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Wang H, Li Y, Wang X, Bu J, Yan G, Lou D. Endogenous sex hormone levels and coronary heart disease risk in postmenopausal women: A meta-analysis of prospective studies. Eur J Prev Cardiol 2017; 24:600-611. [PMID: 28326829 DOI: 10.1177/2047487317693133] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Haihui Wang
- Department of Geriatrics, Shanghai Municipal Hospital of Traditional Chinese Medicine, China
| | - Yuehua Li
- Department of Geriatrics, Shanghai Municipal Hospital of Traditional Chinese Medicine, China
| | - Xinlu Wang
- Department of Geriatrics, Shanghai Municipal Hospital of Traditional Chinese Medicine, China
| | - Jianhong Bu
- Department of Geriatrics, Shanghai Municipal Hospital of Traditional Chinese Medicine, China
| | - Guoliang Yan
- Department of Geriatrics, Shanghai Municipal Hospital of Traditional Chinese Medicine, China
| | - Danfei Lou
- Department of Geriatrics, Shanghai Municipal Hospital of Traditional Chinese Medicine, China
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Karagöz A, Onat A, Aydın M, Can G, Şimşek B, Yüksel M. Distinction of hypertriglyceridemic waist phenotype from simple abdominal obesity: interaction with sex hormone-binding globulin levels to confer high coronary risk. Postgrad Med 2016; 129:288-295. [DOI: 10.1080/00325481.2017.1261608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Ahmet Karagöz
- Department of Internal Medicine, Giresun Univesity, Giresun, Turkey
| | - Altan Onat
- Departments of Cardiology and Public Health, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mesut Aydın
- Cardiology Department, Dicle Univ., Diyarbakir, Turkey
| | - Günay Can
- Departments of Cardiology and Public Health, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Barış Şimşek
- Department of Cardiology, Siyami Ersek Center for Cardiovascular Surgery, Istanbul, Turkey
| | - Murat Yüksel
- Cardiology Department, Dicle Univ., Diyarbakir, Turkey
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Hamilton EJ, Davis WA, Makepeace A, Lim EM, Yeap BB, Peters KE, Davis TME. Prevalence and prognosis of a low serum testosterone in men with type 2 diabetes: the Fremantle Diabetes Study Phase II. Clin Endocrinol (Oxf) 2016; 85:444-52. [PMID: 27106511 DOI: 10.1111/cen.13087] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/17/2016] [Accepted: 04/21/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Because published studies have usually involved imprecise assays and selected patients with limited additional data and follow-up, the consequences of a low serum testosterone in diabetes are unclear. This study assessed the prevalence, associates and prognosis of a low testosterone in community-dwelling men with type 2 diabetes. DESIGN Longitudinal observational study. PATIENTS 788 men (mean ± SD age: 65·8 ± 11·3 years) followed for 4·0 ± 1·1 years. MEASUREMENTS Serum testosterone, SHBG, erectile dysfunction (ED; Sexual Health Inventory for Men score <22), anaemia (haemoglobin <130 g/l), all-cause mortality. RESULTS The mean ± SD total serum testosterone by liquid chromatography/mass spectrometry was 13·1 ± 5·9 nmol/l (30·6% <10 nmol/l). Most men with a total testosterone <10 nmol/l (67·0%) had a normal/low serum LH. Serum testosterone was independently associated with anaemia (P < 0·001), but not ED (P = 0·80), in logistic regression models. The optimal cut-point (Youden Index) for anaemia was 9·8 nmol/l (sensitivity 53·6%, specificity 75·4%). During the follow-up, 102 men (12·9%) died. There was a U-shaped relationship between total serum testosterone quintiles and death (P = 0·003, log rank test). The middle quintile (>11·1 to ≤13·7 nmol/l) had the lowest risk and there was a 78% increased risk for highest (>16·9 nmol/l) vs lowest (≤8·6 nmol/l) quintile in Cox proportional hazards modelling (P = 0·036). Free serum testosterone and SHBG quintiles were not associated with death. CONCLUSIONS These data provide some support for the general conventional serum testosterone <10 nmol/l cut-point in identifying an increased risk of anaemia and the subsequent death in men with type 2 diabetes, but indicate that high-normal levels are also an adverse prognostic indicator.
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Affiliation(s)
- Emma J Hamilton
- School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley and Fremantle Hospitals, Murdoch and Fremantle, WA, Australia
| | - Wendy A Davis
- School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia
| | - Ashley Makepeace
- School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley and Fremantle Hospitals, Murdoch and Fremantle, WA, Australia
| | - Ee Mun Lim
- Department of Biochemistry, PathWest Laboratory Medicine WA, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Bu B Yeap
- School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley and Fremantle Hospitals, Murdoch and Fremantle, WA, Australia
| | - Kirsten E Peters
- School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia
| | - Timothy M E Davis
- School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia
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Daan NMP, Muka T, Koster MPH, Roeters van Lennep JE, Lambalk CB, Laven JSE, Fauser CGKM, Meun C, de Rijke YB, Boersma E, Franco OH, Kavousi M, Fauser BCJM. Cardiovascular Risk in Women With Premature Ovarian Insufficiency Compared to Premenopausal Women at Middle Age. J Clin Endocrinol Metab 2016; 101:3306-15. [PMID: 27300572 DOI: 10.1210/jc.2016-1141] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT A young age at menopause has been associated with increased cardiovascular disease (CVD) risk. OBJECTIVE To compare the cardiovascular risk profile between women with premature ovarian insufficiency (POI) and premenopausal controls of comparable age. DESIGN Cross-sectional case control study. SETTING Two university medical centers. PARTICIPANTS Women above 45 years of age who were previously diagnosed with POI (n = 83) and premenopausal population controls of comparable age (n = 266). MAIN OUTCOME MEASURES Blood pressure, body mass index, waist circumference, electrocardiogram, bilateral carotid intima media thickness, estradiol, T, androstenedione, dehydroepiandrosterone sulfate, SHBG, insulin, glucose, lipids, TSH, free T4, N-terminal pro-B-type natriuretic peptide, C-reactive protein, uric acid, creatinine, and homocysteine were measured. Potential associations between POI status and subclinical atherosclerosis were assessed. RESULTS Women with POI exhibited an increased waist circumference (β = 5.7; 95% confidence interval [CI], 1.6, 9.9), C-reactive protein (β = 0.75; 95% CI, 0.43, 1.08), free T4 levels (β = 1.5; 95% CI, 0.6, 2.4), and lower N-terminal pro-B-type natriuretic peptide (β = -0.35; 95% CI, -0.62, -0.08), estradiol (β = -1.98; 95% CI, -2.48, -1.48), T (β = -0.21; 95% CI, -0.37, -0.06), and androstenedione (β = -0.54; 95% CI, -0.71, -0.38) concentrations compared to controls, after adjusting for confounders. After adjustment, a trend toward increased hypertension (odds ratio = 2.1; 95% CI, 0.99; 4.56) and decreased kidney function was observed in women with POI (creatinine β = 3.5; 95% CI, -0.05, 7.1; glomerular filtration rate β = -3.5; 95% CI, -7.5, 0.46). Women with POI exhibited a lower mean carotid intima media thickness (β = -0.17; 95% CI, -0.21, -0.13) and decreased odds of plaque presence compared to controls (odds ratio = 0.08; 95% CI, 0.03; 0.26). CONCLUSIONS Women with POI exhibited an unfavorable cardiovascular risk profile, including higher abdominal fat, elevated chronic inflammatory factors, and a trend toward increased hypertension and impaired kidney function compared to controls. However, we observed no signs of increased subclinical atherosclerosis in women with POI. Additional studies are required to identify specific determinants of long-term CVD risk in women with POI.
