review of overweight, obesity, and type 2 diabetes among Asian American subgroups. Curr Diabetes Rev 2013; 9:312-31. [PMID: 23590534 PMCID: PMC4465442 DOI: 10.2174/15733998113099990061] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 04/06/2013] [Accepted: 04/08/2013] [Indexed: 11/22/2022]
Abstract
This systematic review synthesizes data published between 1988 and 2009 on mean BMI and prevalence of overweight, obesity, and type 2 diabetes among Asian subgroups in the U.S. We conducted systematic searches in Pub- Med for peer-reviewed, English-language citations that reported mean BMI and percent overweight, obesity, and diabetes among South Asians/Asian Indians, Chinese, Filipinos, Koreans, and Vietnamese. We identified 647 database citations and 23 additional citations from hand-searching. After screening titles, abstracts, and full-text publications, 97 citations remained. None were published between 1988 and 1992, 28 between 1993 and 2003, and 69 between 2004 and 2009. Publications were identified for the following Asian subgroups: South Asian (n=8), Asian Indian (n=20), Chinese (n=44), Filipino (n=22), Korean (n= 8), and Vietnamese (n=3). The observed sample sizes ranged from 32 to 4245 subjects with mean ages from 24 to 78 years. Among samples of men and women, the lowest reported mean BMI was in South Asians (22.1 kg/m(2)), and the highest was in Filipinos (26.8 kg/m(2)). Estimates for overweight (12.8-46.7%) and obesity (2.1-59.0%) were variable. Among men and women, the highest rate of diabetes was reported in Asian Indians with BMI ≥ 30 kg/m(2) (32.9%, age and sex standardized). This review suggests heterogeneity among U.S. Asian populations in cardiometabolic risk factors, yet comparisons are limited due to variability in study populations, methods, and definitions used in published reports. Future efforts should adopt standardized methods to understand overweight, obesity and diabetes in this growing U.S. ethnic population.
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Affiliation(s)
- Lisa R Staimez
- Emory University, Laney Graduate School, Division of Biological and Biomedical Sciences, Nutrition and Health Sciences Program, Atlanta, GA, USA.
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71
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Crandall CJ, Barrett-Connor E. Endogenous sex steroid levels and cardiovascular disease in relation to the menopause: a systematic review. Endocrinol Metab Clin North Am 2013; 42:227-53. [PMID: 23702399 DOI: 10.1016/j.ecl.2013.02.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Heart disease remains a major cause of death among women in the United States. This article focuses on physiologic endogenous estrogen levels with a systematic review of literature related to endogenous sex steroid levels and coronary artery disease (CAD) among postmenopausal women with natural or surgical menopause. There is adequate reason to seek evidence for associations of circulating estrogen levels and CAD. In the future, even if ovarian senescence-associated hormonal changes are confirmed to be associated with CAD in cohort studies of postmenopausal women, there may be other components explaining the gender differences in CAD patterns.
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Affiliation(s)
- Carolyn J Crandall
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90024, USA.
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72
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Endogenous estrogen and androgen levels are not independent predictors of lipid levels in postmenopausal women. Menopause 2013; 20:640-5. [DOI: 10.1097/gme.0b013e318279bd4a] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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73
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74
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Wallace IR, McKinley MC, Bell PM, Hunter SJ. Sex hormone binding globulin and insulin resistance. Clin Endocrinol (Oxf) 2013; 78:321-9. [PMID: 23121642 DOI: 10.1111/cen.12086] [Citation(s) in RCA: 159] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 08/07/2012] [Accepted: 10/24/2012] [Indexed: 01/04/2023]
Abstract
Sex hormone binding globulin (SHBG) is a glycoprotein composed of two 373-amino-acid subunits. The SHBG gene and a promotor region have been identified. The SHBG receptor has yet to be cloned but is known to act through a G-protein-linked second-messenger system following plasma membrane binding. The principal function of SHBG has traditionally been considered to be that of a transport protein for sex steroids, regulating circulating concentrations of free (unbound) hormones and their transport to target tissues. Recent research suggests that SHBG has functions in addition to the binding and transport of sex steroids. Observational studies have associated a low SHBG concentration with an increased incidence of type 2 diabetes mellitus (DM) independent of sex hormone levels in men and women. Genetic studies using Mendelian randomization analysis linking three single nucleotide polymorphisms of the SHBG gene to risk of developing type 2 DM suggest SHBG may have a role in the pathogenesis of type 2 DM. The correlation between SHBG and insulin resistance that is evident in a number of cross-sectional studies is in keeping with the suggestion that the association between SHBG and incidence of type 2 DM is explained by insulin resistance. Several potential mechanisms may account for this association, including the identification of dietary factors that influence SHBG gene transcription. Further research to characterize the SHBG-receptor and the SHBG second messenger system is required. An interventional study examining the effects on insulin resistance of altering SHBG concentrations may help in determining whether this association is causal.
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Affiliation(s)
- Ian R Wallace
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK.
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75
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76
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Davey DA. Androgens in women before and after the menopause and post bilateral oophorectomy: clinical effects and indications for testosterone therapy. ACTA ACUST UNITED AC 2012; 8:437-46. [PMID: 22757734 DOI: 10.2217/whe.12.27] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In postmenopausal women, the ovaries produce significant amounts of androgens for many years after the menopause. Bilateral oophorectomy markedly reduces circulating testosterone (T) in both pre- and postmenopausal women. Oral estrogen therapy in postmenopausal women increases sex hormone-binding globulin and decreases T bioavailablity. Circulating androgens decrease with increasing age. The occurrence of an androgen deficiency syndrome associated with loss of libido and sense of well-being is disputed, but in several randomized controlled trials, transdermal T patches produced a significant improvement in hypoactive sexual desire disorder in postmenopausal women who had bilateral oophorectomy and in some women who had a natural menopause. T therapy is legitimate and is clinically indicated in such women. T therapy may have other benefits in postmenopausal women including an increase in lean body mass and bone mineral density. T therapy should become an integral part of hormone therapy in selected postmenopausal women in the future.
