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Doughan M, Chehab O, Doughan B, Lima JAC, Michos ED. Association of endogenous sex hormone levels with tooth loss due to periodontitis in men and post-menopausal women: The multi-ethnic study of atherosclerosis. J Periodontal Res 2024. [PMID: 38895935 DOI: 10.1111/jre.13312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 05/25/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024]
Abstract
AIM To investigate the association between endogenous sex hormone levels and history of tooth loss related to periodontitis in healthy middle-aged to older men and post-menopausal women. METHODS This cross-sectional study included 5649 participants aged 45-84 (mean age, 63 ± 10 years) from the Multi-Ethnic Study of Atherosclerosis cohort who had sex hormone levels measured and answered a questionnaire regarding perceived periodontal status at exam 1. Multivariable logistic regression was used to examine the association of sex hormones (exposure) with history of tooth loss (outcome), stratified by sex. RESULTS Among post-menopausal women, higher free testosterone (per 1SD) was associated with a greater prevalence of tooth loss [OR 1.49 (95% CI, 1.08-2.05)], whereas higher sex hormone binding globulin (SHBG) was associated with a lower prevalence of tooth loss [OR 0.74 (0.58-0.94)], after adjustment for cardiometabolic risk factors and reproductive factors. In men, higher free testosterone and lower SHBG were associated with a lower prevalent probability of tooth loss in unadjusted analysis, but these associations lost significance after covariate adjustment. CONCLUSION A higher androgenic sex hormone profile in post-menopausal women (i.e., increased free testosterone, lower SHBG) was associated with an increased prevalence of tooth loss, after adjusting cardiometabolic risk factors. No such association was found in men. These findings suggest that sex hormones may influence or serve as a marker for periodontal health.
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Grants
- R01 HL074406 NHLBI NIH HHS
- R01 HL074338 NHLBI NIH HHS
- 946222 American Heart Association
- HHSN268201500003I NHLBI NIH HHS
- N01-HC-95159 National Heart, Lung and Blood Institute
- N01-HC-95160 National Heart, Lung and Blood Institute
- N01-HC-95161 National Heart, Lung and Blood Institute
- N01-HC-95162 National Heart, Lung and Blood Institute
- N01-HC-95163 National Heart, Lung and Blood Institute
- N01-HC-95164 National Heart, Lung and Blood Institute
- N01-HC-95165 National Heart, Lung and Blood Institute
- N01-HC-95166 National Heart, Lung and Blood Institute
- N01-HC-95167 National Heart, Lung and Blood Institute
- N01-HC-95168 National Heart, Lung and Blood Institute
- N01-HC-95169 National Heart, Lung and Blood Institute
- Johns Hopkins University: Amato Fund in Women's Cardiovascular Health Research
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Affiliation(s)
- Maria Doughan
- School of Dentistry, University of Maryland, Baltimore, Maryland, USA
| | - Omar Chehab
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bassel Doughan
- Faculty of Dental Surgery, Côte d'Azur University, Nice, France
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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2
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Lu Y, Kiechl SJ, Wang J, Xu Q, Kiechl S, Pechlaner R. Global distributions of age- and sex-related arterial stiffness: systematic review and meta-analysis of 167 studies with 509,743 participants. EBioMedicine 2023; 92:104619. [PMID: 37229905 PMCID: PMC10327869 DOI: 10.1016/j.ebiom.2023.104619] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Arterial stiffening is central to the vascular ageing process and a powerful predictor and cause of diverse vascular pathologies and mortality. We investigated age and sex trajectories, regional differences, and global reference values of arterial stiffness as assessed by pulse wave velocity (PWV). METHODS Measurements of brachial-ankle or carotid-femoral PWV (baPWV or cfPWV) in generally healthy participants published in three electronic databases between database inception and August 24th, 2020 were included, either as individual participant-level or summary data received from collaborators (n = 248,196) or by extraction from published reports (n = 274,629). Quality was appraised using the Joanna Briggs Instrument. Variation in PWV was estimated using mixed-effects meta-regression and Generalized Additive Models for Location, Scale, and Shape. FINDINGS The search yielded 8920 studies, and 167 studies with 509,743 participants from 34 countries were included. PWV depended on age, sex, and country. Global age-standardised means were 12.5 m/s (95% confidence interval: 12.1-12.8 m/s) for baPWV and 7.45 m/s (95% CI: 7.11-7.79 m/s) for cfPWV. Males had higher global levels than females of 0.77 m/s for baPWV (95% CI: 0.75-0.78 m/s) and 0.35 m/s for cfPWV (95% CI: 0.33-0.37 m/s), but sex differences in baPWV diminished with advancing age. Compared to Europe, baPWV was substantially higher in the Asian region (+1.83 m/s, P = 0.0014), whereas cfPWV was higher in the African region (+0.41 m/s, P < 0.0001) and differed more by country (highest in Poland, Russia, Iceland, France, and China; lowest in Spain, Belgium, Canada, Finland, and Argentina). High vs. other country income was associated with lower baPWV (-0.55 m/s, P = 0.048) and cfPWV (-0.41 m/s, P < 0.0001). INTERPRETATION China and other Asian countries featured high PWV, which by known associations with central blood pressure and pulse pressure may partly explain higher Asian risk for intracerebral haemorrhage and small vessel stroke. Reference values provided may facilitate use of PWV as a marker of vascular ageing, for prediction of vascular risk and death, and for designing future therapeutic interventions. FUNDING This study was supported by the excellence initiative VASCage funded by the Austrian Research Promotion Agency, by the National Science Foundation of China, and the Science and Technology Planning Project of Hunan Province. Detailed funding information is provided as part of the Acknowledgments after the main text.
