Serum Follicle-Stimulating Hormone Levels Are Associated with Cardiometabolic Risk Factors in Post-Menopausal Korean Women

Follicle-Stimulating Hormone and Diabetes in Postmenopausal Women: A Systematic Review and Meta-Analysis

CONTEXT

The co-occurrence of hormonal changes during menopause and the risk of cardio-metabolic disorders has been well studied.

OBJECTIVE

We explored the association of circulating levels of follicle-stimulating hormone (FSH) with diabetes (DM) among postmenopausal women.

METHOD

In this systematic review and meta-analysis, the search was performed in PubMed, Scopus, Web of Sciences, Epistemonikos, and Cochrane Library up to September 2023. Risk of bias was assessed by Newcastle-Ottawa Quality Assessment Scale. Pooled estimates of mean differences in FSH levels were compared between postmenopausal women with and without DM. Correlations between FSH and fasting blood glucose (FBG)/insulin/homeostatic model assessment for insulin resistance (HOMA-IR) as well as pooled effect sizes with their 95% CIs for risk of DM were calculated.

RESULTS

In this study, 14 articles, including 7878 postmenopausal women, met eligibility criteria. Most of the included studies had a low/moderate risk of bias. Women with DM had significantly lower FSH levels than those without DM (standardized mean difference [SMD] -0.751 [95% CI, -1.129 to -.372], I2 = 82.46%, n = 1416). The pooled effect size for diabetes was 0.861 (95% CI, 0.740-1.001; I2 = 80.11%). The pooled risk estimate for DM based on the categorical FSH levels (high vs low) was (HR = 0.550; 95% CI, 0.356-0.850, I2 = 0). The significant inverse correlation was found between FSH levels and glycemic parameters: FBG (r= -0.285 [95% CI -0.441 to -0.113]; n = 1229), HOMA-IR (r = -0.241[-0.378 to -0.0924]; n = 1229) and insulin (r = -0.337 [-0.434 to -0.232]; n = 959)]. There were no statistically significant differences between estradiol levels among diabetic and nondiabetic groups; however, the SMD for luteinizing hormone was similar to that reported for FSH.

CONCLUSION

The available data indicated an indirect association between FSH levels and glucose disturbances among postmenopausal women, notwithstanding heterogeneity among included studies, and the complexity of various influential factors needs to be considered. Further efforts should be made to clarify the underlying mechanisms.

The relationship between follicle-stimulating hormone and metabolic dysfunction-associated fatty liver disease in men

OBJECTIVES

The present study aimed to investigate the relationship between male hormones and metabolic dysfunction-associated fatty liver disease (MAFLD) in males.

METHODS

Data from the Fangchenggang Area Male Health and Examination Survey (FAMHES) were used to analyze the male hormone levels between MAFLD patients and controls. Univariate and multivariate logistic regression analyses were performed to identify risk factors for MAFLD. Receiver operating characteristic curve analysis was used to assess the diagnostic performance of male hormones for MAFLD.

RESULT

A total of 1578 individuals were included, with 482 individuals (30.54%) of MAFLD, including 293 (18.57%) with mild disease and 189 (11.98%) with moderate-to-severe disease. The MAFLD patients were significantly older than those without MAFLD. The LH, FSH, and SHBG levels in the MAFLD patients were significantly greater than those in the control group. Age, FSH, LH, SHBG, and estradiol were all risk factors for MAFLD. Age, FSH, and LH were risk factors for moderate-to-severe MAFLD. FSH was an independent risk factor for MAFLD and moderate-to-severe MAFLD. FSH showed an excellent diagnostic value, with an AUC of 0.992 alone and 0.996 after adjusting age.

CONCLUSIONS

Our findings indicate that FSH may be a potential diagnostic and predictive biomarker for MAFLD.

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Effects of Nutrition Education with Intervention Mapping on Cardiovascular Disease Risk Factors in Women with Borderline Dyslipidemia: Analysis According to Menopausal Status

Background

Menopause causes hormonal, physical, and psychological changes that are associated with an increase in risk of cardiovascular disease (CVD). This study examined the effects of medical nutrition therapy (MNT) on CVD risk factors in pre- and post-menopausal women with borderline dyslipidemia in Korea.