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Affiliation(s)
- Nadine M P Daan
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - Taulant Muka
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - Maria P H Koster
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - Jaenine E Roeters van Lennep
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - Cornelis B Lambalk
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - Joop S E Laven
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - Clemens G K M Fauser
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - Cindy Meun
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - Yolanda B de Rijke
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - Bart C J M Fauser
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
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Associations of androgens with health care utilization and costs in women—Perspectives of a population-based cohort study. Maturitas 2016; 89:5-8. [DOI: 10.1016/j.maturitas.2016.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/29/2016] [Accepted: 04/02/2016] [Indexed: 11/24/2022]
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Rech CMZ, Clapauch R, de Souza MDGC, Bouskela E. Low testosterone levels are associated with endothelial dysfunction in oophorectomized early postmenopausal women. Eur J Endocrinol 2016; 174:297-306. [PMID: 26773076 DOI: 10.1530/eje-15-0878] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The actual consequences of low testosterone levels in women remain uncertain. OBJECTIVE To assess endogenous testosterone influence on body composition, vascular and metabolic function in recent postmenopausal women. DESIGN We studied 81 postmenopausal women under transdermal estradiol (E2) replacement therapy, 36 with bilateral oophorectomy (group O), and 45 controls (group C) through venous occlusion plethysmography, bioimpedance, DEXA, biochemical, hormonal, and inflammatory profile. RESULTS Total testosterone level (TT) in group O was 11.0 (4.0-17.75) vs 23.0 (10.0-42.5) ng/dl in group C (P=0.001). Forearm blood flow, in ml/min/100 ml tissue, was lower in group O compared to group C at baseline (1.57 (1.05-2.47) vs 2.19 (1.59-2.66) P=0.036), following reactive hyperemia response (endothelium-dependent flow mediated dilatation, 3.44 (2.38-4.35) vs 4.3 (3.09-5.52), P=0.031) and following nitroglycerin (endothelium-independent dilation, 1.39 (0.99-1.7) vs 1.76 (1.15-2.0), P=0.025), with a positive correlation between TT and all parameters except for the reactive hyperemia response (r=0.233-0.312, P=0.036-0.004). The sVCAM1 levels were negatively correlated with TT (r=-0.320, P=0.005). E2 and other hormone levels, biochemical parameters and body composition did not differ between groups. Multiple linear regressions showed that the levels of TT, compared with other confounding variables, may explain the variation observed on endothelial parameters, with low explanatory power. CONCLUSION The absence of ovarian testosterone production in recent postmenopausal oophorectomized women was associated with deleterious effects on endothelial function.
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Affiliation(s)
- Ciciliana Maíla Zilio Rech
- Laboratory for Clinical and Experimental Research on Vascular Biology (BIOVASC)Biomedical Center, State University of Rio de Janeiro, São Francisco Xavier Street, 524. Pavilhão Haroldo Lisboa, BIOVASC, UERJ, Rio de Janeiro, BrazilHospital da LagoaJardim Botânico Street, 501, Endocrinology Sector, Health Ministry, Rio de Janeiro, Brazil
| | - Ruth Clapauch
- Laboratory for Clinical and Experimental Research on Vascular Biology (BIOVASC)Biomedical Center, State University of Rio de Janeiro, São Francisco Xavier Street, 524. Pavilhão Haroldo Lisboa, BIOVASC, UERJ, Rio de Janeiro, BrazilHospital da LagoaJardim Botânico Street, 501, Endocrinology Sector, Health Ministry, Rio de Janeiro, Brazil Laboratory for Clinical and Experimental Research on Vascular Biology (BIOVASC)Biomedical Center, State University of Rio de Janeiro, São Francisco Xavier Street, 524. Pavilhão Haroldo Lisboa, BIOVASC, UERJ, Rio de Janeiro, BrazilHospital da LagoaJardim Botânico Street, 501, Endocrinology Sector, Health Ministry, Rio de Janeiro, Brazil
| | - Maria das Graças Coelho de Souza
- Laboratory for Clinical and Experimental Research on Vascular Biology (BIOVASC)Biomedical Center, State University of Rio de Janeiro, São Francisco Xavier Street, 524. Pavilhão Haroldo Lisboa, BIOVASC, UERJ, Rio de Janeiro, BrazilHospital da LagoaJardim Botânico Street, 501, Endocrinology Sector, Health Ministry, Rio de Janeiro, Brazil
| | - Eliete Bouskela
- Laboratory for Clinical and Experimental Research on Vascular Biology (BIOVASC)Biomedical Center, State University of Rio de Janeiro, São Francisco Xavier Street, 524. Pavilhão Haroldo Lisboa, BIOVASC, UERJ, Rio de Janeiro, BrazilHospital da LagoaJardim Botânico Street, 501, Endocrinology Sector, Health Ministry, Rio de Janeiro, Brazil
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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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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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Association between duration of reproductive lifespan and Framingham risk score in postmenopausal women. Maturitas 2015; 82:431-5. [DOI: 10.1016/j.maturitas.2015.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/09/2015] [Accepted: 07/10/2015] [Indexed: 11/19/2022]