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Affiliation(s)
- Yao Lu
- Clinical Research Center, The Third Xiangya Hospital, Central South University, Changsha, China; School of Life Course Sciences, King's College London, London, United Kingdom.
| | - Sophia J Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria; Department of Neurology, Hochzirl Hospital, Zirl, Austria; Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Jie Wang
- Clinical Research Center, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Qingbo Xu
- Centre for Clinical Pharmacology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria; Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria.
| | - Raimund Pechlaner
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
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3
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Mukherjee M, Ogunmoroti O, Jani V, Kapoor K, Beussink-Nelson L, Freed BH, Hays AG, Shah SJ, Michos ED. Characteristics of Right Ventricular to Pulmonary Arterial Coupling and Association With Functional Status Among Older Aged Adults from the Multi-Ethnic Study of Atherosclerosis. Am J Cardiol 2023; 196:41-51. [PMID: 37068356 PMCID: PMC10164695 DOI: 10.1016/j.amjcard.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 03/01/2023] [Accepted: 03/17/2023] [Indexed: 04/19/2023]
Abstract
Although the echocardiographic:derived ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary arterial systolic pressure (PASP) is an important prognostic tool in heart failure (HF), the relation with 6-minute walk distance (6MWD) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) is less established. We sought to establish the normative values of TAPSE:PASP among older adults without cardiovascular disease (CVD) and evaluate the relation with NT-proBNP and 6MWD. Among 1,542 participants of the Multi-Ethnic Study of Atherosclerosis-HF ancillary study, the cross-sectional association of TAPSE:PASP with the outcomes of 6MWD and NT-proBNP was analyzed using multivariable linear regression, with progressive adjustment for sociodemographic and CVD risk factors. Our cohort had a mean age (SD) of 73 ± 8 years, 55% women, and a mean TAPSE:PASP ratio of 0.68 ± 0.16. In the unadjusted analysis, increasing tertiles of TAPSE:PASP were associated with younger age, less diabetes, higher estimated glomerular filtration rate, and less antihypertensive medication use. The TAPSE:PASP ratio significantly correlated with both 6MWD and NT-proBNP in the fully adjusted models. A 1-unit increment in TAPSE:PASP was associated with an adjusted 9.9% (4.8% to 15.2%) higher 6MWD, whereas a 1-unit increment in TAPSE:PASP was associated with an adjusted 38.0% (16.0% to 54.2%) lower NT-proBNP. There was a significant gender interaction of the association of TAPSE:PASP ratio and 6MWD, with stronger association seen in women. Among multiethnic older adults free of clinical CVD, the TAPSE:PASP ratio decreased with age, especially in women and was associated with decreased 6MWD and increasing NT-proBNP, the markers of subclinical HF.
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Affiliation(s)
- Monica Mukherjee
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Oluseye Ogunmoroti
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vivek Jani
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Karan Kapoor
- Division of Cardiology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Lauren Beussink-Nelson
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Benjamin H Freed
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Allison G Hays
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sanjiv J Shah
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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4
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Madsen TE, Sobel T, Negash S, Shrout Allen T, Stefanick ML, Manson JE, Allison M. A Review of Hormone and Non-Hormonal Therapy Options for the Treatment of Menopause. Int J Womens Health 2023; 15:825-836. [PMID: 37255734 PMCID: PMC10226543 DOI: 10.2147/ijwh.s379808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/05/2023] [Indexed: 06/01/2023] Open
Abstract
Understanding the role of both menopausal hormone therapy (MHT) along with non-hormonal options for the treatment of vasomotor symptoms, sleep disruption, and genitourinary symptoms after menopause is critical to the health of women during middle and later life. Recent updates to the evidence for the treatment of menopausal symptoms pertaining to both hormonal and non-hormonal therapies as well as updated guidance from specialty societies can help guide clinicians in their treatment of women going through natural menopause or with estrogen deficiencies due to primary ovarian insufficiency or induced menopause from surgery or medications. The objective of this narrative review is to provide clinicians with an overview of MHT for the use of menopausal symptoms in women, incorporating updated primary evidence for risk versus benefit profiles, recent specialty society recommendations, and alternative, non-hormonal options. In this review, we summarize literature on the use of MHT for menopause-related symptomatology including options for formulations and dosages of MHT, non-hormonal treatment options, and the risk-benefit profile of MHT including long-term health consequences (eg, cardiovascular disease, cognitive decline, venous thromboembolism, and fracture risk). Finally, we highlight areas in which future research is needed to advance care of women after menopause. In summary, both hormonal (MHT) and non-hormonal options exist to treat symptoms of menopause. There is strong evidence for safety and effectiveness of MHT for the treatment of vasomotor symptoms among women who are less than 60 years of age, less than 10 years since menopause, and without significant cardiometabolic comorbidities. For others, treatment with hormonal versus non-hormonal therapies can be considered based on individual risk profiles, as well as other factors such as drug formulation, therapeutic goals, and symptom severity.