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Affiliation(s)
- Dennis A Davey
- Department of Obstetrics & Gynaecology, Faculty of Health Sciences, University of Cape Town, Observatory, Western Cape 7925, South Africa.
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77
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Kim C, Golden SH, Mather KJ, Laughlin GA, Kong S, Nan B, Barrett-Connor E, Randolph JF. Racial/ethnic differences in sex hormone levels among postmenopausal women in the diabetes prevention program. J Clin Endocrinol Metab 2012; 97:4051-60. [PMID: 22879633 PMCID: PMC3485611 DOI: 10.1210/jc.2012-2117] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Sex hormones may differ by race/ethnicity in postmenopausal women. Whether racial/ethnic differences also exist among those who are overweight and glucose intolerant is not clear. OBJECTIVES The objective of the study was to compare sex hormones by race/ethnicity [non-Hispanic white (NHW), Hispanic, African-American (AA)] in overweight, glucose-intolerant, postmenopausal women. DESIGN This was a secondary analysis of a randomized controlled trial. PARTICIPANTS Participants included postmenopausal glucose-intolerant women participating in the Diabetes Prevention Program. INTERVENTIONS Interventions included intensive lifestyle modification (consisting of diet and physical activity) or metformin 850 mg twice a day vs. placebo. MAIN OUTCOME MEASURES Baseline levels and 1-yr intervention-related changes in SHBG, total and bioavailable estradiol (E2), total and bioavailable testosterone, and dehydroepiandrosterone were measured. RESULTS At baseline, among women not using estrogen (n = 370), NHW had higher total and bioavailable E2 and testosterone levels than Hispanics independent of age, type of menopause, waist circumference, alcohol intake, and current smoking. NHW also had higher levels of bioavailable E2 and lower levels of SHBG than AA. At baseline, among estrogen users (n = 310), NHW had higher total and bioavailable E2 than Hispanics and higher levels of SHBG than AA after adjustment. At 1 yr, among women not using estrogen, NHW had larger declines in total E2 and bioavailable E2 levels than AA after adjustment for the above covariates, changes in waist circumference, and randomization arm. At 1 yr, among estrogen users, sex hormone changes did not differ by race/ethnicity. CONCLUSIONS Among postmenopausal women, there were significant race/ethnicity differences in baseline sex hormones and changes in sex hormones.
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Affiliation(s)
- Catherine Kim
- Departments of Biostatistics and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan 48109-5429, USA.
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El Khoudary SR, Wildman RP, Matthews K, Thurston RC, Bromberger JT, Sutton-Tyrrell K. Endogenous sex hormones impact the progression of subclinical atherosclerosis in women during the menopausal transition. Atherosclerosis 2012; 225:180-6. [PMID: 22981430 PMCID: PMC3478422 DOI: 10.1016/j.atherosclerosis.2012.07.025] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 07/10/2012] [Accepted: 07/15/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To determine whether endogenous sex hormones (estradiol (E2), testosterone (T), sex hormone binding globulin (SHBG), and follicle stimulating hormone (FSH)) are longitudinally associated with progression of atherosclerosis among women at midlife. METHODS 249 Pre- or early peri-menopausal women (42-57 years) from the Study of Women's Health Across the Nation (SWAN) were followed for up to 9 years (median = 3.7 years) and had up to 5 repeated measures of common carotid intima-media thickness (IMT) and adventitial diameter (AD). Linear mixed models were used for statistical analysis. Final models included age at baseline, time since baseline, cycle day of blood draw, race, income, SBP, BMI, insulin resistance index, lipids, C-reactive protein and co-morbidity. RESULTS In final models for IMT, each one log unit decrease in SHBG was associated with a 0.005 mm/year increase in IMT progression (P = 0.003). E2, T, and FSH were not associated with level or progression of IMT. For AD, each one log unit decrease in E2 was associated with a 0.012 mm/year increase in AD progression (P = 0.04) and each one log unit increase in FSH was associated with a 0.016 mm/year increase in AD progression (P = 0.003). T and SHBG were not associated with progression or level of AD. CONCLUSIONS Independent of SBP, BMI, lipids and other covariates, lower E2 and SHBG, and higher FSH were associated with increased subclinical atherosclerosis progression in women at midlife.
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Affiliation(s)
- Samar R. El Khoudary
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Rachel P. Wildman
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Karen Matthews
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Rebecca C. Thurston
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Joyce T. Bromberger
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Kim Sutton-Tyrrell
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
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Morrison JA, Glueck CJ, Daniels SR, Horn PS, Wang P. Determinants of ApoB, ApoA1, and the ApoB/ApoA1 ratio in healthy schoolgirls, prospectively studied from mean ages 10 to 19 years: the Cincinnati National Growth and Health Study. Metabolism 2012; 61:1377-87. [PMID: 22512822 PMCID: PMC3752903 DOI: 10.1016/j.metabol.2012.02.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 02/22/2012] [Accepted: 02/27/2012] [Indexed: 11/22/2022]
Abstract
The objectives were to prospectively assess determinants of apolipoproteins B (ApoB), A1 (ApoA1), and the ApoB/ApoA1 ratio in 797 healthy black and white schoolgirls from mean ages 10 to 19. There was prospective 9-year follow-up, with measures of ApoB at mean ages 10, 12, 14, 16 and 19, ApoA1 at mean ages 12, 14, 16, and 19, and assessment of annual reports of delayed menstrual cyclicity (≥42 days) from ages 14 to 19. Studies of 402 black and 395 white healthy schoolgirls were done in public and private schools, in urban and suburban Cincinnati. Black girls had lower ApoB, higher ApoA1, and lower ApoB/ApoA1. SHBG at age 14 in white and black girls was inversely correlated with the ApoB/ApoA1. At age 19, ≥3 annual reports of menstrual delay ≥42 days and metabolic syndrome were associated with higher ApoB and a higher ApoB/ApoA1 ratio. From ages 14 to 19, BMI and TG were independently positively associated with ApoB. Menstrual cyclicity ≥42 days, metabolic syndrome, BMI, and TG were independently positively associated with ApoB/ApoA1 ratios, while black race was negatively associated. The atherogenic ApoB/ApoA1 ratio from ages 14 to 19 is lower in black girls, and positively associated with hyperandrogenism, menstrual cyclicity ≥42 days, BMI, TG, and the metabolic syndrome, facilitating an adolescent approach to primary prevention of cardiovascular disease.
