Estrogen and coronary artery disease in postmenopausal women

Estrone, sex hormone binding globulin and lipid profiles in older women: an observational study

OBJECTIVE

We investigated whether estrone and sex hormone binding globulin (SHBG) concentrations are associated with lipid concentrations in older postmenopausal women.

METHODS

This was a cross-sectional study of 6358 Australian women, aged 70-95 years, recruited between 2010 and 2014. Associations between estrone and SHBG and lipid concentrations were examined in participants not using medications that influence estrogen concentrations or lipid-lowering therapy. Linear regression models included age, body mass index, smoking, alcohol consumption, renal function and diabetes, with the lowest quartile (Q1) as the reference for estrone and SHBG.

RESULTS

The study included 3231 participants with median age of 74.0 (interquartile range 71.7-77.9) years. Estrone concentration Q3 and Q4 were positively associated with high-density lipoprotein cholesterol (HDL-C) (p = 0.017 and p = 0.046, respectively). Inverse associations were seen for estrone Q4 with total cholesterol (p = 0.018), Q2 and Q4 with non-HDL-C (p = 0.045 and p = 0.002, respectively) and Q3 and Q4 with triglycerides (p = 0.030 and p = 0.001, respectively). For SHBG, Q2, Q3 and Q4 were positively associated with HDL-C (all p < 0.001), and inversely with non-HDL-C (all p = 0.001) and triglycerides (all p < 0.001).

CONCLUSIONS

Estrone and SHBG are associated with lipid concentrations in older women. SHBG, but not estrone, may provide additional clinical predictive utility for the assessment of cardiometabolic disease risk in older women.

Prevention of Cardiovascular Disease in Women

Appropriate screening and lifestyle modification are the foundations of effective cardiovascular disease (CVD) prevention in women. All adult women should undergo a cardiovascular risk assessment, including family history, smoking, diet, and exercise assessments, and measurement of fasting lipid profile, waist and hip dimensions, and blood pressure. Women should be advised of their 10-year estimated risk of developing a cardiovascular event using the Framingham risk calculator as recommended by the National Cholesterol Education Program. Based on the level of risk, women should receive counseling on dietary modification, physical activity, weight loss, and the need for pharmacologic intervention for blood pressure, lipid, and diabetes management. In addition, women who are overweight, have a history of gestational diabetes, or family history of diabetes should have a fasting glucose measured. Women who smoke should receive advice, encouragement, and assistance for smoking cessation. Postmenopausal hormone therapy should not be considered a treatment option for primary or secondary prevention of CVD. Women and their families should be advised of the possible signs of CVD and the need to seek immediate medical attention in the event of prolonged, new, or severe symptoms. Women with coronary artery disease especially need close attention to their risk factor levels and should receive intensive intervention to achieve optimal control.