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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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Kim C, Cushman M, Khodneva Y, Lisabeth LD, Judd S, Kleindorfer DO, Howard VJ, Safford MM. Risk of Incident Coronary Heart Disease Events in Men Compared to Women by Menopause Type and Race. J Am Heart Assoc 2015; 4:JAHA.115.001881. [PMID: 26133958 PMCID: PMC4608073 DOI: 10.1161/jaha.115.001881] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background We examined whether type of menopause affects sex differences in coronary heart disease (CHD) events and whether the impact is similar in blacks and whites. Methods and Results Participants were enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort between 2003 and 2007 without CHD at baseline (n=23 086). Cox regression models were used to calculate the hazard of incident nonfatal CHD (definite or probable myocardial infarction) and acute CHD death, adjusting for age, age at last menstrual period <45 years, region, education level, income, diabetes, smoking, systolic blood pressure, lipid levels, albumin-creatinine ratio, physical activity, C-reactive protein, body mass index, waist circumference, and medication use. White women in natural menopause (hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.31, 0.66) and surgical menopause (HR, 0.65; 95% CI, 0.42, 0.99) had a reduced hazard of nonfatal events, compared to white men. Black women in natural menopause (HR, 0.69; 95% CI, 0.47, 1.03), but not surgical menopause (HR, 0.81; 95% CI, 0.51, 1.29), had a marginally reduced hazard of nonfatal events, compared to black men. Women had lower risk of acute CHD death than men regardless of their menopause type and race. Conclusions Sex differences in the risk of incident CHD events were larger among whites than blacks and varied by type of menopause. Women consistently had a lower risk of incident CHD death than men, but the magnitude of sex differences was greater in whites than blacks for nonfatal events, regardless of menopause type.
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Affiliation(s)
- Catherine Kim
- Departments of Medicine and Obstetrics & Gynecology, University of MichiganAnn Arbor, MI
- Correspondence to: Catherine Kim, MD, MPH, 2800 Plymouth Rd, Building 16, Room 430W, Ann Arbor, MI 48109. E-mail:
| | - Mary Cushman
- Department of Medicine, University of VermontBurlington, VT
| | - Yulia Khodneva
- Division of Preventive Medicine, University of Alabama at BirminghamAL
| | - Lynda D Lisabeth
- Department of Epidemiology, University of Michigan School of Public HealthAnn Arbor, MI
| | - Suzanne Judd
- Department of Epidemiology, University of Alabama at BirminghamAL
| | | | | | - Monika M Safford
- Division of Preventive Medicine, University of Alabama at BirminghamAL
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Liu K, Shen C, Chen X. Expression of androgen receptor in coronary artery in the cases of sudden coronary death. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:3742-3747. [PMID: 26097556 PMCID: PMC4466943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/23/2015] [Indexed: 06/04/2023]
Abstract
To study the expression of androgen receptor (AR) in the cases of sudden death caused by coronary heart disease (CHD) and relationship between AR and sudden coronary death (SCD) to explore the mechanism of the development of coronary atherosclerosis and provide references for the prevent and treatment of CHD and medicolegal identification of SCD. 53 cases selected from the autopsied cases in our department from 2011 to 2012 were divided into 3 groups: 18 case of SCD, including 11 males and 7 females, as experimental group, another 18 cases, including 11 males and 7 females, with CHD but died of mechanical injuries and poisoning as control group I, and 17 cases without CHD who also died of mechanical injuries and poisoning including 10 males and 7 females, as control group II. After HE-stained and immunohistochemistry-stained (SP) for the slices, the expression of AR in coronary arteries were observed and the average optical density (AOD) of positive signal in each case were detected by using Image-Pro Plus 6.0 software. We found strongly positive expression of AR in control group II, weakly positive expression in control group I and a little weaker in the experimental group. The expression of AR in coronary artery was reduced in CHD patients, which suggested that androgen may have favorable effects on the cardiovascular system.
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Affiliation(s)
- Kaiyi Liu
- Department of Forensic Pathology, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430030, China
- Department of Pathology, Meizhou People’s HospitalMeizhou 514031, China
| | - Chunyu Shen
- Department of Forensic Pathology, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430030, China
- Department of Molecular Pharmacology and Physiology, University of South FloridaTampa, 33620 FL, USA
| | - Xinshan Chen
- Department of Forensic Pathology, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430030, China
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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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Benn M, Voss SS, Holmegard HN, Jensen GB, Tybjærg-Hansen A, Nordestgaard BG. Extreme Concentrations of Endogenous Sex Hormones, Ischemic Heart Disease, and Death in Women. Arterioscler Thromb Vasc Biol 2015; 35:471-7. [DOI: 10.1161/atvbaha.114.304821] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marianne Benn
- From the Department of Clinical Biochemistry, Gentofte Hospital (M.B., H.N.H.), Department of Clinical Biochemistry, Herlev Hospital (S.S.V., B.G.N.), Department of Clinical Biochemistry, Rigshospitalet (A.T.-H.), and The Copenhagen City Heart Study, Frederiksberg Hospital (M.B., G.B.J., A.T.-H., B.G.N.), and Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark (M.B., A.T.-H., B.G.N.)
| | - Sidsel Skou Voss
- From the Department of Clinical Biochemistry, Gentofte Hospital (M.B., H.N.H.), Department of Clinical Biochemistry, Herlev Hospital (S.S.V., B.G.N.), Department of Clinical Biochemistry, Rigshospitalet (A.T.-H.), and The Copenhagen City Heart Study, Frederiksberg Hospital (M.B., G.B.J., A.T.-H., B.G.N.), and Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark (M.B., A.T.-H., B.G.N.)
| | - Haya N. Holmegard
- From the Department of Clinical Biochemistry, Gentofte Hospital (M.B., H.N.H.), Department of Clinical Biochemistry, Herlev Hospital (S.S.V., B.G.N.), Department of Clinical Biochemistry, Rigshospitalet (A.T.-H.), and The Copenhagen City Heart Study, Frederiksberg Hospital (M.B., G.B.J., A.T.-H., B.G.N.), and Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark (M.B., A.T.-H., B.G.N.)