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Affiliation(s)
- Tracy E Madsen
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Talia Sobel
- Division of Women’s Health Internal Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Seraphina Negash
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Tara Shrout Allen
- Division of Preventive Medicine, University of California San Diego, San Diego, CA, USA
| | | | - JoAnn E Manson
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew Allison
- Department of Family Medicine, University of California San Diego, San Diego, CA, USA
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5
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Kazzi B, Ogunmoroti O, Rodriguez CP, Zhao D, Minhas AS, Osibogun O, Subramanya V, Allison MA, Ouyang P, Michos ED. Parity History and Later Life Sex Hormone Levels in the Multi-Ethnic Study of Atherosclerosis (MESA). Can J Cardiol 2022; 38:1893-1900. [PMID: 36087657 DOI: 10.1016/j.cjca.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/14/2022] [Accepted: 09/01/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Multiparity is a risk factor for cardiovascular disease (CVD). A more androgenic sex hormone profile, with a higher testosterone (T)/estradiol (E2) ratio, is associated with worse CVD outcomes in women and might be one mechanism linking multiparity to increased CVD risk. We investigated the relationship between parity and sex hormones at mid-to-older age. METHODS We performed a cross-sectional analysis of 2979 women with data on parity and endogenous sex hormone levels from the Multi-Ethnic Study of Atherosclerosis (MESA), a community-based cohort. Parity and gravidity (our exposures) were categorized as 0 (reference), 1-2, 3-4, or ≥ 5. Our outcome measures were T, E2, sex hormone binding globulin, dehydroepiandrosterone, and T/E2 ratio. Progressively adjusted linear regression was used to evaluate the association of parity/gravidity with sex hormones. RESULTS In multivariable adjusted models, there were no significant associations of parity with E2, dehydroepiandrosterone, and sex hormone binding globulin. Compared with nulliparity, after adjustment for CVD risk factors, women with 1-2 and 3-4 live births had higher T, but this was not significant for grand multiparity (≥ 5 live births). However, grand multigravidity (≥ 5 pregnancies) was associated with 10% (95% confidence interval [CI], 1%-20%) higher T and 14% (95% CI, 1%-29%) higher T/E2, compared with null gravidity. Grand multiparity was associated with an 18% (95% CI, 4%-34%) higher T/E2 ratio compared with nulliparity, after adjustment for CVD risk factors. CONCLUSIONS In this multiethnic cohort, women with grand multigravidity and grand multiparity had higher T/E2 levels, reflecting a more androgenic sex hormone profile. Longitudinal studies on sex hormones' influence on the relationship between multiparity and CVD are warranted.
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Affiliation(s)
- Brigitte Kazzi
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carla P Rodriguez
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Di Zhao
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anum S Minhas
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Vinita Subramanya
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Matthew A Allison
- Department of Family Medicine, University of California San Diego, San Diego, California, USA
| | - Pamela Ouyang
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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6
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Mizrak I, Asserhøj LL, Lund MAV, Greisen GO, Clausen TD, Main KM, Vejlstrup NG, Jensen RB, Pinborg A, Madsen PL. Aortic distensibility is equal in prepubertal girls and boys and increases with puberty in girls. Am J Physiol Heart Circ Physiol 2022; 323:H312-H321. [PMID: 35687504 DOI: 10.1152/ajpheart.00097.2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Windkessel function is governed by conductance artery compliance that is associated with cardiovascular disease in adults independently of other risk factors. Sex-related differences in conductance artery compliance partly explain the sex-related differences in risk of cardiovascular disease. Studies on sex-related differences in conductance artery function in prepubertal children are few and inconclusive. This study determined conductance artery compliance and cardiac function by magnetic resonance imaging in 150 healthy children (75 girls) aged 7-10 years. Any sex-related difference in conductance artery function was determined with correction for other potential predictors in multivariable linear regression models. Our data showed that ascending (crude mean difference 1.11 95% CI (0.22; 2.01)) and descending (crude mean difference 1.10 95% CI (0.09; 1.91)) aortic distensibility were higher in girls, but differences disappeared after adjustment for pubertal status and other identified potential predictors. Systolic and diastolic blood pressure, cardiac output, left ventricle (LV) systolic function, and total peripheral resistance did not differ between the sexes. In girls, heart rate was 7 bpm higher, whereas pulse pressure (by 2 mmHg), and LV end-diastolic volume index (by 7 mL) and stroke volume (by 5 mL) were lower. LV peak filling rate indexed to LV end-diastolic volume was 0.5 s-1 higher in girls. In conclusion, prepubertal girls and boys have equal conductance artery function. Thus, the well-known sex difference in adult conductance artery function seems to develop after the onset of puberty with girls initially increasing aortic distensibility.
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Affiliation(s)
- Ikram Mizrak
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark.,Fertility Department, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Louise L Asserhøj
- Fertility Department, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,International Center for Research and Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten A V Lund
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gorm O Greisen
- Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tine D Clausen
- Department of Gynecology and Obstetrics, North Zealand Hospital, Copenhagen University Hospital, Hilleroed, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Katharina M Main
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,International Center for Research and Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Niels G Vejlstrup
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rikke B Jensen
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,International Center for Research and Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anja Pinborg
- Fertility Department, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Per L Madsen
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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7
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Ogunmoroti O, Osibogun O, Zhao D, Mehta RC, Ouyang P, Lutsey PL, Robinson-Cohen C, Michos ED. Associations between endogenous sex hormones and FGF-23 among women and men in the Multi-Ethnic Study of Atherosclerosis. PLoS One 2022; 17:e0268759. [PMID: 35613118 PMCID: PMC9132299 DOI: 10.1371/journal.pone.0268759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Abstract
Elevated levels of testosterone and fibroblast growth factor 23 (FGF-23) are both independently associated with a higher risk of cardiovascular disease (CVD). However, the relationship between sex hormones and FGF-23 is not well established. We explored the association between sex hormones and FGF-23 among middle-aged to older men and women in MESA. We studied 3,052 men and 2,868 postmenopausal women free of CVD at the time of enrollment with baseline serum sex hormones [total testosterone (T), free T, estradiol (E2) and sex hormone binding globulin (SHBG)] and intact FGF-23. In sex-stratified analyses, we examined the cross-sectional associations between log-transformed sex hormones (per 1 SD) and log-transformed FGF-23 using multiple linear regression adjusted for socio-demographics, CVD risk factors, estimated glomerular filtration rate and mineral metabolites (25-hydroxyvitamin D, calcium, phosphorus and parathyroid hormone). The mean (SD) age of study participants was 64 (10) years. The median (IQR) of FGF-23 was similar in women and men [38 (30-46) vs 38 (31-47) pg/mL]. In adjusted analyses, among women, 1 SD increment in free T was associated with 3% higher FGF-23 while SHBG was associated with 2% lower FGF-23. In men, 1 SD increment in E2 was associated with 6% higher FGF-23 whereas total T/E2 ratio was associated with 7% lower FGF-23. In conclusion, this exploratory analysis found that a more androgenic sex hormone profile was directly associated with FGF-23 in women and inversely associated with FGF-23 in men. Longitudinal studies are required to determine whether FGF-23 mediates the relationship between sex hormones and CVD risk.
