Endogenous sex hormone levels in postmenopausal women undergoing carotid artery endarterectomy

Abstract

Objective: To study the endogenous sex hormone levels in natural postmenopausal women and their association with the presence of internal carotid artery (ICA) atherosclerosis. Design: Case-control study Methods: We compared 56 patients with severe ICA atherosclerosis referred for carotid artery endarterectomy (CEA) with 56 age-matched control subjects free of severe atherosclerotic disease. The presence of atherosclerosis was determined by high-resolution B-mode ultrasound. Metabolic parameters and sex hormones were measured or calculated: total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, glucose, insulin, quantitative insulin sensitivity check index, insulin resistance index, IGF-I, DHEA, DHEA sulfate (DHEA-S), free testosterone, total testosterone, estrone, estradiol, androstenedione, and sex hormone-binding globulin. Results: The cases had statistically significant lower levels of both total testosterone (0.23G0.12 vs 0.31G0.20 mg/l, PZ0.043) and free testosterone (3.42G1.94 vs 4.59G2.97 ng/l, PZ0.009) and significantly lower levels of androstenedione (625.3G168.7 vs 697.0G211.9 ng/l, PZ0.017) when compared with controls. Multivariate linear regression analysis, adjusted for traditional cardiovascular risk factors, baseline and physiologic characteristics, showed a significant inverse relationship between both serum free testosterone (bZK0.234, PZ0.028) and androstenedione (bZK0.241, PZ0.028) levels with the presence of severe atherosclerosis of ICA. Conclusions:The study provides evidence of a positive association between low serum androgen levels and severe ICA atherosclerosis in postmenopausal women. It suggests that higher, but physiological, levels of androgens in postmenopausal women have a protective role in the development of atherosclerosis of ICA.European Journal of Endocrinology 156 687-693

Testosterone, SHBG and cardiovascular health in postmenopausal women

“…Bernini et al 19 showed an inverse association between FT and carotid intima-media thickness (cIMT) in 44 postmenopausal women. Similar findings were reported by Debing et al 20 who found that cases with carotid atherosclerosis had lower levels of FT than atherosclerotic free controls. In another case-control study, 74 carotid atherosclerosis was also found to be more common in women in the lowest TT quartile than in the highest TT quartile.…”

“…18 However, reverse associations between testosterone and markers of atherosclerosis have been reported as well. 19,20 This review aims to summarize the current evidence on the role of endogenous testosterone in cardiovascular health in postmenopausal women and to highlight potential adverse effects of testosterone therapy.…”

MECHANISMS IN ENDOCRINOLOGY: Endogenous sex steroids and cardio- and cerebro-vascular disease in the postmenopausal period

“…In the case-control study of Debing et al in 56 patients undergoing carotid artery endarterectomy and 56 age-matched controls, it was found that total testosterone and D4-androstenedione levels were lower in the patients' group compared with the controls. The inverse association of circulating androgens with carotid atherosclerosis remained significant even after controlling for classical CVD risk factors (21). These results were reproduced in the same year by Montalcini et al (22).…”

“…In the recent large study of Sievers et al (32) assessing 2914 women followed for 4.5 years, it was demonstrated that women with the Table 1 Cumulative results of studies investigating associations of endogenous estrogen and androgen levels with cardio-and cerebrovascular disease risk in postmenopausal women (reference in parenthesis). Prospective case-control 297 No independent association of E with CVD risk (12) Case-control 400 No independent association of E and A with CVD risk (13) Cross-sectional 344 Positive association of total testosterone with threefold higher CHD risk (14) Case-control 200 Positive association of A with CVD (21) Case-control 112 Inverse association of A with carotid atherosclerosis (22) Cross-sectional 101 Inverse association of A with carotid atherosclerosis (23) Case-control 364 Inverse association of total testosterone with carotid atherosclerosis (25) 12-year FU, population-based 639 U-shaped association of A with CHD risk FU, follow-up; E, estrogen; A, androgen; CVD, cardiovascular disease; CHD, coronary heart disease.…”

The influence of aerobic training on body composition in premenopausal women undergoing endocrine therapy for breast cancer

“…Long-term hypo-oestrogenaemia is one of the major factors responsible for the development of atherosclerosis and the severity of insulin resistance, hypertension and impaired glucose metabolism [11,13,14]. Visceral obesity promotes the release of large amounts of free fatty acids (FFA), which results in the inhibition of glucose uptake by target cells, hyperinsulinaemia and subsequent insulin resistance [15]. Insulin resistance and hyperinsulinaemia through the intensification of the synthesis of lipoproteins of very low density lipoproteins (VLDL) in the liver lead to the occurrence of hyperlipidaemia char-acterized by proatherogenic lipid profile, increased LDL cholesterol and reduced levels of protective HDL fraction [16].…”