Effect of High Androgen Levels on Cardiovascular Risk in Postmenopausal Women

Contrary to popular belief, women with postmenopausal high androgen levels are not at increased risk for cardiovascular disease (CVD), according to a prospective population-based cohort study published in the Journal of Clinical Endocrinology & Metabolism.¹

Polycystic ovary syndrome (PCOS) is associated with hyperandrogenism, which may lead to metabolic disturbances that increase the risk for CVD morbidity and mortality later in life.^1-6

To assess the association of high serum androgen levels with the prevalence of atherosclerosis and incidence of CVD in postmenopausal women, researchers in the Netherlands followed 2578 women age >55 years (mean age, 70.19 years) with an average time since menopause of 19.85 years and a median follow-up of 11.36 years.¹

During this period, 359 (15.3%) women developed CVD (stroke and/or coronary heart disease). Although women with PCOS exhibited an unfavorable metabolic profile, the researchers found no association between high androgen levels and incident stroke, coronary heart disease, or CVD in this population. Therefore, long-term health outcomes in women with PCOS may be better than previously assumed.

The authors concluded that “persistent high androgen levels in women after menopause were associated with an increase in surrogate markers of CVD but did not show a robust association with cardiovascular disease. Long term health in these women might therefore be better than previously thought.”¹

However, long-term follow-up should be conducted in a large group of women diagnosed with PCOS during their premenopausal years to confirm these findings and to develop guidelines for cardiovascular screening in this population.

References

1. Meun C, Franco OH, Dhana K, et al. High androgens in postmenopausal women and the risk for atherosclerosis and cardiovascular disease: the Rotterdam study [published online February 1, 2018]. J Clin Endocrinol Metab. doi: 10.1210/jc.2017-02421
2. Daan NM, Louwers YV, Koster MP, et al. Cardiovascular and metabolic profiles amongst different polycystic ovary syndrome phenotypes: who is really at risk? Fertil Steril. 2014;102(5):1444-1451.
3. Ali AT. Polycystic ovary syndrome and metabolic syndrome. Ceska Gynekol. 2015;80(4):279-289.
4. Schmidt J, Brannström M, Landin-Wilhelmsen K, Dahlgren E. Reproductive hormone levels and anthropometry in postmenopausal women with polycystic ovary syndrome (PCOS): a 21-year follow-up study of women diagnosed with PCOS around 50 years ago and their age-matched controls. J Clin Endocrinol Metab. 2011;96(7):2178-2185.
5. Wild RA, Carmina E, Diamanti-Kandarakis E, et al. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab. 2010;95(5):2038-2049.
6. Dahlgren E, Janson PO, Johansson S, Lapidus L, Odén A. Polycystic ovary syndrome and risk for myocardial infarction. Evaluated from a risk factor model based on a prospective population study of women. Acta Obstet Gynecol Scand. 1992;71(8):599-604.