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Affiliation(s)
- Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, United States of America
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Rupal C. Mehta
- Division of Nephrology and Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- The Jesse Brown Veterans Administration Medical Center, Chicago, Illinois, United States of America
| | - Pamela Ouyang
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, United States of America
| | - Cassianne Robinson-Cohen
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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8
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Sharma A, Ogunmoroti O, Fashanu OE, Zhao D, Ouyang P, Budoff MJ, Thomas IC, Michos ED. Associations of endogenous sex hormone levels with the prevalence and progression of valvular and thoracic aortic calcification in the Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2022; 341:71-79. [PMID: 34785061 PMCID: PMC8760158 DOI: 10.1016/j.atherosclerosis.2021.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/24/2021] [Accepted: 11/04/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS Sex hormones (SH) may contribute to sex differences in cardiovascular disease (CVD). High free testosterone (T) and low sex hormone binding globulin (SHBG) have been associated with progression of coronary artery calcification in women. We now examined the association of SH with extra-coronary calcification (ECC) prevalence and progression among MESA participants. METHODS We studied 2,737 postmenopausal women and 3,130 men free of clinical CVD with baseline SH levels. ECC measurements [ascending and descending thoracic aortic calcification (ATAC, DTAC), mitral annular calcification (MAC), aortic valve calcification (AVC)] were obtained by computed tomography at baseline and after 2.4 ± 0.9 years. We used multivariable Poisson regression to evaluate associations with ECC prevalence and incidence (Agatston scores >0) and linear mixed effects models for ECC progression, per 1-SD increment in log(SH) in women and men separately. RESULTS The mean age was 65 ± 9 and 62 ± 10 years for women and men, respectively. In women, greater free T and lower SHBG were associated with MAC incidence in a demographic-adjusted model only. In men, lower free T was associated with MAC prevalence, DTAC incidence and progression, while greater SHBG was associated with MAC prevalence and DTAC progression after further adjusting for CVD risk factors. CONCLUSIONS In this diverse cohort free of CVD, we found some associations of SH with ECC measures. In particular, free T was inversely associated with prevalent MAC and DTAC progression in men independent of CVD risk factors. SH may influence vascular calcification, but further work is needed to understand clinical implications of these findings.
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Affiliation(s)
- Apurva Sharma
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Oluseye Ogunmoroti
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Di Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Pamela Ouyang
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Isac C. Thomas
- Division of Cardiology, University of California San Diego, San Diego, CA, USA
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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9
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Armeni E, Lambrinoudaki I. Menopause, androgens, and cardiovascular ageing: a narrative review. Ther Adv Endocrinol Metab 2022; 13:20420188221129946. [PMID: 36325501 PMCID: PMC9619256 DOI: 10.1177/20420188221129946] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 09/09/2022] [Indexed: 11/07/2022] Open
Abstract
Cardiovascular disease is the leading cause of death worldwide; however, women tend to be less affected than men during their reproductive years. The female cardiovascular risk increases significantly around the time of the menopausal transition. The loss of the protective action of ovarian oestrogens and the circulating androgens has been implicated in possibly inducing subclinical and overt changes in the cardiovascular system after the menopausal transition. In vitro studies performed in human or animal cell lines demonstrate an adverse effect of testosterone on endothelial cell function and nitric oxide bioavailability. Cohort studies evaluating associations between testosterone and/or dehydroepiandrosterone and subclinical vascular disease and clinical cardiovascular events show an increased risk for women with more pronounced androgenicity. However, a mediating effect of insulin resistance is possible. Data on cardiovascular implications following low-dose testosterone treatment in middle-aged women or high-dose testosterone supplementation for gender affirmatory purposes remain primarily inconsistent. It is prudent to consider the possible adverse association between testosterone and endothelial function during the decision-making process of the most appropriate treatment for a postmenopausal woman.