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Affiliation(s)
- John A. Morrison
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Charles J. Glueck
- Cholesterol Center, Jewish Hospital of Cincinnati, Cincinnati, OH, USA
- Corresponding author. Cholesterol Center, UC Health Business Center, 3200 Burnet Avenue, Cincinnati OH, 45229, USA. Tel.: +1 513 924 8261; fax: +1 513 924 8273
| | | | - Paul S. Horn
- Department of Mathematical Sciences, University of Cincinnati, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ping Wang
- Cholesterol Center, Jewish Hospital of Cincinnati, Cincinnati, OH, USA
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80
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Mueller NT, Odegaard AO, Gross MD, Koh WP, Yuan JM, Pereira MA. Age at menarche and cardiovascular disease mortality in Singaporean Chinese women: the Singapore Chinese Health Study. Ann Epidemiol 2012; 22:717-22. [PMID: 22939833 DOI: 10.1016/j.annepidem.2012.08.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Revised: 07/05/2012] [Accepted: 08/06/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE To examine whether age at menarche was inversely associated with cardiovascular disease (CVD) mortality in Singaporean Chinese women. METHODS We followed prospectively 34,022 Chinese women aged 45 to 74 at enrollment (1993-1998), with complete data on study variables, through 2009 for primary cause of death from CVD, including coronary heart disease (CHD) and cerebrovascular disease (CERE). Hazard ratios (HRs) for CVD mortality were computed across menarcheal age categories and adjusted for potential confounders and body mass index. RESULTS Over 460,374 person-years of follow-up, 1852 women died from CVD, 998 from CHD and 557 from CERE. There was a significant interaction between age at menarche and smoking (P < .05). In nonsmokers, age at menarche was inversely associated with risk for CVD and CHD mortality. HRs (and 95% confidence interval) for CVD mortality across menarcheal age categories (≤ 12, 13-14, 15-16, ≥ 17) were 1.06 (0.87-1.29), 1 (referent), 0.89 (0.79-1.00), and 0.80 (0.69-0.93), respectively (P(trend) < .001); HRs for CHD mortality were 1.06 (0.80-1.34), 1 (referent), 0.76 (0.65-0.90), and 0.72 (0.58-0.88), respectively (P(trend) < .001). Among nonsmokers, there was no association between age at menarche and CERE mortality. Among smokers, menarcheal age was not associated with CVD, CHD or CERE mortality. CONCLUSIONS Menarcheal age was inversely associated with risk of CVD mortality in nonsmoking Chinese women.
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Affiliation(s)
- Noel T Mueller
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN 55454, USA.
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81
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Abstract
Testosterone is increasingly used as part of postmenopausal HRT regimens. Unfortunately, few androgenic preparations designed specifically for use in women have been approved by regulatory authorities. Ongoing concerns exist surrounding the potential long-term effects of testosterone therapy. Here, we review the most recent data on postmenopausal testosterone therapy, focusing particularly on the effects of testosterone on breast, endometrium and cardiovascular health.
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Affiliation(s)
- Kate Maclaran
- West London Menopause & PMS Centre, Department of Gynaecology, Queen Charlotte's & Chelsea Hospital, Du Cane Road, London W12 0HS, UK
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82
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Polotsky AJ, Allshouse A, Crawford SL, Harlow SD, Khalil N, Santoro N, Legro RS. Relative contributions of oligomenorrhea and hyperandrogenemia to the risk of metabolic syndrome in midlife women. J Clin Endocrinol Metab 2012; 97:E868-77. [PMID: 22466350 PMCID: PMC3387411 DOI: 10.1210/jc.2011-3357] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
CONTEXT Young reproductive-age women with irregular menses and androgen excess are at high risk for unfavorable metabolic profile; however, recent data suggest that menstrual regularity and hyperandrogenism improve with aging in affected women approaching menopause. OBJECTIVE The objective of the study was to determine whether women with hyperandrogenemia (HA) and a history of oligomenorrhea (Oligo) are at an elevated risk for metabolic syndrome (MetS) at the early stages of menopausal transition. METHODS Baseline data from 2543 participants (mean age of 45.8 yr) in the Study of Women's Health Across the Nation were analyzed. Women with a lifetime history of more than one 3-month interval of nongestational and nonlactational amenorrhea were classified as having a history of Oligo. The highest tertile of serum testosterone was used to define HA. Women with normal serum androgens and eumenorrhea were used as the reference group. Logistic regression models generated adjusted odds ratios (AOR), controlling for age, ethnicity, body mass index, smoking, and study site. RESULTS Oligo was associated with MetS only when coincident with HA [AOR of 1.93 for Oligo and HA [95% confidence interval (CI) 1.17-3.17], AOR of 1.25 for Oligo and normal androgens (95% CI 0.81-1.93)]. In contrast, HA conferred a consistently significant risk for MetS, regardless of the menstrual frequency status [AOR of 1.48 for HA and eumenorrhea (95% CI 1.15-1.90)]. CONCLUSIONS Our results suggest that HA but not history of Oligo is independently associated with the risk of prevalent MetS in pre- and perimenopausal women in their 40s.
