Clinical signs of androgen excess as risk factors for coronary artery disease

Wild, Robert A.; Grubb, Blair P.; Hartz, Arthur J.; Nort, Joseph J. Van; Bachman, William; Bartholomew, Mary J.

doi:10.1016/s0015-0282(16)53699-1

Cited by 172 publications

(68 citation statements)

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“…13 PCOS is also associated with insulin-induced elevations of plasminogen activator inhibitor (PAI)-1, which is a potent inhibitor of fibrinolysis. 14 While some studies have found PCOS to be associated with coronary heart disease risk factors, [15][16][17][18][19][20] other studies have shown that women with PCOS were 3 times more likely to have a family history of venous thrombosis. 21 Mak and Dokras 22 hypothesized that women with PCOS likely have an increased baseline risk for developing thrombosis compared with other women in the general population.…”

Section: Author Manuscript Author Manuscriptmentioning

confidence: 99%

“…These findings also demonstrate the complex nature of PCOS and its related clinical consequences. For instance, increased cardiovascular risks has been found among women with phenotype A (hyperandrogenism and ovulatory dysfunction) or classic PCOS [15][16][17][18][19][20] ; on the other hand, Wiltgen and Spritzer 30 showed that hirsute ovulatory patients with polycystic ovaries (phenotype B) had a lower prevalence of cardiovascular risk factors than those with the classic PCOS phenotype. One would then expect that the highest probability of VTE also would be found among women with phenotype A and the lowest probability among women with phenotype B.…”

Section: Commentmentioning

confidence: 99%

See 1 more Smart Citation

Is polycystic ovary syndrome another risk factor for venous thromboembolism? United States, 2003–2008

Okoroh

Hooper

Atrash

et al. 2012

American Journal of Obstetrics and Gynecology

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OBJECTIVE-We sought to determine prevalence and likelihood of venous thromboembolism (VTE) among women with and without polycystic ovary syndrome (PCOS). STUDY DESIGN-We performed a cross-sectional analysis using Thomson Reuters MarketScanCommercial databases for the years 2003 through 2008. The association between VTE and PCOS among women aged 18-45 years was assessed using age-stratified multivariable logistic regression models.RESULTS-Prevalence of VTE per 100,000 was 374.2 for PCOS women and 193.8 for women without PCOS. Compared with women without PCOS, those with PCOS were more likely to have VTE (adjusted odds ratio [aOR] 18-24 years, 3.26; 95% confidence interval [CI], 2.61-4.08; aOR 25-34 years, 2.39; 95% CI, 2.12-2.70; aOR 35-45 years, 2.05; 95% CI, 1.84-2.38). A protective association (odds ratio, 0.8; 95% CI, 0.73-0.98) with oral contraceptive use was noted for PCOS women.CONCLUSION-PCOS might be a predisposing condition for VTE, particularly among women aged 18-24 years. Oral contraceptive use might be protective. Keywordspolycystic ovary syndrome; prevalence; venous thromboembolism Venous thromboembolism (VTE) is a chronic condition that includes both deep vein thrombosis (DVT) and pulmonary embolism (PE). Initial presentation might be leg pain, tenderness, shortness of breath, or pleuritic chest pain, or there might be no symptoms. 1 VTE is the third most common cardiovascular disease-after myocardial infarction and stroke-among the general population. 2,3 The overall annual incidence of VTE is estimated © 2012 Mosby, Inc. All rights reserved.Reprints: Ekwutosi M. Okoroh, MD, Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop E64, Atlanta, GA 30333. Eokoroh@cdc.gov. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.The authors report no conflict of interest.Presented orally at the 60th Annual Epidemic Intelligence Service Conference, Atlanta, GA, April 11-15, 2011. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author Manuscript to be 1-2 per 1000 adults per year. [4][5][6][7] These incident estimates, however, might not represent the entire population because VTE incidence differs by age and race, and slightly by sex. VTE is a multifactorial disease with both inherited and acquired risk factors. In 26-47% of first-time VTE cases, the etiology is unknown 4,5,8 ; a possible predisposing condition not yet assessed is polycystic ovary syndrome (PCOS).PCOS is the most common endocrine disorder affecting women of reproductive age. Estimates of its prevalence vary and range from 4-6%. 9-12 Its exact etiology is unknown, but it is characterized by a heterogeneous presentation of hyperandrogenism, ovulatory dysfunction, and polycystic ovaries. 13 PCOS is also associated with insulin-induced elevations of plasminogen activator inhibitor (P...

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Section: Author Manuscript Author Manuscriptmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Is polycystic ovary syndrome another risk factor for venous thromboembolism? United States, 2003–2008

Okoroh

Hooper

Atrash

et al. 2012

American Journal of Obstetrics and Gynecology

View full text Add to dashboard Cite

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“…Indirect evidence for a role of androgens comes from findings of clinical studies showing an unfavorable cardiovascular risk profile in hyperandrogenic conditions such as hirsutism 13 and the polycystic ovary syndrome. 14 Several studies in postmenopausal women have also shown a positive correlation between testosterone and various CVD risk factors.…”

Section: Introductionmentioning

confidence: 99%

Testosterone, SHBG and cardiovascular health in postmenopausal women

Brand

Schouw

2010

Int J Impot Res

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Cardiovascular disease (CVD) affects men and women differently with women having a lower incidence and later onset of disease. Research has recently refocused interest on the cardiovascular role of androgens. The purpose of this review is to summarize the evidence available on the association between testosterone and cardiovascular health in postmenopausal women. Published studies relating testosterone and sex hormone-binding globulin (SHBG) to CVD and its risk factors were reviewed. Studies included in this review suggest that increased androgenicity, characterized by high testosterone and low SHBG levels, is associated with an adverse CVD risk factor profile in postmenopausal women. However, evidence for an association with cardiovascular events is lacking and it is uncertain whether the observed associations with endogenous testosterone have clinical implications regarding the use of postmenopausal testosterone therapy. Large-scale, longitudinal studies relating testosterone and SHBG levels to cardiovascular risk factors and endpoints are needed to determine the temporal relationship between androgenicity and cardiovascular risk and to ascertain the long-term efficacy and safety of testosterone therapy in postmenopausal women.

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“…Clinical signs of hyperandrogenism, hirsutism and acne have been recognized as common characteristics of women suffering catheterization for coronary artery disease and were related with more serious disease (Wild, Grubb et al 1990). There is little proof of an association among androgenic alopecia and raised cardiovascular risk in men, and there is www.intechopen.com even less in women (Rebora 2001).…”

Section: Hyperandrogenismmentioning

confidence: 99%