| | - Gorm B. Jensen
- From the Department of Clinical Biochemistry, Gentofte Hospital (M.B., H.N.H.), Department of Clinical Biochemistry, Herlev Hospital (S.S.V., B.G.N.), Department of Clinical Biochemistry, Rigshospitalet (A.T.-H.), and The Copenhagen City Heart Study, Frederiksberg Hospital (M.B., G.B.J., A.T.-H., B.G.N.), and Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark (M.B., A.T.-H., B.G.N.)
| | - Anne Tybjærg-Hansen
- From the Department of Clinical Biochemistry, Gentofte Hospital (M.B., H.N.H.), Department of Clinical Biochemistry, Herlev Hospital (S.S.V., B.G.N.), Department of Clinical Biochemistry, Rigshospitalet (A.T.-H.), and The Copenhagen City Heart Study, Frederiksberg Hospital (M.B., G.B.J., A.T.-H., B.G.N.), and Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark (M.B., A.T.-H., B.G.N.)
| | - Børge G. Nordestgaard
- From the Department of Clinical Biochemistry, Gentofte Hospital (M.B., H.N.H.), Department of Clinical Biochemistry, Herlev Hospital (S.S.V., B.G.N.), Department of Clinical Biochemistry, Rigshospitalet (A.T.-H.), and The Copenhagen City Heart Study, Frederiksberg Hospital (M.B., G.B.J., A.T.-H., B.G.N.), and Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark (M.B., A.T.-H., B.G.N.)
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Fagman JB, Wilhelmson AS, Motta BM, Pirazzi C, Alexanderson C, De Gendt K, Verhoeven G, Holmäng A, Anesten F, Jansson JO, Levin M, Borén J, Ohlsson C, Krettek A, Romeo S, Tivesten Å. The androgen receptor confers protection against diet-induced atherosclerosis, obesity, and dyslipidemia in female mice. FASEB J 2014; 29:1540-50. [PMID: 25550469 PMCID: PMC4470404 DOI: 10.1096/fj.14-259234] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 12/09/2014] [Indexed: 12/13/2022]
Abstract
Androgens have important cardiometabolic actions in males, but their metabolic role in females is unclear. To determine the physiologic androgen receptor (AR)–dependent actions of androgens on atherogenesis in female mice, we generated female AR-knockout (ARKO) mice on an atherosclerosis-prone apolipoprotein E (apoE)–deficient background. After 8 weeks on a high-fat diet, but not on a normal chow diet, atherosclerosis in aorta was increased in ARKO females (+59% vs. control apoE-deficient mice with intact AR gene). They also displayed increased body weight (+18%), body fat percentage (+62%), and hepatic triglyceride levels, reduced insulin sensitivity, and a marked atherogenic dyslipidemia (serum cholesterol, +52%). Differences in atherosclerosis, body weight, and lipid levels between ARKO and control mice were abolished in mice that were ovariectomized before puberty, consistent with a protective action of ovarian androgens mediated via the AR. Furthermore, the AR agonist dihydrotestosterone reduced atherosclerosis (−41%; thoracic aorta), subcutaneous fat mass (−44%), and cholesterol levels (−35%) in ovariectomized mice, reduced hepatocyte lipid accumulation in hepatoma cells in vitro, and regulated mRNA expression of hepatic genes pivotal for lipid homeostasis. In conclusion, we demonstrate that the AR protects against diet-induced atherosclerosis in female mice and propose that this is mediated by modulation of body composition and lipid metabolism.—Fagman, J. B., Wilhelmson, A. S., Motta, B. M., Pirazzi, C., Alexanderson, C., De Gendt, K., Verhoeven, G., Holmäng, A., Anesten, F., Jansson, J.-O., Levin, M., Borén, J., Ohlsson, C., Krettek, A., Romeo, S., Tivesten, A. The androgen receptor confers protection against diet-induced atherosclerosis, obesity, and dyslipidemia in female mice.
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Affiliation(s)
- Johan B Fagman
- *Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Laboratory for Experimental Medicine and Endocrinology, Department of Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Physiology, Institute of Neuroscience and Physiology, and Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Nordic School of Public Health, Gothenburg, Sweden; and Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna S Wilhelmson
- *Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Laboratory for Experimental Medicine and Endocrinology, Department of Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Physiology, Institute of Neuroscience and Physiology, and Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Nordic School of Public Health, Gothenburg, Sweden; and Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Benedetta M Motta
- *Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Laboratory for Experimental Medicine and Endocrinology, Department of Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Physiology, Institute of Neuroscience and Physiology, and Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Nordic School of Public Health, Gothenburg, Sweden; and Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carlo Pirazzi
- *Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Laboratory for Experimental Medicine and Endocrinology, Department of Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Physiology, Institute of Neuroscience and Physiology, and Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Nordic School of Public Health, Gothenburg, Sweden; and Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Camilla Alexanderson
- *Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Laboratory for Experimental Medicine and Endocrinology, Department of Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Physiology, Institute of Neuroscience and Physiology, and Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Nordic School of Public Health, Gothenburg, Sweden; and Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karel De Gendt
- *Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Laboratory for Experimental Medicine and Endocrinology, Department of Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Physiology, Institute of Neuroscience and Physiology, and Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Nordic School of Public Health, Gothenburg, Sweden; and Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Guido Verhoeven
- *Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Laboratory for Experimental Medicine and Endocrinology, Department of Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Physiology, Institute of Neuroscience and Physiology, and Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Nordic School of Public Health, Gothenburg, Sweden; and Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Agneta Holmäng
- *Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Laboratory for Experimental Medicine and Endocrinology, Department of Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Physiology, Institute of Neuroscience and Physiology, and Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Nordic School of Public Health, Gothenburg, Sweden; and Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Fredrik Anesten
- *Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Laboratory for Experimental Medicine and Endocrinology, Department of Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Physiology, Institute of Neuroscience and Physiology, and Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Nordic School of Public Health, Gothenburg, Sweden; and Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - John-Olov Jansson
- *Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Laboratory for Experimental Medicine and Endocrinology, Department of Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Physiology, Institute of Neuroscience and Physiology, and Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Nordic School of Public Health, Gothenburg, Sweden; and Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Malin Levin
- *Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Laboratory for Experimental Medicine and Endocrinology, Department of Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Physiology, Institute of Neuroscience and Physiology, and Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Nordic School of Public Health, Gothenburg, Sweden; and Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Borén