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Affiliation(s)
- Alex J Polotsky
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, Colorado 80045, USA.
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Park BJ, Shim JY, Lee YJ, Lee JH, Lee HR. Inverse relationship between bioavailable testosterone and subclinical coronary artery calcification in non-obese Korean men. Asian J Androl 2012; 14:612-5. [PMID: 22522505 DOI: 10.1038/aja.2012.19] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Although low testosterone levels in men have been associated with high risk for cardiovascular disease, little is known about the association between male sex hormones and subclinical coronary disease in men with apparently low cardiometabolic risk. This study was performed to investigate the association between male sex hormones and subclinical coronary artery calcification measured as coronary calcium score in non-obese Korean men. We examined the relationship of total testosterone, sex hormone-binding globulin, bioavailable testosterone and free testosterone with coronary calcium score in 291 non-obese Korean men (mean age: 52.8±9.3 years) not having a history of cardiovascular disease. Using multiple linear regression, we evaluated associations between log (sex hormone) levels and log (coronary calcium score) after adjusting for confounding variables in 105 men with some degree of coronary calcification defined as coronary calcium score ≥ 1. In multiple linear regression analysis, bioavailable testosterone was inversely associated with coronary calcium score (P=0.046) after adjusting for age, body mass index, smoking status, alcohol consumption, regular exercise, mean blood pressure, resting heart rate, C-reactive protein, fasting plasma glucose, total cholesterol, triglyceride, high-density lipoprotein (HDL) cholesterol, hypertension medication and hyperlipidemia medication, whereas total testosterone, sex hormone-binding globulin and free testosterone were not (P=0.674, P=0.121 and P=0.102, respectively). Our findings indicate that bioavailable testosterone is inversely associated with the degree of subclinical coronary artery calcification in non-obese men.
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Affiliation(s)
- Byoung-Jin Park
- Department of Family Medicine, Yonsei University College of Medicine, Seoul 135-720, Korea
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Pappa T, Vemmos K, Mantzou E, Savvari P, Stamatelopoulos K, Alevizaki M. Estradiol levels predict short-term adverse health outcomes in postmenopausal acute stroke women. Eur J Neurol 2012; 19:1300-4. [DOI: 10.1111/j.1468-1331.2012.03714.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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85
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Stamatelopoulos KS, Armeni E, Georgiopoulos G, Kazani M, Kyrkou K, Stellos K, Koliviras A, Alexandrou A, Creatsa M, Papamichael C, Lambrinoudaki I. Recently postmenopausal women have the same prevalence of subclinical carotid atherosclerosis as age and traditional risk factor matched men. Atherosclerosis 2012; 221:508-13. [DOI: 10.1016/j.atherosclerosis.2011.12.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Revised: 10/21/2011] [Accepted: 12/03/2011] [Indexed: 01/17/2023]
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86
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Creatsa M, Armeni E, Stamatelopoulos K, Rizos D, Georgiopoulos G, Kazani M, Alexandrou A, Dendrinos S, Augoulea A, Papamichael C, Lambrinoudaki I. Circulating androgen levels are associated with subclinical atherosclerosis and arterial stiffness in healthy recently menopausal women. Metabolism 2012; 61:193-201. [PMID: 21820132 DOI: 10.1016/j.metabol.2011.06.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Revised: 06/03/2011] [Accepted: 06/05/2011] [Indexed: 01/09/2023]
Abstract
Although increasing evidence supports an association between endogenous sex hormones and cardiovascular disease, the results still remain controversial. This study aims to examine the association between endogenous sex hormones and indices of vascular function and structure. Serum follicle-stimulating hormone, luteinizing hormone, estradiol, testosterone, sex hormone-binding globulin, dehydroepiandrosterone sulfate (DHEAS), and Δ4-androstenedione were measured in 120 healthy postmenopausal women aged 41 to 60 years. Possible associations with surrogate markers of subclinical atherosclerosis, arterial stiffness, and endothelial function were investigated. Indices of arterial structure included carotid and femoral intima-media thickness and atheromatous plaques presence. Indices of arterial function included flow-mediated dilation of the brachial artery, carotid-femoral pulse wave velocity (PWV), and augmentation index. Total testosterone and free androgen index (FAI) were the most important predictors of common carotid artery intima-media thickness (β = 0.376 and β = 0.236, P < .001 and P = .014, respectively). Similarly, FAI was the only significant independent predictor of PWV (β = 0.254, P = .027) after adjusting for age, smoking, body mass index, homeostasis model assessment of insulin resistance, and blood lipids. Free estrogen index showed a positive association with PWV, independently of age, smoking, and body mass index, but not of homeostasis model assessment of insulin resistance and blood lipids. Age-adjusted levels of DHEAS exhibited a significant independent negative association with measures of augmentation index. Follicle-stimulating hormone, luteinizing hormone, estradiol, sex hormone-binding globulin, and Δ4-androstenedione were not associated with any of the vascular parameters independently of traditional cardiovascular risk factors. Higher serum testosterone and FAI are associated with subclinical atherosclerosis in healthy recently menopausal women. This association is independent of traditional cardiovascular risk factors or insulin resistance. On the contrary, serum DHEAS exhibits a negative association with arterial stiffness.