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Affiliation(s)
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynecology, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
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10
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WANG J, XIE J, MENG X, GONG X. Comparison of CT and MRI in imaging diagnosis of aortic dissection. FOOD SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1590/fst.23621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | - Junmin XIE
- Affiliated Hospital of Hebei University, China
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11
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Varma B, Ogunmoroti O, Ndumele CE, Kazzi B, Rodriquez CP, Osibogun O, Allison MA, Bertoni AG, Michos ED. Associations between endogenous sex hormone levels and adipokine levels in the Multi-Ethnic Study of Atherosclerosis. Front Cardiovasc Med 2022; 9:1062460. [PMID: 36712262 PMCID: PMC9880051 DOI: 10.3389/fcvm.2022.1062460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/29/2022] [Indexed: 01/14/2023] Open
Abstract
Background Differences in sex hormone levels contribute to differences in cardiovascular disease (CVD) risk. Adipokines play a role in cardiometabolic pathways and have differing associations with CVD. Adipokine levels differ by sex; however, the association between sex hormone profiles and adipokines is not well established. We hypothesized that a more androgenic sex hormone profile would be associated with higher leptin and resistin and lower adiponectin levels among postmenopausal women, with the opposite associations in men. Methods We performed an analysis of 1,811 adults in the Multi-Ethnic Study of Atherosclerosis who had both sex hormones and adipokines measured an average of 2.6 years apart. Sex hormones [Testosterone (T), estradiol (E2), sex hormone binding globulin (SHBG), and dehydroepiandrosterone (DHEA)] were measured at exam 1; free T was estimated. Serum adipokines (leptin, resistin, adiponectin) were measured at exams 2 or 3. We used multivariable linear regression to examine the cross-sectional associations between sex hormones and adipokines. Results The mean (SD) age was 63 (10) years, 48% were women; 59% non-White participants. For leptin, after adjusting for demographics only, higher free T and lower SHBG, were associated with higher leptin in women; this association was attenuated after further covariate adjustment. However in men, higher free T and lower SHBG were associated with greater leptin levels in fully adjusted models. For adiponectin, lower free T and higher SHBG were associated with greater adiponectin in both women and men after adjustment for CVD risk factors. For resistin, no significant association was found women, but an inverse association with total T and bioT was seen in men. Conclusion Overall, these results further suggest a more androgenic sex profile (higher free T and lower SHBG) is associated with a less favorable adipokine pattern. These findings may provide mechanistic insight into the interplay between sex hormones, adipokines, and CVD risk.
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Affiliation(s)
- Bhavya Varma
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Chiadi E Ndumele
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Brigitte Kazzi
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Carla P Rodriquez
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
| | - Matthew A Allison
- Department of Family Medicine, University of California, San Diego, San Diego, CA, United States
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, United States
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12
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Cooper LL, Rong J, Larson MG, Benjamin EJ, Hamburg NM, Vasan RS, Mitchell GF. Discrepancies in Observed and Predicted Longitudinal Change in Central Hemodynamic Measures: The Framingham Heart Study. Hypertension 2021; 78:973-982. [PMID: 34365810 DOI: 10.1161/hypertensionaha.121.17558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Leroy L Cooper
- From the Biology Department, Vassar College, Poughkeepsie, NY (L.L.C.)
| | - Jian Rong
- Boston University and NHLBI's Framingham Study, MA (J.R., M.G.L., E.J.B., R.S.V.)
| | - Martin G Larson
- Boston University and NHLBI's Framingham Study, MA (J.R., M.G.L., E.J.B., R.S.V.).,Department of Mathematics and Statistics, Boston University, MA (M.G.L.)
| | - Emelia J Benjamin
- Boston University and NHLBI's Framingham Study, MA (J.R., M.G.L., E.J.B., R.S.V.).,Cardiology and Preventive Medicine Sections, Department of Medicine, Boston University School of Medicine, Boston, MA (E.J.B., R.S.V.).,Department of Epidemiology, Boston University School of Public Health (E.J.B., R.S.V.).,Evans Department of Medicine (E.J.B., N.M.H., R.S.V.), Boston University School of Medicine, Boston, MA.,Whitaker Cardiovascular Institute (E.J.B., N.M.H., R.S.V.), Boston University School of Medicine, Boston, MA
| | - Naomi M Hamburg
- Evans Department of Medicine (E.J.B., N.M.H., R.S.V.), Boston University School of Medicine, Boston, MA.,Whitaker Cardiovascular Institute (E.J.B., N.M.H., R.S.V.), Boston University School of Medicine, Boston, MA
| | - Ramachandran S Vasan
- Boston University and NHLBI's Framingham Study, MA (J.R., M.G.L., E.J.B., R.S.V.).,Cardiology and Preventive Medicine Sections, Department of Medicine, Boston University School of Medicine, Boston, MA (E.J.B., R.S.V.).,Department of Epidemiology, Boston University School of Public Health (E.J.B., R.S.V.).,Evans Department of Medicine (E.J.B., N.M.H., R.S.V.), Boston University School of Medicine, Boston, MA.,Whitaker Cardiovascular Institute (E.J.B., N.M.H., R.S.V.), Boston University School of Medicine, Boston, MA
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13
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St‐Onge M, Aggarwal B, Allison MA, Berger JS, Castañeda SF, Catov J, Hochman JS, Hubel CA, Jelic S, Kass DA, Makarem N, Michos ED, Mosca L, Ouyang P, Park C, Post WS, Powers RW, Reynolds HR, Sears DD, Shah SJ, Sharma K, Spruill T, Talavera GA, Vaidya D. Go Red for Women Strategically Focused Research Network: Summary of Findings and Network Outcomes. J Am Heart Assoc 2021; 10:e019519. [PMID: 33619972 PMCID: PMC8174263 DOI: 10.1161/jaha.120.019519] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/17/2020] [Indexed: 02/01/2023]
Abstract
The Go Red for Women movement was initiated by the American Heart Association (AHA) in the early 2000s to raise awareness concerning cardiovascular disease (CVD) risk in women. In 2016, the AHA funded 5 research centers across the United States to advance our knowledge of the risks and presentation of CVD that are specific to women. This report highlights the findings of the centers, showing how insufficient sleep, sedentariness, and pregnancy-related complications may increase CVD risk in women, as well as presentation and factors associated with myocardial infarction with nonobstructive coronary arteries and heart failure with preserved ejection fraction in women. These projects were augmented by collaborative ancillary studies assessing the relationships between various lifestyle behaviors, including nightly fasting duration, mindfulness, and behavioral and anthropometric risk factors and CVD risk, as well as metabolomic profiling of heart failure with preserved ejection fraction in women. The Go Red for Women Strategically Focused Research Network enhanced the evidence base related to heart disease in women, promoting awareness of the female-specific factors that influence CVD.