- *Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Laboratory for Experimental Medicine and Endocrinology, Department of Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Physiology, Institute of Neuroscience and Physiology, and Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Nordic School of Public Health, Gothenburg, Sweden; and Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Claes Ohlsson
- *Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Laboratory for Experimental Medicine and Endocrinology, Department of Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Physiology, Institute of Neuroscience and Physiology, and Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Nordic School of Public Health, Gothenburg, Sweden; and Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alexandra Krettek
- *Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Laboratory for Experimental Medicine and Endocrinology, Department of Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Physiology, Institute of Neuroscience and Physiology, and Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Nordic School of Public Health, Gothenburg, Sweden; and Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stefano Romeo
- *Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Laboratory for Experimental Medicine and Endocrinology, Department of Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Physiology, Institute of Neuroscience and Physiology, and Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Nordic School of Public Health, Gothenburg, Sweden; and Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Åsa Tivesten
- *Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Laboratory for Experimental Medicine and Endocrinology, Department of Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Physiology, Institute of Neuroscience and Physiology, and Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Nordic School of Public Health, Gothenburg, Sweden; and Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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68
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Vandenberg LN, Bowler AG. Non-monotonic dose responses in EDSP Tier 1 guideline assays. ACTA ACUST UNITED AC 2014. [DOI: 10.4161/23273739.2014.964530] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Pietrzak A, Czuczwar P, Mosiewicz J, Paszkowski T, Chodorowska G, Bartosinska J, Gerkowicz A, Paluszkiewicz P, Freud T, Cohen AD. Cardiovascular disease in psoriatic post-menopausal women. J Eur Acad Dermatol Venereol 2014; 29:1231-4. [PMID: 25073722 DOI: 10.1111/jdv.12620] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 05/26/2014] [Accepted: 06/06/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND It is generally accepted that the risk of cardiovascular disease (CVD) in women is significantly increased after the menopause. Hormonal changes associated with the menopausal transition may also alter the course of autoimmune diseases. It has been reported that menopause may exacerbate the symptoms of rheumatoid arthritis, systemic sclerosis and giant cell arteritis, but attenuate the course of systemic lupus erythemathosus. There is a growing body of literature indicating that the course of psoriasis may be altered by menopausal hormone changes. Considering the fact that both psoriasis and menopause are independent risk factors for CVD, and that menopause may exacerbate the course of psoriasis, a possible additive effect between these two conditions may be crucial for proper monitoring and treatment of peri- and post-menopausal psoriatic patients. OBJECTIVE The aim of this study is to analyse potential relationship between psoriasis, menopausal status and risk of CVD. MATERIALS AND METHODS A retrospective analysis of the Clalit Health Services database was performed in an attempt to provide new data and the available literature concerning these issues was reviewed. Data on cardiovascular events in 10 872 female psoriatic patients and 19 471 controls were extracted and compared. RESULTS In both psoriatic and control patients the association of CVD increased with age. The association of CVD was significantly greater in psoriatic patients, but no significant differences were found between any of age groups. CONCLUSIONS The association of psoriasis and CVD in women increases with age but there is insufficient evidence to confirm that menopause increases the risk of psoriasis. Further studies directly addressing this issue are needed.
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Affiliation(s)
- A Pietrzak
- Chair and Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - P Czuczwar
- 3rd Chair and Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - J Mosiewicz
- Chair and Department of Internal Medicine, Medical University of Lublin, Lublin, Poland
| | - T Paszkowski
- 3rd Chair and Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - G Chodorowska
- 3rd Chair and Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - J Bartosinska
- 3rd Chair and Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - A Gerkowicz
- 3rd Chair and Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - P Paluszkiewicz
- Department of Surgery and Surgical Nursing, Medical University of Lublin, Lublin, Poland
| | - T Freud
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - A D Cohen
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel.,Chief Physician Office, Central Headquarters, Clalit Health Services, Tel Aviv, Israel
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70
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Yuki A, Ando F, Otsuka R, Shimokata H. Low free testosterone is associated with loss of appendicular muscle mass in Japanese community-dwelling women. Geriatr Gerontol Int 2014; 15:326-33. [DOI: 10.1111/ggi.12278] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Atsumu Yuki
- Faculty of Education; Kochi University; Kochi Japan
| | - Fujiko Ando
- Faculty of Health and Medical Sciences; Aichi Shukutoku University; Nagakute Japan
| | - Rei Otsuka
- Section of the NILS-LSA; National Center for Geriatrics and Gerontology; Obu Japan
| | - Hiroshi Shimokata
- Graduate School of Nutritional Sciences; Nagoya University of Arts and Sciences; Nisshin Japan
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71
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Spoletini I, Vitale C, Pelliccia F, Fossati C, Rosano GMC. Androgens and cardiovascular disease in postmenopausal women: a systematic review. Climacteric 2014; 17:625-34. [DOI: 10.3109/13697137.2014.887669] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Dousdampanis P, Trigka K, Fourtounas C, Bargman JM. Role of testosterone in the pathogenesis, progression, prognosis and comorbidity of men with chronic kidney disease. Ther Apher Dial 2013; 18:220-30. [PMID: 24119223 DOI: 10.1111/1744-9987.12101] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Testosterone deficiency and hypogonadism are common conditions in men with chronic kidney disease (CKD). A disturbed hypothalamic-pituitary-gonadal axis due to CKD is thought to contribute to androgen deficiency. Data from experimental studies support the hypothesis that exogenous administration of testosterone may induce the activation of the renin-angiotensin system (RAS), the production of endothelin and the regulation of anti- or/and proinflammatory cytokines involved in the pathogenesis of hypertension and kidney damage. On the other hand, low testosterone levels in male patients with CKD are paradoxically associated with a higher risk of morbidity and mortality, possibly explained by anemia, osteoporosis and cardiovascular disease. In this article, we present an overview of clinical and experimental studies of the impact of testosterone on the progression and prognosis of male patients with CKD; even today, this remains a controversial issue.