Methods

In total, 76 participants were divided into the MNT and control groups. MNT was performed for 12 weeks using intervention mapping with consideration of weight, blood lipid levels, and dietary assessment results. Anthropometric and biochemical measurements and dietary intake were analyzed.

Results

The dietary energy and cholesterol intake, waist circumference (WC), blood triacylglycerol and very-low-density lipoprotein cholesterol levels, and atherogenic index (AI) of the pre-menopausal MNT group decreased significantly after the intervention. Moreover, dietary cholesterol intake, WC, waist-to-hip ratio, body fat percentage, total blood cholesterol, low-density lipoprotein to high-density lipoprotein ratio, and AI decreased significantly in the post-menopausal MNT group after the intervention.

Conclusion

MNT for 12 weeks is effective in decreasing risk factors associated with CVD in Korean women with borderline dyslipidemia, and the effects differ between pre- and post-menopausal women.

Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Associations of follicle-stimulating hormone and luteinizing hormone with metabolic syndrome during the menopausal transition from the National Health and Nutrition Examination Survey

BACKGROUND

The increased risk of metabolic syndrome (MetS) during the menopausal transition might partly attribute to the changes in follicle-stimulating hormone (FSH) and luteinizing hormone (LH). However, few studies were conducted to examine the associations of FSH and LH concentrations with MetS at the full range of reproductive aging, especially in the US population. The aim of this study is to examine the associations of FSH, LH, and LH/FSH ratio with the risk of MetS and severity score in the US women.

METHODS

Data were derived from the National Health and Nutrition Examination Survey. Women aged from 35 to 60 years were eligible. MetS was defined as having at least 3 of the following: a waist circumference ≥ 88 cm, a triglycerides level ≥ 150 mg/dL, a high density lipoprotein < 50 mg/dL, a systolic blood pressure ≥ 130 mm Hg or a diastolic blood pressure ≥ 85 mm Hg or taking hypertension medications, or a fasting plasma glucose level ≥100 mg/dL or taking diabetes medications. The MetS severity score was calculated according to race/ethnicity- specific equation.

RESULTS

There were 3,831 women included in this study. Increases in serum FSH and LH levels per 1 SD were separately linked to a 22.6% (OR: 0.774; 95% CI: 0.646, 0.929; and P= 0.006) and 18.5% (OR: 0.815; 95% CI: 0.690, 0.962; and P= 0.006) lower risk of MetS only in postmenopausal women. Meanwhile, increases in serum FSH and LH levels per 1SD were associated with a decrease of -0.157 (95% CI :-2.967, -2.034) and -0.078 (95% CI: -2.688, -1.806) MetS severity score in perimenopausal women and -0.195 (95% CI: -2.192, -1.023) and -0.098 (95% CI:-1.884, -0.733) in postmenopausal women. However, LH/FSH ratio had no connections with the risk of MetS and MetS severity score across the menopausal transition.

CONCLUSIONS

Elevated serum FSH and LH levels, but not LH/FSH ratio, were associated with a lower risk of MetS and MetS severity score, especially in postmenopausal women. Therefore, serum FSH and LH levels might be efficient predictors for screening and identifying women at risk of MetS across the menopausal transition.

Association of follicle stimulating hormone and serum lipid profiles in postmenopausal women

The aim of the study was to observe the association between follicle stimulating hormone (FSH) levels and serum lipid profiles in postmenopausal women. A total of 411 healthy postmenopausal women with a mean age of 55 years (range 45-65 years) were enrolled in this study. Data on age, time of last menstrual period, past medical history, use of medications, and smoking status were collected, and body weight, height, and blood pressure were measured. Blood samples were collected to measure the serum concentrations of FSH, luteinizing hormone (LH), estradiol (E2), glucose, total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) using routine methods. FSH levels were negatively associated with LDL-C, even after adjustment for age, LH, E2, BMI, systolic blood pressure (SBP), and diastolic blood pressure (DBP) (OR = 0.185, 95% CI = 0.051-0.669). Although FSH may also be negatively associated with dyslipidemia (P = .06 for trend) and hypercholesterolemia (P = .079 for trend), but no statistical significance was found after adjusting for confounding factors, particularly BMI. All relevant data are within the paper and its Supporting Information files. The results indicated that lower FSH levels might increase the odds of dyslipidemia, especially the risk of LDL-C elevation, which is an important factor that increases the risk of CVD in postmenopausal women.