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Affiliation(s)
- Maria Creatsa
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, GR-11528, Athens, Greece
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Effect modification of obesity on associations between endogenous steroid sex hormones and arterial calcification in women at midlife. Menopause 2011; 18:906-14. [PMID: 21471825 DOI: 10.1097/gme.0b013e3182099dd2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to examine whether obesity modifies the effects of endogenous steroid sex hormones on arterial calcification in women at midlife. METHODS Associations between estradiol, testosterone, sex hormone-binding globulin, and free androgen index and the presence and extent of coronary and aortic calcification were evaluated in 187 obese (body mass index, ≥30 kg/m) and 281 nonobese (body mass index, <30 kg/m) women from the Study of Women's Health Across the Nation. Logistic and linear regressions were used as appropriate. RESULTS Prevalence rates of coronary and aortic calcification were significantly higher among obese compared with nonobese women (P < 0.001, for both). In multivariable analyses, steroid sex hormones were not associated with the presence of coronary calcification. However, for the extent of coronary calcification, significant interactions were found between obesity and both sex hormone-binding globulin (P < 0.0001) and free androgen index (P = 0.008). In nonobese women, higher sex hormone-binding globulin (P = 0.0006) and lower free androgen index (P = 0.01) were associated with a greater extent of coronary calcification, whereas lower sex hormone-binding globulin was associated with greater extent of coronary calcification in obese women (P = 0.05). For aortic calcification outcomes, higher sex hormone-binding globulin was associated with the presence of aortic calcification among nonobese women (odds ratio, 1.64; 95% CI, 1.16-2.32, for each 1-SD greater sex hormone-binding globulin). CONCLUSIONS Associations between endogenous steroid sex hormones and arterial calcification vary by obesity status among perimenopausal women. Further research is needed to better understand the possible mechanisms of these associations.
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88
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Haring R, Travison TG, Bhasin S, Vasan RS, Wallaschofski H, Davda MN, Coviello A, Murabito JM. Relation between sex hormone concentrations, peripheral arterial disease, and change in ankle-brachial index: findings from the Framingham Heart Study. J Clin Endocrinol Metab 2011; 96:3724-32. [PMID: 21937625 PMCID: PMC3232625 DOI: 10.1210/jc.2011-1068] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 08/29/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Our objective was to investigate cross-sectional and longitudinal associations of sex hormone concentrations with ankle-brachial index (ABI) and peripheral arterial disease (PAD). METHODS AND RESULTS We used data from 3034 (1612 women) participants of the Framingham Heart Study. ABI was measured and PAD defined as ABI below 0.90, intermittent claudication, or lower extremity revascularization. Sex hormone concentrations were measured by liquid chromatography-tandem mass spectrometry [total testosterone (T), total estradiol, and estrone], immunofluorometric assay (SHBG), or calculated (free T). Sex-specific multivariable linear and logistic regression models were conducted for each sex hormone separately. Cross-sectional multivariable analyses revealed that men with lower free T and higher estrone (E1) concentrations had a significantly lower ABI [for free T, lowest vs. higher quartiles, β = -0.02, with 95% confidence interval (CI) = -0.04 to -0.001; and for E1, highest vs. lower quartiles, β = -0.02, with 95% CI = -0.04 to -0.002, respectively). Lower total T and SHBG concentrations were also associated with prevalent PAD in age-adjusted [odds ratio (OR) = 2.24, 95% CI = 1.17-4.32; and OR = 2.06; 95% CI = 1.07-3.96, lowest vs. highest quartile, respectively), but not in multivariable logistic regression models. Longitudinal multivariable analyses showed an association of lower SHBG with ABI change (decline ≥ 0.15; n = 69) in men [OR for SHBG quartiles 1, 2, and 3 as compared with quartile 4 were 2.56 (95% CI = 1.01-6.45), 2.28 (95% CI = 0.98-5.32), and 2.93 (95% CI = 1.31-6.52), respectively]. In women, none of the investigated associations yielded statistically significant estimates. CONCLUSION Our investigation of a middle-aged community-based sample suggests that sex hormone concentrations in men but not in women may be associated with PAD and ABI change.
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Affiliation(s)
- Robin Haring
- Preventive Medicine and Epidemiology Section, Boston University School of Public Health, Boston, Massachusetts 02118, USA.
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89
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Saltiki K, Stamatelopoulos K, Voidonikola P, Lazaros L, Mantzou E, Georgiou I, Anastasiou E, Papamichael C, Alevizaki M. Association of the SHBG gene promoter polymorphism with early markers of atherosclerosis in apparently healthy women. Atherosclerosis 2011; 219:205-10. [DOI: 10.1016/j.atherosclerosis.2011.06.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 06/10/2011] [Accepted: 06/29/2011] [Indexed: 11/28/2022]
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90
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Maturana MA, Moreira RMC, Spritzer PM. Lipid accumulation product (LAP) is related to androgenicity and cardiovascular risk factors in postmenopausal women. Maturitas 2011; 70:395-9. [PMID: 22018728 DOI: 10.1016/j.maturitas.2011.09.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Revised: 09/09/2011] [Accepted: 09/27/2011] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To investigate whether lipid accumulation product (LAP) is related to androgen and sex hormone binding globulin (SHBG) levels and to cardiovascular risk factors in postmenopausal women with no evidence of established cardiovascular disease. STUDY DESIGN Cross-sectional study. MAIN OUTCOME MEASURES LAP (waist-58 × triglycerides [nmol/L]), LAP ≥ arbitrary cutoff point of 34.5, serum testosterone, SHBG, ultrasensitive C-reactive protein (us-CRP). RESULTS Forty-nine women (mean age 55±5 years; median amenorrhea time 5.5 years [3-8]) were studied: 14% had the metabolic syndrome and 24.5% were hypertensive. Compared with LAP<34.5, LAP ≥ 34.5 (n=29, 59%) was associated with higher testosterone (p=0.021) and free androgen index (FAI) (p=0.003) and lower SHBG levels (p=0.013). Us-CRP (p=0.012), total cholesterol (p=0.041), glucose (p=0.020) and homeostasis model assessment (HOMA) (p=0.019) were higher, and high-density lipoprotein cholesterol (HDL-C) (p=0.001) was lower with LAP ≥ 34.5. LAP was positively correlated with total testosterone (r=0.349, p=0.014), FAI (rs=0.470, p=0.001), us-CRP (r=0.315, p=0.042), systolic (r=0.318, p=0.028) and diastolic (r=0.327, p=0.023) blood pressure, total cholesterol (r=0.498, p<0.001) and glucose (rs=0.319, p=0.026). LAP was negatively correlated with SHBG (rs=-0.430, p=0.003) and HDL-C (r=-0.319, p=0.026). CONCLUSIONS LAP index seems to be associated with androgens and SHBG and with cardiovascular risk factors in postmenopausal women. Also, LAP seems to be a suitable method to screen for cardiovascular risk in postmenopause.