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74
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Shiraki N, Nakashima A, Doi S, Carrero JJ, Sugiya N, Ueno T, Stenvinkel P, Kohno N, Masaki T. Low serum testosterone is associated with atherosclerosis in postmenopausal women undergoing hemodialysis. Clin Exp Nephrol 2013; 18:499-506. [DOI: 10.1007/s10157-013-0840-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 07/03/2013] [Indexed: 12/17/2022]
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75
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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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76
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Barrett-Connor E. The Rancho Bernardo Study: 40 years studying why women have less heart disease than men and how diabetes modifies women's usual cardiac protection. Glob Heart 2013; 8:S2211-8160(12)00262-1. [PMID: 24187655 PMCID: PMC3810980 DOI: 10.1016/j.gheart.2012.12.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Forty years ago, few cohort studies of cardiovascular disease (CVD) included women and fewer still included diabetes or glycemia as a risk factor. I describe here the Rancho Bernardo Study (RBS), a single-site, >40-year cohort study of sex differences in heart disease and how diabetes modifies women's natural cardioprotection. More than 6000 participants were followed for morbidity and mortality, with nearly 3000 survivors (and death certificates for >85% of decedents). In RBS more than half of diabetes was undiagnosed without an oral glucose tolerance test (OGTT); more women than men had isolated post-challenge hyperglycemia (IPH) as their only glucose evidence of diabetes; men had more diabetes than women, with higher fasting but lower post-challenge glucose levels than women; women with diabetes had more classical CVD risk factors than men; excess risk-factor clustering partially explained how diabetes eradicates female cardioprotection. Post-challenge glucose was a stronger CVD risk factor than fasting glucose. Endogenous insulin was not an independent CVD risk factor in women or men. Men with higher testosterone levels developed less diabetes and had fewer metabolic syndrome components. In men higher total testosterone levels predicted a reduced risk of all-cause and CVD but not cancer mortality. In women both extremes of bioavailable testosterone predicted fatal coronary heart disease but not all-cause mortality. Summary point estimates from large systematic reviews of individual data have replicated most RBS findings. Ongoing research can further clarify how diabetes modifies women's cardioprotection from mid-life to old age.
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Affiliation(s)
- Elizabeth Barrett-Connor
- Division of Epidemiology, Department of Family and Preventive Medicine, University of California, San Diego
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77
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Atkin SL. Cardiovascular disease in polycystic ovary syndrome. Clin Endocrinol (Oxf) 2013; 78:823-4. [PMID: 23362921 DOI: 10.1111/cen.12151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 12/06/2012] [Accepted: 01/10/2013] [Indexed: 01/20/2023]
Affiliation(s)
- S L Atkin
- Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, Michael White Diabetes Centre, Hull, UK.
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78
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Barrett-Connor E. Menopause, atherosclerosis, and coronary artery disease. Curr Opin Pharmacol 2013; 13:186-91. [PMID: 23352690 DOI: 10.1016/j.coph.2013.01.005] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 01/04/2013] [Accepted: 01/07/2013] [Indexed: 11/18/2022]
Abstract
Women have coronary heart disease (CHD) later than men. This review describes studies of CHD risk factors or outcomes based on studies of premenopausal women followed through the menopause transition, and prospective cohort studies of younger or older women with CHD risk markers or disease outcomes in the context of their menopause history. Major early reports from both types of studies are included in order to put more recent work in context. Most attention has been paid to the Healthy Women Study (HWS), Study of Women's Health across the Nation (SWAN), the Nurses' Health Study (NHS), and the Rancho Bernardo Study (RBS) because they continue to produce recent publications designed to distinguish the effect of age from the effect of menopause. Understanding these differences has important implications for women's cardiovascular health, but remains incomplete. Transition studies have relatively short (<10 years) follow-up and exclude women with surgical menopause. Cohort studies suggest that women with oophorectomy are at greater risk for CHD than intact women, pointing to a greater risk from testosterone deficiency than from estradiol levels.
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Affiliation(s)
- Elizabeth Barrett-Connor
- Division of Epidemiology, Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA 92093-0607, USA.
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79
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Carrero JJ, Stenvinkel P. The vulnerable man: impact of testosterone deficiency on the uraemic phenotype. Nephrol Dial Transplant 2012; 27:4030-41. [PMID: 22962412 DOI: 10.1093/ndt/gfs383] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Testosterone deficiency or hypogonadism is a common finding in men undergoing dialysis, to a great extent a consequence of the failing kidney per se. Testosterone restoration in hypogonadism is common practice among endocrinologists. However, there is currently little awareness of this condition among both uremic patients and nephrologists, and in many cases, testosterone deficiency remains unscreened and untreated. This review article summarizes our current understanding of the role of testosterone deficiency at the crossroad of cardiometabolic complications of patients with chronic kidney disease. Pathways discussed include, among others, the plausible role of testosterone deficiency in the development of anaemia and ESA hyporesponsiveness, muscle catabolism, endothelial dysfunction, cognitive dysfunction, decreased libido, cardiovascular disease and mortality. As there are limited sources to guide decision-making, we also review existing testosterone replacement therapy studies in the context of CKD as well as considerations for side and adverse effects. This review makes a case for consideration of screening and better management of hypogonadism in men undergoing dialysis.
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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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81
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Scarabin-Carré V, Canonico M, Brailly-Tabard S, Trabado S, Ducimetière P, Giroud M, Ryan J, Helmer C, Plu-Bureau G, Guiochon-Mantel A, Scarabin PY. High level of plasma estradiol as a new predictor of ischemic arterial disease in older postmenopausal women: the three-city cohort study. J Am Heart Assoc 2012; 1:e001388. [PMID: 23130139 PMCID: PMC3487322 DOI: 10.1161/jaha.112.001388] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 04/24/2012] [Indexed: 12/17/2022]
Abstract
Background Despite evidence that estrogens may be involved in atherothrombosis, the role of endogenous sex steroid hormones in ischemic arterial disease among postmenopausal women remains uncertain. Methods and Results In the Three-City prospective cohort study of subjects (n=9294) >65 years of age, we investigated the association of total 17β-estradiol, bioavailable 17β-estradiol, and total testosterone with the 4-year incidence of ischemic arterial disease among postmenopausal women who did not use any hormone therapy. We designed a case–cohort study including a random sample of 537 subjects and 106 incident cases of first cardiovascular events. Weighted Cox proportional-hazards models with age as the time scale were used to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) for ischemic arterial disease by a 1–standard deviation increase in sex steroid hormones. In univariate analysis, HR of ischemic arterial disease was positively and significantly associated with both total and bioavailable estradiol levels. These associations remained significant after adjustment for traditional cardiovascular risk factors, including body mass index, diabetes, hypercholesterolemia, hypertension, and smoking status (HR: 1.42, 95% CI: 1.12–1.79, P<0.01; and HR: 1.42, 95% CI: 1.12–1.78, P<0.01, respectively). Separate analysis for coronary heart disease yielded similar results (adjusted HR: 1.49, 95% CI: 1.10–2.02, P=0.01; and adjusted HR: 1.50, 95% CI: 1.11–2.04, P<0.01, respectively), and a borderline significant trend was observed for ischemic stroke (HR: 1.34, 95% CI: 0.95–1.89, P=0.08; and HR: 1.32, 95% CI: 0.94–1.84, P=0.11, respectively). By contrast, no significant association was found between total testosterone and ischemic arterial disease in both univariate and adjusted analyses. Conclusions High plasma level of endogenous estradiol emerges as a new predictor of ischemic arterial disease in older postmenopausal women. (J Am Heart Assoc. 2012;1:e001388 doi: 10.1161/JAHA.112.001388.)