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Affiliation(s)
- Marie‐Pierre St‐Onge
- Sleep Center of ExcellenceDepartment of MedicineColumbia University Irving Medical CenterNew YorkNY
| | - Brooke Aggarwal
- Sleep Center of ExcellenceDepartment of MedicineColumbia University Irving Medical CenterNew YorkNY
| | - Matthew A. Allison
- Division of Preventive MedicineDepartment of Family Medicine and Public HealthSchool of MedicineUniversity of California San DiegoLa JollaCA
| | - Jeffrey S. Berger
- Sarah Ross Soter Center for Women's Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
| | | | - Janet Catov
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of PittsburghPA
- Magee‐Womens Research InstituteUniversity of PittsburghPA
| | - Judith S. Hochman
- Sarah Ross Soter Center for Women's Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
| | - Carl A. Hubel
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of PittsburghPA
- Magee‐Womens Research InstituteUniversity of PittsburghPA
| | - Sanja Jelic
- Sleep Center of ExcellenceDepartment of MedicineColumbia University Irving Medical CenterNew YorkNY
| | - David A. Kass
- Division of CardiologyDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Nour Makarem
- Sleep Center of ExcellenceDepartment of MedicineColumbia University Irving Medical CenterNew YorkNY
| | - Erin D. Michos
- Division of CardiologyDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Lori Mosca
- Division of CardiologyDepartment of MedicineColumbia University Irving Medical CenterNew YorkNY
| | - Pamela Ouyang
- Division of CardiologyDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Chorong Park
- Sarah Ross Soter Center for Women's Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
| | - Wendy S. Post
- Division of CardiologyDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Robert W. Powers
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of PittsburghPA
- Magee‐Womens Research InstituteUniversity of PittsburghPA
| | - Harmony R. Reynolds
- Sarah Ross Soter Center for Women's Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
| | - Dorothy D. Sears
- Division of Preventive MedicineDepartment of Family Medicine and Public HealthSchool of MedicineUniversity of California San DiegoLa JollaCA
- College of Health SolutionsArizona State UniversityPhoenixAZ
- Department of Medicine and Moores Cancer CenterUniversity of California San DiegoLa JollaCA
| | | | - Kavita Sharma
- Division of CardiologyDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Tanya Spruill
- Sarah Ross Soter Center for Women's Cardiovascular ResearchNYU Grossman School of MedicineNew YorkNY
| | | | - Dhananjay Vaidya
- General Internal MedicineDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMD
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14
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Campos-Arias D, De Buyzere ML, Chirinos JA, Rietzschel ER, Segers P. Longitudinal Changes of Input Impedance, Pulse Wave Velocity, and Wave Reflection in a Middle-Aged Population: The Asklepios Study. Hypertension 2021; 77:1154-1165. [PMID: 33486987 DOI: 10.1161/hypertensionaha.120.16149] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Daime Campos-Arias
- From the IBiTech, Ghent University, Belgium (D.C.A., P.S.).,Biomechanics and Biomaterials Research Group, Universidad Tecnológica de La Habana (CUJAE), La Habana, Cuba (D.C.A.)
| | - Marc L De Buyzere
- Department of Cardiovascular Diseases, Ghent University, Belgium (M.L.D., E.R.R.)
| | - Julio A Chirinos
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C.).,University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C.)
| | - Ernst R Rietzschel
- Department of Cardiovascular Diseases, Ghent University, Belgium (M.L.D., E.R.R.).,Biobanking and Cardiovascular Epidemiology, Ghent University Hospital, Belgium (E.R.R.)
| | - Patrick Segers
- From the IBiTech, Ghent University, Belgium (D.C.A., P.S.)
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15
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Kilic D, Kilic ID, Sevgican CI, Kilic O, Alatas E, Arslan M, Avci E, Guler T. Arterial stiffness measured by cardio-ankle vascular index is greater in non-obese young women with polycystic ovarian syndrome. J Obstet Gynaecol Res 2020; 47:521-528. [PMID: 33145911 DOI: 10.1111/jog.14543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/25/2020] [Accepted: 10/16/2020] [Indexed: 11/29/2022]
Abstract
AIM The association of metabolic abnormalities and polycystic ovarian syndrome (PCOS) has been documented, but few studies have focused on cardiovascular risk in these women. The aim of this study was to compare arterial stiffness by using the cardio-ankle vascular index (CAVI) in PCOS women with controls, and to evaluate whether any clinical or laboratory variables had independent associations with it. METHODS A group of 160 women, matched for age and body mass index were recruited. Diagnosis of PCOS was made according to the Rotterdam criteria. Arterial stiffness using CAVI was evaluated in non-obese young woman, with and without PCOS. RESULTS In the PCOS group (n = 80), 60 cases (75%) had findings of hyperandrogenism, 59 (73.8%) had ovulatory dysfunction, and 70 (87.5%) had an ultrasonographic appearance of polycystic ovaries. Women with PCOS had significantly higher mean CAVI values when compared to subjects without PCOS (5.78 ± 0.64 vs 5.28 ± 0.77, P < 0.001). Multiple regression analysis revealed that androgen excess was associated with increased arterial stiffness, independent of ovulatory dysfunction, polycystic ovaries, body mass index and age. CONCLUSION This data suggests that vascular compliance is decreased in young women with PCOS. Androgen excess is independently associated with increased arterial stiffness.
