Association of endogenous sex hormone levels with coronary artery calcium progression among post-menopausal women in the Multi-Ethnic Study of Atherosclerosis (MESA).

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.

• Authors: Vinita Subramanya, Di Zhao, Pamela Ouyang, Wendy Ying, Dhananjay Vaidya, Chiadi E Ndumele, Susan R Heckbert, Matthew J Budoff, Wendy S Post, Erin D Michos
• Journal: Journal of cardiovascular computed tomography (J Cardiovasc Comput Tomogr) 2019 Jan - Feb Vol. 13 Issue 1 Pg. 41-47 ISSN: 1876-861X [Electronic] United States
• PMID: 30297127 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2018. Published by Elsevier Inc.

Chemical References

• Biomarkers
• Gonadal Steroid Hormones
• Sex Hormone-Binding Globulin
• Testosterone
• Dehydroepiandrosterone
• Estradiol

Topics

• Aged
• Aged, 80 and over
• Biomarkers (blood)
• Computed Tomography Angiography
• Coronary Angiography (methods)
• Coronary Artery Disease (blood, diagnostic imaging, ethnology)
• Dehydroepiandrosterone (blood)
• Disease Progression
• Estradiol (blood)
• Female
• Gonadal Steroid Hormones (blood)
• Humans
• Incidence
• Middle Aged
• Multidetector Computed Tomography
• Postmenopause (blood, ethnology)
• Prevalence
• Prospective Studies
• Risk Factors
• Sex Hormone-Binding Globulin (analysis)
• Testosterone (blood)
• Time Factors
• United States (epidemiology)
• Vascular Calcification (blood, diagnostic imaging, ethnology)