Relationship Between Serum Sex Hormones and Coronary Artery Disease in Postmenopausal Women

Abstract

Although sex hormones appear to be importantly involved in the development of coronary heart disease, apparently no study has yet reported an alteration in an endogenous sex hormone level in relation to coronary heart disease in women. In an attempt to determine whether any sex hormone abnormality might be a factor in the development of myocardial infarction in women, estradiol and testosterone, as well as sex hormone-binding globulin, insulin, dehydroepiandrosterone sulfate, and risk factors for myocardial infarction, were measured in relation to the degree of coronary artery disease (CAD) in 60 postmenopausal women undergoing coronary angiography. In a multiple-regression analysis with the degree of CAD as the dependent variable and free testosterone (FT), estradiol, age, body mass index, systolic blood pressure, cholesterol, smoking, and insulin as independent variables in the model, only FT (P < .008) and cholesterol (P = .01) were significantly related to the degree of CAD, both positively. To exclude a possible confounding effect due to prior myocardial infarction, the multiple-regression analysis was repeated for the subgroup of 49 patients remaining after excluding the 11 patients who had ever had a myocardial infarction; again only FT (P < .04) and cholesterol (P = .05) were significantly related to the degree of CAD. Neither total testosterone in place of FT nor HDL cholesterol in place of total cholesterol in the model was significantly related to CAD. Sex hormone-binding globulin and dehydroepiandrosterone sulfate, added individually to the model, showed no significant relationship to CAD. These results raise the possibility that in women an elevated FT level may be a risk factor for coronary atherosclerosis.

Endogenous sex hormones and risk factors for atherosclerosis in healthy Greek postmenopausal women

“…Haffner et al (35) reported a positive association between endogenous total testosterone and systolic and diastolic blood pressure in postmenopausal women. Furthermore, hypertensive postmenopausal women are reported to have higher mean testosterone and free-to-total testosterone ratio compared with normotensive women (48). The same group demonstrated a significant association between free testosterone and blood pressure in healthy and diabetic postmenopausal women (49).…”

Testosterone, SHBG and cardiovascular health in postmenopausal women

“…Phillips et al 75 examined the correlation between testosterone and the degree of coronary atherosclerosis in a cross-sectional design among 60 patients with coronary artery disease. In this study, increasing FT levels were associated with coronary artery disease severity, independent of estradiol, BMI and other cardiovascular risk factors.…”

Menopause, Estrogens, and Endothelial Dysfunction: Current Concepts

“…52 On the other hand, androgen and sex hormone-binding globulin (SHBG) levels have been associated with risk of cardiovascular disease in pre-and postmenopausal women. 53,54 An increase in circulating androgens appears to be associated with insulin resistance and a predictor of diabetes mellitus. [55][56][57] In a previous study, we demonstrated a positive association, independent of obesity, between testosterone levels and hyperinsulinemia in postmenopausal women with no clinical evidence of cardiovascular disease.…”