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Affiliation(s)
- Valérie Scarabin-Carré
- Centre for Research in Epidemiology and Population Health, Inserm Unit 1018, Hormones and Cardiovascular Disease, Villejuif, France (V.S., M.C., G.P.-B., P.-Y.S.) ; Université Paris-Sud, UMR-S 1018, Villejuif, France (V.S., M.C., P.D., P.-Y.S.)
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82
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Vandenberg LN, Colborn T, Hayes TB, Heindel JJ, Jacobs DR, Lee DH, Shioda T, Soto AM, vom Saal FS, Welshons WV, Zoeller RT, Myers JP. Hormones and endocrine-disrupting chemicals: low-dose effects and nonmonotonic dose responses. Endocr Rev 2012; 33:378-455. [PMID: 22419778 PMCID: PMC3365860 DOI: 10.1210/er.2011-1050] [Citation(s) in RCA: 1986] [Impact Index Per Article: 165.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 02/07/2012] [Indexed: 02/08/2023]
Abstract
For decades, studies of endocrine-disrupting chemicals (EDCs) have challenged traditional concepts in toxicology, in particular the dogma of "the dose makes the poison," because EDCs can have effects at low doses that are not predicted by effects at higher doses. Here, we review two major concepts in EDC studies: low dose and nonmonotonicity. Low-dose effects were defined by the National Toxicology Program as those that occur in the range of human exposures or effects observed at doses below those used for traditional toxicological studies. We review the mechanistic data for low-dose effects and use a weight-of-evidence approach to analyze five examples from the EDC literature. Additionally, we explore nonmonotonic dose-response curves, defined as a nonlinear relationship between dose and effect where the slope of the curve changes sign somewhere within the range of doses examined. We provide a detailed discussion of the mechanisms responsible for generating these phenomena, plus hundreds of examples from the cell culture, animal, and epidemiology literature. We illustrate that nonmonotonic responses and low-dose effects are remarkably common in studies of natural hormones and EDCs. Whether low doses of EDCs influence certain human disorders is no longer conjecture, because epidemiological studies show that environmental exposures to EDCs are associated with human diseases and disabilities. We conclude that when nonmonotonic dose-response curves occur, the effects of low doses cannot be predicted by the effects observed at high doses. Thus, fundamental changes in chemical testing and safety determination are needed to protect human health.
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Affiliation(s)
- Laura N Vandenberg
- Tufts University, Center for Regenerative and Developmental Biology, Department of Biology, 200 Boston Avenue, Suite 4600, Medford, Massachusetts 02155, USA.
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Janse F, Tanahatoe S, Eijkemans M, Fauser B. Testosterone concentrations, using different assays, in different types of ovarian insufficiency: a systematic review and meta-analysis. Hum Reprod Update 2012; 18:405-19. [DOI: 10.1093/humupd/dms013] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Davis SR, Braunstein GD. Efficacy and Safety of Testosterone in the Management of Hypoactive Sexual Desire Disorder in Postmenopausal Women. J Sex Med 2012; 9:1134-48. [DOI: 10.1111/j.1743-6109.2011.02634.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Abstract
Polycystic ovary syndrome (PCOS) has been associated with increased cardiovascular risk (CVR) markers, but population studies have not clarified whether there is an increase in cardiovascular morbidity and mortality. Four different PCOS phenotypes resulted from the Rotterdam criteria that may differ in their CVR potential, thus introducing further complexity. This has led to studies using surrogate CVR markers including biomarkers in blood and imaging such as flow-mediated vasodilatation. In PCOS, both peripheral and central insulin resistance (IR) have been shown. Weight loss has been shown to improve IR and visceral fat, while insulin sensitizer therapies with metformin or thiazolidinediones improve IR and endothelial dysfunction. IR is also found in non-alcoholic fatty liver disease that in turn is very common in PCOS; studies have suggested that IR may be improved by treatment with metformin and omega-3 fish oils. PCOS patients have a more dyslipidemic phenotype that is worse in 'classical PCOS' associated with a higher CVR. Studies with atorvastatin and simvastatin have reported a decrease in the lipid parameters and an improvement in CVR indices including IR, but it is unclear whether this is due to their lipid-lowering action or a pleiotropic effect of the statin. In this expert opinion review, the relevant literature published during the last 2 years was considered. It focuses on some recent important data that has emerged while also exposing the gaps that remain in our knowledge that need to be addressed.
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Affiliation(s)
- T Sathyapalan
- Hull York Medical School, Academic Endocrinology, Diabetes and Metabolism, Michael White Diabetes Centre, 220-236 Anlaby Road, Hull, UK.
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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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87
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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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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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90
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Abstract
Androgen deficiency in aging men is common, and the potential sequelae are numerous. In addition to low libido, erectile dysfunction, decreased bone density, depressed mood, and decline in cognition, studies suggest strong correlations between low testosterone, obesity, and the metabolic syndrome. Because causation and its directionality remain uncertain, the functional and cardiovascular risks associated with androgen deficiency have led to intense investigation of testosterone replacement therapy in older men. Although promising, evidence for definitive benefit or detriment is not conclusive, and treatment of late-onset hypogonadism is complicated.
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Affiliation(s)
- Jeremy B Shelton
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, USA.