Associations of reproductive factors with postmenopausal follicle stimulating hormone

Purpose

Recent studies have suggested that higher postmenopausal follicle stimulating hormone (FSH) may be associated with lower risk of diabetes. However, relatively little is known about postmenopausal FSH levels, including the level of variation between women and whether reproductive factors are associated with this variation.

Methods

We assessed the relationship of multiple reproductive factors with FSH levels among 588 postmenopausal women in the Kuopio Ischaemic Heart Disease Risk Factor Study. Participants were aged 53 to 73 years and not using hormone therapy at study enrollment (1998–2001) when reproductive factors were assessed and FSH was measured.

Results

After adjustment for age, menopause timing, sex steroid levels, adiposity and behavioral factors, we observed numbers of pregnancies and age at first birth were each inversely associated with FSH levels. For example, women with ≥ 3 births and an age at first birth ≥ 25 years had mean FSH levels that were 7.8 IU/L lower than those of women with 1–2 births and an age at first birth ≤ 24 years (P = 0.003). Number of miscarriages was inversely associated with FSH levels (-2.7 IU/L per miscarriage; P = 0.02). Women reporting 4 or more years of past hormone therapy use had significantly higher mean FSH levels than women who had never used hormone therapy (P for trend = 0.006).

Conclusion

Multiple reproductive factors were associated with postmenopausal FSH, independent of estradiol, adiposity and other confounders. These findings warrant replication and further exploration of potential underlying mechanism.

Serum Follicle-Stimulating Hormone and 5-Year Change in Adiposity in Healthy Postmenopausal Women

CONTEXT

Evidence from animal studies suggests that the gradual rise in follicle-stimulating hormone (FSH) during reproductive senescence may contribute to the change in adiposity distribution characteristic of menopause. The potential independent role the interrelationships of FSH and estradiol (E2) may play in postmenopausal adiposity changes are not well studied.

OBJECTIVE

Our objective was to evaluate the associations of FSH and dual x-ray absorptiometry (DXA)-derived adiposity measures, with consideration of estradiol and postmenopausal hormone therapy use.

METHODS

In a sample of 667 postmenopausal women from the Women's Health Initiative Buffalo OsteoPerio Ancillary Study, we studied the associations of serum FSH and E2 levels with dual x-ray absorptiometry (DXA)-derived adiposity measures via cross-sectional and longitudinal analyses (5-year follow-up).

RESULTS

In cross-sectional analyses, FSH levels were inversely associated with all measures of adiposity in models adjusted for age, years since menopause, smoking status, pack-years, and hormone therapy (HT) use; these associations were not influenced by adjustment for serum E2. In longitudinal analyses, the subset of women who discontinued HT over follow-up (n = 242) experienced the largest increase in FSH (+33.9 mIU/mL) and decrease in E2 (-44.3 pg/mL) and gains in all adiposity measures in unadjusted analyses. In adjusted analyses, an increase in FSH was associated with a gain in percentage of total body fat, total body fat mass, and subcutaneous adipose tissue (SAT).

CONCLUSION

While cross-sectional findings suggest that FSH is inversely associated with adiposity, our longitudinal findings suggest that greater increases in FSH were associated with greater increases in percentage of total body fat, total body fat mass, and SAT. Future studies are needed to provide additional insight into FSH-adiposity mechanisms in larger samples.

Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Adaptive potential of cardiovascular system and its relationship with sex hormones and dopamine levels in women of Arkhangelsk Oblast and Yamalo-Nenets Autonomous Okrug

Aim. To assess the adaptive potential of cardiovascular system in female population of the Russian Arctic territory and its relationship with sex hormones and dopamine levels.

Material and methods. The study involved 253 women living in European North (Arkhangelsk Oblast) and Asian North (Yamalo-Nenets Autonomous Okrug), who were divided into groups of fertile (n=58 and n=70, respectively) and postmenopausal women (n=59 and n=66, respectively). Enzyme immunoassay of serum was used to determine the levels of follicle-stimulating and luteinizing hormones (LH), progesterone, prolactin, total and free testosterone, estradiol, sex hormone-binding globulin. In plasma, dopamine level was identified. Adaptive potential (AP) was estimated according to R. M. Baevsky method.

Results. A significant disadaptation was revealed in residents of Asian North compared to European North as follows: the proportion of persons with poor adaptation increases from 16% in European North to 26% in Asian North in fertile women, while the proportion of persons with adaptation failure increases from 9 to 23% in postmenopausal women. The strongest relationships between hormonal parameters and AP level were found in postmenopausal women: in European North, adaptation impairment is associated with higher levels of testosterone at lower concentrations of follicle-stimulating hormone, LH and sex hormone-binding globulin; in Asian North, adaptation failure is associated with lower values of LH, prolactin, testosterone, and dopamine.

Conclusion. A greater AP impairment, which characterizes cardiovascular system adaptation, was noted among Asian North residents. We revealed significant relationships between cardiovascular function and hormonal parameters. In European North residents, poor adaptation is associated with a more androgenic sex hormone profile, while in Asian North — with lower values of LH, prolactin, testosterone and dopamine.

A low follicle-stimulating hormone level is a protective factor for non-alcoholic fatty liver disease in older men aged over 80

PURPOSE

Recent studies have suggested the significant relationship between follicle-stimulating hormone (FSH) and non-alcoholic fatty liver disease (NAFLD) in postmenopausal women. However, it is unknown whether FSH impacts the risk of NAFLD in men. This study aimed to investigate the association between serum FSH levels and NAFLD in elderly Chinese men aged 80-98, a particular group with worse outcomes of NAFLD.

PATIENTS AND METHODS

A cross-sectional analysis was performed in 444 subjects in a geriatric health center. The highest quartile of serum FSH was used as reference. Hepatic steatosis was defined according to the results of liver ultrasound. Fibrosis-4 (FIB-4) Index > 2.67 was defined as advanced fibrosis.

RESULTS

Based on liver ultrasound, 108 (24.3%) subjects had NAFLD. FSH level were negatively correlated with total testosterone, estradiol, nutritional risk, and the prevalence of high education level (all P < 0.01), and positively correlated with age, luteinizing hormone, alanine aminotransferase and aspartate aminotransferase (all P < 0.05). The correlation between FSH and body mass index or antihypertensive drug usage was marginally significant (P = 0.057; P = 0.066, respectively). The percentage of subjects with NAFLD had a trend to increase following the quartiles of serum FSH (20.0% in quartile 1, 18.2% in quartile 2, 27.3% in quartile 3, and 31.6% in quartile 4). After adjustment for common pathogenic risk factors, nutritional risk, and other sex hormones, serum FSH were progressively associated with odds ratios for NAFLD. The adjusted odds ratios and 95% CIs for quartile 1, quartile 2, and quartile 3, compared with quartile 4 were 0.132 (0.034-0.516), 0.190 (0.052-0.702), and 0.404 (0.139-1.173), respectively. Obesity was not involved in the potential negative role of circulating FSH on the risk of NAFLD in our population. Furthermore, our results revealed no significant association between FSH and advance fibrosis, the OR (95% CI) for advanced fibrosis was 1.018 (0.983-1.054) (P = 0.316) after adjusting for the potential covariates, although a positive correlation of FSH and FIB-4 score was observed (r = 0.325, P = 0.001).

CONCLUSION

Low FSH level may decrease the risk of NAFLD in elderly Chinese men. These findings warrant replication in more extensive studies.