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Affiliation(s)
- Maria Augusta Maturana
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
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Wehr E, Pilz S, Boehm BO, Grammer TB, März W, Obermayer-Pietsch B. Low free testosterone levels are associated with all-cause and cardiovascular mortality in postmenopausal diabetic women. Diabetes Care 2011; 34:1771-7. [PMID: 21715525 PMCID: PMC3142041 DOI: 10.2337/dc11-0596] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Hyperandrogenemia is associated with cardiovascular risk factors in women but evidence about the relationship of testosterone levels with mortality is sparse. We aimed to evaluate whether total testosterone (TT), free testosterone (FT), and sex hormone-binding globulin (SHBG) are associated with all-cause and cardiovascular mortality in a cohort of postmenopausal women. RESEARCH DESIGN AND METHODS We measured TT and SHBG levels in 875 postmenopausal women who were referred for coronary angiography (during 1997-2000). FT was calculated according to the Vermeulen method. The main outcome measures were Cox proportional hazard ratios (HRs) for mortality from all causes and from cardiovascular causes. RESULTS After a median follow-up time of 7.7 years, 179 women (20.5%) had died. There were 101 deaths due to cardiovascular disease (56.4% of all deaths). We found no association of FT, TT, and SHBG levels with mortality in all postmenopausal women. In postmenopausal diabetic women, multivariable-adjusted HRs (with 95% CIs) in the fourth compared with the first FT quartile for all-cause and cardiovascular mortality were 0.38 (0.08-0.90), P = 0.025, and 0.28 (0.08-0.90), P = 0.032, respectively. We found no association of TT and SHBG with mortality in diabetic postmenopausal women. CONCLUSIONS In postmenopausal diabetic women referred for coronary angiography, low FT levels are independently associated with increased all-cause and cardiovascular mortality.
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Affiliation(s)
- Elisabeth Wehr
- Department of Internal Medicine, Medical UniversityGraz, Graz, Austria.
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Abstract
PURPOSE OF REVIEW To examine the recent data pertaining to the relationships between testosterone and cardiovascular disease (CVD) and cancer in women. RECENT FINDINGS Despite the entrenched belief that higher blood levels of testosterone increase the risk of CVD in women, data from recent observational studies mostly show an inverse relationship between testosterone and CVD risk. One pilot study suggests favorable effects of nonoral testosterone treatment of women with established congestive cardiac failure which merits further evaluation. The relationship between endogenous testosterone production and breast cancer risk remains contentious, with recent studies indicating either no relationship, or a possible increase in risk when estrone and estradiol are not taken into account. No randomized controlled trial of testosterone therapy has been sufficiently large or of sufficient duration to establish whether such treatment may influence breast cancer occurrence. There does not appear to be an association between testosterone and endometrial cancer, or other malignancies on review of published studies. SUMMARY Testosterone is inversely associated with increased CVD risk in women, whereas low sex hormone binding globulin increases CVD risk. The relationship between testosterone and breast cancer remains unclear, although a clear signal of risk has not emerged from studies of women treated with testosterone therapy over the past decade.
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Affiliation(s)
- Susan R Davis
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Maggio M, Ceda GP, Lauretani F, Bandinelli S, Corsi AM, Giallauria F, Guralnik JM, Zuliani G, Cattabiani C, Parrino S, Ablondi F, Dall'aglio E, Ceresini G, Basaria S, Ferrucci L. SHBG, sex hormones, and inflammatory markers in older women. J Clin Endocrinol Metab 2011; 96:1053-9. [PMID: 21239514 PMCID: PMC3070258 DOI: 10.1210/jc.2010-1902] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT In premenopausal and older women, high testosterone and estradiol (E2) and low SHBG levels are associated with insulin resistance and diabetes, conditions characterized by low-grade inflammation. OBJECTIVE The aim of the study was to examine the relationship between SHBG, total testosterone, total E2, and inflammatory markers in older women. DESIGN AND PATIENTS We conducted a retrospective cross-sectional study of 433 women at least 65 yr old from the InCHIANTI Study, Italy, who were not on hormone replacement therapy or recently hospitalized and who had complete data on SHBG, testosterone, E2, C-reactive protein (CRP), IL-6, soluble IL-6 receptor (sIL-6r), and TNF-α. Relationships between sex hormones and inflammatory markers were examined by multivariate linear regression analyses adjusted for age, body mass index, smoking, insulin, physical activity, and chronic disease. RESULTS In fully adjusted analyses, SHBG was negatively associated with CRP (P = 0.007), IL-6 (P = 0.008), and sIL-6r (P = 0.02). In addition, testosterone was positively associated with CRP (P = 0.006), IL-6 (P = 0.001), and TNF-α (P = 0.0002). The negative relationship between testosterone and sIL-6r in an age-adjusted model (P = 0.02) was no longer significant in a fully adjusted model (P = 0.12). E2 was positively associated with CRP (P = 0.002) but not with IL-6 in fully adjusted models. In a final model including E2, testosterone, and SHBG, and all the confounders previously considered, SHBG (0.23 ± 0.08; P = 0.006) and E2 (0.21 ± 0.08; P = 0.007), but not testosterone (P = 0.21), were still significantly associated with CRP. CONCLUSION In late postmenopausal women not on hormone replacement therapy, SHBG and E2 are, respectively, negative and positive, independent and significant correlates of a proinflammatory state.