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Affiliation(s)
- Derya Kilic
- Department of Obstetrics and Gynecology, Pamukkale University Medical School, Denizli, Turkey
| | - Ismail Dogu Kilic
- Department of Cardiology, Pamukkale University Medical School, Denizli, Turkey
| | | | - Oguz Kilic
- Department of Cardiology, Simav Doc. Dr. Ismail Karakuyu State Hospital, Kutahya, Turkey
| | - Erkan Alatas
- Department of Obstetrics and Gynecology, Pamukkale University Medical School, Denizli, Turkey
| | - Muhammet Arslan
- Department of Radiology, Pamukkale University Medical School, Denizli, Turkey
| | - Esin Avci
- Department of Biochemistry, Pamukkale University Medical School, Denizli, Turkey
| | - Tolga Guler
- Department of Obstetrics and Gynecology, Pamukkale University Medical School, Denizli, Turkey
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16
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Mathews L, Subramanya V, Zhao D, Ouyang P, Vaidya D, Guallar E, Yeboah J, Herrington D, Hays AG, Budoff MJ, Michos ED. Endogenous Sex Hormones and Endothelial Function in Postmenopausal Women and Men: The Multi-Ethnic Study of Atherosclerosis. J Womens Health (Larchmt) 2019; 28:900-909. [PMID: 31170017 DOI: 10.1089/jwh.2018.7441] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: The relationship of endogenous sex hormones (SH) with vascular endothelial function and with cardiovascular disease (CVD) is incompletely understood. We examined the associations between SH and endothelial function measured by brachial artery flow-mediated dilation (FMD). Materials and Methods: We included 1368 postmenopausal women and 1707 men, free of clinical CVD, participating in MESA Visit 1 (2000-2002). Serum SH [total testosterone, SH binding globulin (SHBG), dehydroepiandrosterone (DHEA), estradiol] were measured; free testosterone was calculated. The percent FMD difference (%FMD) was measured by high-resolution ultrasound. Using multivariable-adjusted linear regression, we tested the cross-sectional associations of SH (log transformed, compared per one SD increment) with %FMD. Results: The mean age of women and men were 64.2 and 61.4 years, respectively. Among women, after adjusting for demographics, CVD risk factors, and hormone therapy, higher SHBG was associated with greater %FMD [β = 0.215% (95% CI 0.026-0.405)], whereas higher free testosterone was associated with a smaller %FMD [-0.209% (-0.402, -0.017)]. Estradiol and DHEA were not associated with %FMD in women after multivariable adjustment. There was an age interaction, with higher free testosterone and lower SHBG associated with worse FMD in women <65 years of age, but not in those ≥65 years (p = 0.04). We did not see similar associations in men. Conclusions: A more androgenic SH profile of higher free testosterone and lower SHBG was associated with worse %FMD in postmenopausal women. Changes in SH with aging and menopause may result in vascular changes in women. Further studies are needed to assess longitudinal changes in SH levels and their association with vascular function.
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Affiliation(s)
- Lena Mathews
- 1Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland.,2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Vinita Subramanya
- 1Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Di Zhao
- 2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Pamela Ouyang
- 1Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Dhananjay Vaidya
- 2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,3Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Eliseo Guallar
- 2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Joseph Yeboah
- 4Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David Herrington
- 4Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Allison G Hays
- 1Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Matthew J Budoff
- 5David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Erin D Michos
- 1Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland.,2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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17
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Ying W, Zhao D, Ouyang P, Subramanya V, Vaidya D, Ndumele CE, Sharma K, Shah SJ, Heckbert SR, Lima JA, deFilippi CR, Budoff MJ, Post WS, Michos ED. Sex Hormones and Change in N-Terminal Pro-B-Type Natriuretic Peptide Levels: The Multi-Ethnic Study of Atherosclerosis. J Clin Endocrinol Metab 2018; 103:4304-4314. [PMID: 30137406 PMCID: PMC6194855 DOI: 10.1210/jc.2018-01437] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 08/15/2018] [Indexed: 01/24/2023]
Abstract
Context Sex hormones may influence sex differences in cardiovascular disease (CVD). N-terminal pro-B-type natriuretic peptide (NT-proBNP), a predictor of CVD, is higher in women than men, which may relate to sex hormones. Objective To evaluate whether total testosterone (T), bioavailable T, free T, estradiol, dehydroepiandrosterone (DHEA), and SHBG are associated with NT-proBNP. Design Cohort study. Participants Cross-sectional sample included 2371 postmenopausal women and 2688 men free of CVD, of which 2041 women and 2348 men were included longitudinally. Main Outcome Measures NT-proBNP at baseline (2000 to 2002) and one or more repeat NT-proBNPs (through 2012). Analyses adjusted for CVD risk factors. Results Women had higher NT-proBNP than men (median 79.9 vs 38.5 pg/mL). Cross-sectionally, higher bioavailable T, free T, DHEA, and lower SHBG levels were independently associated with lower NT-proBNP among both women and men (all P < 0.05). Higher total T in women and estradiol in men were also associated with lower NT-proBNP (both P < 0.05). Longitudinally, in women, higher total T, bioavailable T, free T, DHEA, and lower estradiol and SHBG were associated with greater 10-year increase in NT-proBNP (all P < 0.05). In men, higher free T and estradiol were associated with greater NT-proBNP increase (both P < 0.05). Conclusions A more androgenic sex hormone pattern was inversely associated with NT-proBNP cross-sectionally and may contribute to sex differences in NT-proBNP. Longitudinally, a more androgenic sex hormone pattern was associated with greater increase in NT-proBNP in women, which may reflect a mechanism for CVD risk after menopause.
