Low Levels of Sex Hormone-Binding Globulin Constitute an Independent Risk Factor for Arterial Stiffness in Korean Women

Relationship of Noninvasive Assessment of Arterial Stiffness with 10-Year Atherosclerotic Cardiovascular Disease (ASCVD) Risk in a General Middle-Age and Elderly Population

Purpose

As a powerful indicator of arterial stiffening, the brachial-ankle pulse wave velocity (baPWV) has been extensively validated for predicting cardiovascular events. However, whether and how the brachial-ankle pulse wave velocity (baPWV) is correlated with the 10-year atherosclerotic cardiovascular disease (ASCVD) risk is unclear. This study aimed to investigate the association between baPWV and 10-year ASCVD risk in Chinese population.

Methods

A total of 1768 subjects were enrolled from Shanghai, China. They were divided into two groups according to the Pooled Cohorts Equations model made by ACC/AHA as follows: low ASCVD risk (n = 992, 10-year ASCVD risk <7.5%) and high ASCVD risk (n = 776, 10-year ASCVD risk ≥7.5%). The baseline characteristics were obtained via the use of a questionnaire. Measurement of baPWV, laboratory tests, and echocardiography were conducted by trained physicians. The relationship between baPWV and 10-year ASCVD risk was evaluated using multiple logistic regression model and generalized additive model.

Results

The mean age of the subjects was 58.89±8.60 years, 32.69% of which were male. Non-linear relationship analysis revealed threshold effects between baPWV and 10-year ASCVD risk in which a baPWV of approximately 16 m/s might be the threshold effect of 10-year ASCVD risk. After multivariable adjustment, logistic-regression analysis demonstrated that ankle-brachial index (ABI) (OR 5.28, 95% CI 1.20–12.23) and baPWV (OR 9.09, 95% CI 6.84–12.07) were independently correlated with 10-year ASCVD risk. The AUC for baPWV for predicting 10-year ASCVD risk was 0.80 (95% CI 0.78–0.82).

Conclusion

Increased baPWV as an indicator of arterial stiffness correlates strongly with 10-year ASCVD risk in general middle-aged and elderly populations. The association between baPWV and 10-year ASCVD risk is not purely linear but non-linear. Subjects with baPWV above 16 m/s are more likely to encounter a higher 10-year ASCVD risk.

Definition, Prevalence, and Risk Factors of Low Sex Hormone-Binding Globulin in US Adults

CONTEXT

Lower sex hormone-binding globulin (SHBG) is associated with many diseases including cardiovascular disease, cancer, polycystic ovarian syndrome, arthritis, and liver disease. However, the definition of low SHBG and its prevalence in US adults are unknown.

OBJECTIVE

To define low SHBG and to determine its prevalence and risk factors in US adults.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study included adults ≥20 years from the US National Health and Nutrition Examination Survey (NHANES) from 2013 to 2016 who had fasting serum SHBG.

EXPOSURES

NHANES coverage during 2013-2016.

MAIN OUTCOMES MEASURES

Definition, prevalence, and risk factors of low SHBG.

RESULTS

This study included 4093 adults (weighted sample size of 204 789 616) with a mean (SD) age of 47.5 (17.0) years. In a "healthy" reference sub-cohort of 1477 adults, low SHBG was defined as SHBG < 12.3 nmol/L in men < 50 years, <23.5 nmol/L in men ≥ 50 years, <14.5 nmol/L in women < 30 years, and <21.9 nmol/L in women ≥ 30 years. The estimated US national prevalence of low SHBG was 3.3% in men, 2.7% in women, and 3.0% overall. Risk factors for this condition in both men and women included higher body mass index, diabetes, ethnicity (being other than Hispanic, non-Hispanic black, or non-Hispanic white), chronic obstructive pulmonary disease, coronary heart disease, and smoking.

CONCLUSIONS

This study established the criteria for low SHBG among US adults. The estimated US national prevalence of low SHBG was 3.3% in men and 2.7% in women.

Tree nut consumption is associated with higher sex hormone-binding globulin levels in premenopausal US women

Low levels of sex hormone-binding globulin (SHBG) are associated with many diseases including hypertension, diabetes, and polycystic ovarian syndrome. Walnuts increased circulating SHBG in 31 women complicated with polycystic ovarian syndrome. However, whether tree nuts increase SHBG in women in a general population is unknown. It was hypothesized in this study that consumption of tree nuts was positively associated with SHBG levels in women in a general population. This cohort study included 2699 adult women from the 2013- to 2016 US National Health and Nutrition Examination Survey. Tree nut consumers were defined as those who consumed tree nuts on either of the 2 24-hours recall days. Associations of tree nut consumption with SHBG were assessed using least squares regression. Among the 2699 women, 234 were consuming tree nuts. The median SHBG concentrations were 67.1 and 59.3 nmol/L among tree nut consumers and non-consumers, respectively. Tree nut consumption was positively associated with circulating SHBG (β = 0.041, P = .018) but not testosterone nor estradiol after adjustment for all tested confounders. Sub-analyses showed that the positive association of tree nuts with SHBG presented in premenopausal women but not in postmenopausal women. Tree nut consumption remained independently associated with higher circulating levels of SHBG in premenopausal women when tree nut consumption was expressed as percentage of energy derived from tree nuts or when tree nut consumption was defined as a tree nut intake of ≥0.25 ounce per day. Future research will verify the effectiveness of using tree nuts to treat low SHBG in premenopausal women in the general population.

Sex hormones in association with general joint laxity and hypermobility in the temporomandibular joint in adolescents-results of the epidemiologic LIFE child study

OBJECTIVES

The aim of this cross-sectional study was to investigate whether sex hormones (testosterone, oestradiol, sex-hormone-binding globulin = SHBG) are associated with general joint laxity (GJL) and hypermobility or derangements of the temporomandibular joint (TMJ) in adolescents.

METHODS

Within the LIFE Child study, 970 adolescents (10-18 years) were included. GJL was assessed using the Beighton test. Maximum mouth opening (MMO) and clinical clicking sounds as signs of disc displacement (DD) in the TMJ were assessed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Serum levels of sex hormones were assessed using standardised laboratory analyses.

RESULTS

Hypermobile joints were found in 54.9% (N = 532) of the sample; females were more affected than males (61.4% vs. 51.8%, P < 0.001). Using logistic regression analyses, the odds ratio (OR) for having >1 hypermobile joints increased to 1.15 (95% confidence interval [CI]: 1.04-1.27) in males and 1.09 (95% CI: 1.02-1.17) in females per 10 units of the SHBG serum level, compared to those without hypermobile joints-after controlling for the effect of age, adjusted BMI, pubertal development (Tanner scale), testosterone as well as oestradiol levels. Female subjects with >1 hypermobile joints showed a higher OR (1.89; 95% CI: 1.05-3.43) for having clinical clicking sounds in the TMJ and a 3.28 times higher OR (95% CI: 1.44-7.44) for MMO ≥ 55 mm.

CONCLUSIONS

We observed age- and gender-independent associations of higher SHBG serum levels with GJL in adolescents. Moreover, hypermobile female adolescents show a more frequent hypermobility of the TMJ and clinical signs of DD.