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Affiliation(s)
- Marcello Maggio
- Department of Internal Medicine and Biomedical Sciences, Section of Geriatrics, University of Parma, 43100 Parma, Italy.
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Abstract
The pathogenesis of coronary artery calcification and its role in atherogenesis has not been completely understood but is a new focus of interest in experimental and clinical research. Various bioactive substances, including hormones, have been implicated in the process of arterial calcification. This review considers the relationship between coronary artery calcification and hormones. These hormones may become therapeutic targets for the prevention of arterial calcification.
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Affiliation(s)
| | - Michael Henein
- Heart Centre and Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
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Abstract
OBJECTIVE Higher frequency of subclinical atherosclerosis has been linked with androgen levels in postmenopausal women. Advanced glycation end-products (AGEs) are well-recognized atherogenic molecules. Therefore, we investigated the association of postmenopausal sex steroid and metabolic status with serum AGE levels. METHODS Serum sex hormones, fasting glucose, fasting insulin, and AGEs were assessed in 106 healthy postmenopausal women. Insulin resistance was estimated by using the homeostasis model assessment of insulin resistance (HOMA-IR). RESULTS Women in the highest testosterone quartile (Q4) had higher serum AGE levels (Q1, 5.22 IU/mL ± 0.50; Q2, 5.08 ± 0.53 IU/mL; Q3, 5.78 ± 1.10 IU/mL vs Q4, 7.35 ± 1.23 IU/mL; P < 0.0005) compared with women in the lowest testosterone quartiles. Accordingly, women in the highest free androgen index (FAI) quartile had higher serum AGE levels (Q1, 5.36 ± 0.59 IU/mL; Q2, 5.28 ± 0.72 IU/mL vs Q4, 6.68 ± 1.48 IU/mL; P < 0.0005) compared with women in the lowest FAI quartile. These findings remained significant after adjustment for age, body mass index, HOMA-IR, and fasting glucose and fasting insulin levels. A highly significant correlation was found for testosterone and FAI with AGEs and persisted after adjustment for age, body mass index, HOMA-IR, and fasting glucose and fasting insulin levels (r = 0.67, P < 0.0005) CONCLUSIONS The data from the current study suggest that higher levels of AGEs are positively associated with higher androgen levels. This association, identified for the first time, may provide an additional insight into the pathophysiological mechanisms linking the described higher prevalence of cardiovascular events with higher androgen levels in postmenopausal women.
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Ventetuolo CE, Ouyang P, Bluemke DA, Tandri H, Barr RG, Bagiella E, Cappola AR, Bristow MR, Johnson C, Kronmal RA, Kizer JR, Lima JAC, Kawut SM. Sex hormones are associated with right ventricular structure and function: The MESA-right ventricle study. Am J Respir Crit Care Med 2011; 183:659-67. [PMID: 20889903 PMCID: PMC3081282 DOI: 10.1164/rccm.201007-1027oc] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Accepted: 09/30/2010] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Sex hormones have effects on the left ventricle, but hormonal influences on the right ventricle (RV) are unknown. OBJECTIVES We hypothesized that sex hormones would be associated with RV morphology in a large cohort free of cardiovascular disease. METHODS Sex hormones were measured by immunoassay and RV ejection fraction (RVEF), stroke volume (RVSV), mass, end-diastolic volume, and end-systolic volume (RVESV) were measured by cardiac magnetic resonance imaging in 1,957 men and 1,738 postmenopausal women. The relationship between each hormone and RV parameter was assessed by multivariate linear regression. MEASUREMENTS AND MAIN RESULTS Higher estradiol levels were associated with higher RVEF (β per 1 ln[nmol/L], 0.88; 95% confidence interval [CI], 0.32 to 1.43; P = 0.002) and lower RVESV (β per 1 ln[nmol/L], -0.87; 95% CI, -1.67 to -0.08; P = 0.03) in women using hormone therapy. In men, higher bioavailable testosterone levels were associated with higher RVSV (β per 1 ln[nmol/L], 1.97; 95% CI, 0.20 to 3.73; P = 0.03) and greater RV mass and volumes (P ≤ 0.01). Higher dehydroepiandrosterone levels were associated with higher RVSV (β per 1 ln[nmol/L], 1.37; 95% CI, 0.15 to 2.59; P = 0.03) and greater RV mass (β per 1 ln[nmol/L], 0.25; 95% CI, 0.00 to 0.49; P = 0.05) and volumes (P ≤ 0.001) in women. CONCLUSIONS Higher estradiol levels were associated with better RV systolic function in women using hormone therapy. Higher levels of androgens were associated with greater RV mass and volumes in both sexes.