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91
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Coviello AD, Zhuang WV, Lunetta KL, Bhasin S, Ulloor J, Zhang A, Karasik D, Kiel DP, Vasan RS, Murabito JM. Circulating testosterone and SHBG concentrations are heritable in women: the Framingham Heart Study. J Clin Endocrinol Metab 2011; 96:E1491-5. [PMID: 21752884 PMCID: PMC3167671 DOI: 10.1210/jc.2011-0050] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Many factors influence the concentration of circulating testosterone and its primary binding protein, SHBG. However, little is known about the genetic contribution to their circulating concentrations in women, and their heritability in women is not well established. OBJECTIVE Our objective was to estimate the heritability of circulating total testosterone (TT), free testosterone (FT), and SHBG in women in families from the Framingham Heart Study. METHODS Women in the Framingham Heart Study who were not pregnant, had not undergone bilateral oophorectomy, and were not using exogenous hormones were eligible for this investigation. TT was measured using liquid chromatography tandem mass spectrometry and SHBG using an immunofluorometric assay (Delfia-Wallac), and FT was calculated. Heritability estimates were calculated using variance-components methods in Sequential Oligogenic Linkage Analysis Routines (SOLAR) and were adjusted for age, age(2), body mass index (BMI), BMI(2), diabetes, smoking, and menopausal status. Bivariate analyses were done to assess genetic correlation between TT, FT, and SHBG. RESULTS A total of 2685 women were studied including 868 sister pairs and 688 mother-daughter pairs. Multivariable adjusted heritability estimates were 0.26 ± 0.05 for FT, 0.26 ± 0.05 for TT, and 0.56 ± 0.05 for SHBG (P < 1.0 × 10(-7) for all). TT was genetically correlated with SHBG [genetic correlation coefficient (ρG) = 0.31 ± 0.10] and FT (ρG = 0.54 ± 0.09), whereas SHBG was inversely correlated with FT (ρG = -0.60 ± 0.08). CONCLUSION Circulating TT, FT, and SHBG concentrations in women are significantly heritable, underscoring the importance of further work to identify the specific genes that contribute significantly to variation in sex steroid concentrations in women. The strong shared genetic component among pairs of TT, FT, and SHBG concentrations suggests potential pleiotropic effects for some of the underlying genes.
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Affiliation(s)
- A D Coviello
- Sections of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston University School of Public Health, Boston, Massachusetts 02118, USA.
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92
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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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93
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Stanton SJ, Mullette-Gillman OA, McLaurin RE, Kuhn CM, LaBar KS, Platt ML, Huettel SA. Low- and high-testosterone individuals exhibit decreased aversion to economic risk. Psychol Sci 2011; 22:447-53. [PMID: 21393575 DOI: 10.1177/0956797611401752] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Testosterone is positively associated with risk-taking behavior in social domains (e.g., crime, physical aggression). However, the scant research linking testosterone to economic risk preferences presents inconsistent findings. We examined the relationship between endogenous testosterone and individuals' economic preferences (i.e., risk preference, ambiguity preference, and loss aversion) in a large sample (N = 298) of men and women. We found that endogenous testosterone levels have a significant U-shaped association with individuals' risk and ambiguity preferences, but not loss aversion. Specifically, individuals with low or high levels of testosterone (more than 1.5 SD from the mean for their gender) were risk and ambiguity neutral, whereas individuals with intermediate levels of testosterone were risk and ambiguity averse. This relationship was highly similar in men and women. In contrast to received wisdom regarding testosterone and risk, the present data provide the first robust evidence for a nonlinear association between economic preferences and levels of endogenous testosterone.
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Affiliation(s)
- Steven J Stanton
- Center for Cognitive Neuroscience, Duke University, Durham, NC 27708-0999, USA
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94
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Nachtigall L, Casson P, Lucas J, Schofield V, Melson C, Simon JA. Safety and tolerability of testosterone patch therapy for up to 4 years in surgically menopausal women receiving oral or transdermal oestrogen. Gynecol Endocrinol 2011; 27:39-48. [PMID: 21142609 DOI: 10.3109/09513590.2010.487597] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Two clinical trials previously demonstrated the safety of 300 μg/day transdermal testosterone patch (TTP) treatment for up to 6 months in 1094 surgically menopausal women with hypoactive sexual desire disorder (HSDD). Adverse events (AE), clinical laboratory tests, vital signs, physical examinations and mammograms were evaluated in open-label extensions of these two trials for up to 4 years and are presented in this article. Nine hundred and sixty-seven patients received at least one application of the TTP resulting in 1092 patient-years of exposure. There was no increase over time in the rate of new occurrences or severity of AEs, serious AEs, or withdrawals due to AEs. The most common AEs associated with treatment were application site reactions and unwanted hair growth; however, most were mild and rarely resulted in study withdrawal. No clinically meaningful changes in serum chemistry, haematology, lipid profile, carbohydrate metabolism, renal and liver function or coagulation parameters were noted with up to 4 years of therapy. Consistent with age-appropriate expected rates, three cases of invasive breast cancer were observed. No important changes in the safety or tolerability profile of TTP were revealed with long-term use for up to 4 years in otherwise healthy oophorectomised women with HSDD on concomitant oestrogen.
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Affiliation(s)
- Lila Nachtigall
- New York University School of Medicine, New York, NY 10016, USA
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95
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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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96
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Farage MA, Miller KW, Ledger W. Confronting the challenges of postmenopausal urogenital health. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/ahe.10.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The global population is aging, especially in Western industrialized nations. In the USA, 38% of adults are over the age of 45 and 13% of adults are over the age of 65 years. Moreover, postmenopausal women now comprise 60% of adults aged over 65 years of age, a proportion that will rise as the population ages. This article reviews some of the more common urogenital health issues among older women. Changes to urogenital morphology and physiology are discussed, highlighting the impact on tissue atrophy, sexuality, prevalence of certain vulvar dermatoses, susceptibility to infection and urinary continence. We review treatment approaches, challenge some of the current paradigms and discuss the need for future research.
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Affiliation(s)
| | - Kenneth W Miller
- Feminine & Adult Care, The Procter & Gamble Company, Cincinnati, OH, USA
| | - William Ledger
- The New York Presbyterian Hospital, Weill Medical College of Cornell University, NY, USA
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