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Affiliation(s)
- Wendy Ying
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Pamela Ouyang
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vinita Subramanya
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dhananjay Vaidya
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chiadi E Ndumele
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Kavita Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Susan R Heckbert
- Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle, Washington
| | - Joao A Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Matthew J Budoff
- Harbor-UCLA Medical Center, David Geffen School of Medicine, Los Angeles, California
| | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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18
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Subramanya V, Zhao D, Ouyang P, Ying W, Vaidya D, Ndumele CE, Heckbert SR, Budoff MJ, Post WS, Michos ED. Association of endogenous sex hormone levels with coronary artery calcium progression among post-menopausal women in the Multi-Ethnic Study of Atherosclerosis (MESA). J Cardiovasc Comput Tomogr 2018; 13:41-47. [PMID: 30297127 DOI: 10.1016/j.jcct.2018.09.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/23/2018] [Accepted: 09/29/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Sex differences in the incidence and manifestation of cardiovascular disease (CVD) suggest the involvement of sex hormones in disease pathogenesis. Coronary artery calcium (CAC) and its progression, measured by non-contrast cardiac computed tomography, are markers of subclinical atherosclerosis and predict CVD, even among low-risk women. We hypothesized that sex hormone levels were associated with CAC progression among women in the Multi-Ethnic Study of Atherosclerosis. METHODS We studied 2759 post-menopausal women (age 65 ± 9 years), free of baseline CVD, with baseline serum sex hormones and CAC measured at Exam 1 (2000-2002). Of this sample, 2427 had ≥1 follow-up CAC measurement through Exam 5 (2010-2012). Using mixed effects linear regression methods, we tested change in log[CAC+1] score by log[sex hormone] levels (continuous, comparing the 90th versus 10th percentiles). Models adjusted for demographics, lifestyle factors, cardiovascular risk factors, hormone therapy, and years since menopause. RESULTS At baseline, we found no associations between sex hormones and prevalent CAC. Over a median of 4.7 years, in fully-adjusted models, women with higher free testosterone levels had relatively greater CAC progression [Ratio 1.26 (95% CI 1.01-1.56)], whereas higher sex hormone binding globulin (SHBG) was associated with lower progression risk [0.80 (0.64-0.99). No associations were seen for total testosterone, estradiol, or dehydroepiandrosterone. CONCLUSION A more androgenic hormone profile of higher free testosterone and lower SHBG is associated with a greater CAC progression up to 10-years in post-menopausal women. Sex hormone levels may help identify women at increased risk for CVD who may benefit from additional risk-reducing strategies.
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Affiliation(s)
- Vinita Subramanya
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Di Zhao
- Dept. of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Pamela Ouyang
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wendy Ying
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dhananjay Vaidya
- Dept. of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Chiadi E Ndumele
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Dept. of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Susan R Heckbert
- Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Matthew J Budoff
- Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Wendy S Post
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Dept. of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Dept. of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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19
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Ogola BO, Zimmerman MA, Clark GL, Abshire CM, Gentry KM, Miller KS, Lindsey SH. New insights into arterial stiffening: does sex matter? Am J Physiol Heart Circ Physiol 2018; 315:H1073-H1087. [PMID: 30028199 DOI: 10.1152/ajpheart.00132.2018] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This review discusses sexual dimorphism in arterial stiffening, disease pathology interactions, and the influence of sex on mechanisms and pathways. Arterial stiffness predicts cardiovascular mortality independent of blood pressure. Patients with increased arterial stiffness have a 48% higher risk for developing cardiovascular disease. Like other cardiovascular pathologies, arterial stiffness is sexually dimorphic. Young women have lower stiffness than aged-matched men, but this sex difference reverses during normal aging. Estrogen therapy does not attenuate progressive stiffening in postmenopausal women, indicating that currently prescribed drugs do not confer protection. Although remodeling of large arteries is a protective adaptation to higher wall stress, arterial stiffening increases afterload to the left ventricle and transmits higher pulsatile pressure to smaller arteries and target organs. Moreover, an increase in aortic stiffness may precede or exacerbate hypertension, particularly during aging. Additional studies are needed to elucidate the mechanisms by which females are protected from arterial stiffness to provide insight into its mechanisms and, ultimately, therapeutic targets for treating this pathology.
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Affiliation(s)
- Benard O Ogola
- Department of Pharmacology, Tulane University , New Orleans, Louisiana
| | | | - Gabrielle L Clark
- Department of Biomedical Engineering, Tulane University , New Orleans, Louisiana
| | - Caleb M Abshire
- Department of Pharmacology, Tulane University , New Orleans, Louisiana
| | - Kaylee M Gentry
- Department of Pharmacology, Tulane University , New Orleans, Louisiana
| | - Kristin S Miller
- Department of Biomedical Engineering, Tulane University , New Orleans, Louisiana
| | - Sarah H Lindsey
- Department of Pharmacology, Tulane University , New Orleans, Louisiana
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