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Affiliation(s)
- Corey E. Ventetuolo
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Pamela Ouyang
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - David A. Bluemke
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Harikrishna Tandri
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - R. Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Emilia Bagiella
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Anne R. Cappola
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Michael R. Bristow
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Craig Johnson
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Richard A. Kronmal
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Jorge R. Kizer
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Joao A. C. Lima
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Steven M. Kawut
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
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Lambrinoudaki I. Cardiovascular risk in postmenopausal women with the polycystic ovary syndrome. Maturitas 2010; 68:13-6. [PMID: 20943333 DOI: 10.1016/j.maturitas.2010.09.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 09/14/2010] [Accepted: 09/14/2010] [Indexed: 10/19/2022]
Abstract
Polycystic ovary syndrome (PCOS) is one of the commonest endocrine disorders, affecting 5-10% of the female population of reproductive age. "Classic" PCOS is characterized by clinical or biochemical hyperandrogenism and oligo-ovulation. According to the 2003 Rotterdam criteria, two additional phenotypes are recognized: (1) the ovulatory patient with androgen excess and polycystic ovarian morphology and (2) the anovulatory patient with polycystic ovarian morphology without androgen excess. PCOS is associated with an adverse cardiometabolic profile, consisting of increased total or central adiposity, increased blood pressure, a pro-atherogenic lipid profile, increased inflammatory markers, insulin resistance and abnormal glucose metabolism. Furthermore, the incidence of overt or gestational diabetes mellitus, as well as of preeclampsia is significantly higher in PCOS patients. Among the various PCOS phenotypes, those with evidence of androgen excess have the highest burden of cardiovascular risk. Studies evaluating the incidence of cardiovascular disease in postmenopausal women with PCOS are extremely sparse. The available data so far indicate that coronary heart disease, as well as cerebrovascular disease is more common in postmenopausal PCOS patients. Persisting high androgen levels through the menopause, obesity and maturity onset diabetes mellitus are proposed as the main mechanisms accounting for the increased risk.
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Affiliation(s)
- Irene Lambrinoudaki
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, 27, Themistokleous Street, Dionysos, GR-14578 Athens, Greece.
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Sievers C, Klotsche J, Pieper L, Schneider HJ, März W, Wittchen HU, Stalla GK, Mantzoros C. Low testosterone levels predict all-cause mortality and cardiovascular events in women: a prospective cohort study in German primary care patients. Eur J Endocrinol 2010; 163:699-708. [PMID: 20685832 DOI: 10.1530/eje-10-0307] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Although associations between testosterone and cardiovascular (CV) morbidity in women have been proposed, no large prospective study has evaluated potential associations between testosterone and mortality in women. The objective was to determine whether baseline testosterone levels in women are associated with future overall or CV morbidity and mortality. DESIGN Prospective cohort study with a 4.5-year follow-up period. METHODS From a representative sample of German primary care practices, 2914 female patients between 18 and 75 years were analyzed for the main outcome measures: CV risk factors, CV diseases, and all-cause mortality. RESULTS At baseline, the study population was aged 57.96±14.37 years with a mean body mass index of 26.71±5.17 kg/m(2). No predictive value of total testosterone for incident CV risk factors or CV diseases was observed in logistic regressions. Patients with total testosterone levels in the lowest quintile Q1, however, had a higher risk to die of any cause or to develop a CV event within the follow-up period compared to patients in the collapsed quintiles Q2-Q5 in crude and adjusted Cox regression models (all-cause mortality: Q2-Q5 versus Q1: crude hazard ratios (HR) 0.49, 95% confidence interval (CI) 0.33-0.74; adjusted HR 0.62, 95% CI 0.42-0.939; CV events: Q2-Q5 versus Q1: crude HR 0.54, 95% CI 0.38-0.77; adjusted HR 0.68, 95% CI 0.48-0.97). Kaplan-Meier curves revealed similar data. CONCLUSIONS Low baseline testosterone in women is associated with increased all-cause mortality and incident CV events independent of traditional risk factors.
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Affiliation(s)
- Caroline Sievers
- Department of Endocrinology, Max Planck Institute of Psychiatry, Kraepelinstrasse 2-10, Munich, Germany.
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Calderon-Margalit R, Schwartz SM, Wellons MF, Lewis CE, Daviglus ML, Schreiner PJ, Williams OD, Sternfeld B, Carr JJ, O'Leary DH, Sidney S, Friedlander Y, Siscovick DS. Prospective association of serum androgens and sex hormone-binding globulin with subclinical cardiovascular disease in young adult women: the "Coronary Artery Risk Development in Young Adults" women's study. J Clin Endocrinol Metab 2010; 95:4424-31. [PMID: 20554712 PMCID: PMC2936074 DOI: 10.1210/jc.2009-2643] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
CONTEXT The role of endogenous androgens and SHBG in the development of cardiovascular disease in young adult women is unclear. OBJECTIVE Our objective was to study the prospective association of serum androgens and SHBG with subclinical coronary and carotid disease among young to middle-aged women. DESIGN AND SETTING This was an ancillary study to the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based multicenter cohort study with 20 yr of follow-up. PARTICIPANTS Participants included 1629 women with measurements of serum testosterone and SHBG from yr 2, 10, or 16 and subclinical disease assessment at yr 20 (ages 37-52 yr). MAIN OUTCOME MEASURES Coronary artery calcified plaques (CAC) and carotid artery intima-media thickness (IMT) were assessed at yr 20. The IMT measure incorporated the common carotid arteries, bifurcations, and internal carotid arteries. RESULTS SHBG (mean of yr 2, 10, and 16) was inversely associated with the presence of CAC (multivariable adjusted odds ratio for women with SHBG levels above the median = 0.59; 95% confidence interval = 0.40-0.87; P = 0.008). SHBG was also inversely associated with the highest quartile of carotid-IMT (odds ratio for women with SHBG levels in the highest quartile = 0.56; 95% confidence interval = 0.37-0.84; P for linear trend across quartiles = 0.005). No associations were observed for total or free testosterone with either CAC or IMT. CONCLUSION SHBG levels were inversely associated with subclinical cardiovascular disease in young to middle-aged women. The extent to which low SHBG is a risk marker or has its own independent effects on atherosclerosis is yet to be determined.
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Affiliation(s)
- R Calderon-Margalit
- Departments of Epidemiology, University of Washington, Seattle, Washington 98101, USA.
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Getting to the heart of things: is endogenous estradiol associated with coronary artery calcification? Menopause 2010; 17:887-8. [PMID: 20647954 DOI: 10.1097/gme.0b013e3181eb9d3c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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