Sex Hormone Levels May Affect Postmenopausal Heart Disease Risk

Blood test
Blood test
Researchers assessed the effect of testosterone, estradiol, dehydroepiandrosterone, and sex hormone-binding globulin levels on coronary heart disease, heart failure, and cardiovascular disease in postmenopausal women.

Postmenopausal women with a higher ratio of testosterone to estradiol are at elevated risk for cardiovascular disease (CVD), coronary heart disease, and heart failure events, although a higher level of estradiol was found to be associated with lower risk for coronary heart disease, according to a study published in the Journal of the American College of Cardiology.

Previous studies that assessed the relationship between sex hormone levels and CVD have been limited by small sample sizes, use of hospital-based study populations, suboptimal measurement of CVD events, or short duration of follow-up. Therefore, the present study sought to evaluate the link between sex hormone levels and incident CVD, coronary heart disease, and heart failure events in a community-based population of postmenopausal women over a 12-year follow-up period.

All data were taken from the Multi-Ethnic Study of Atherosclerosis (MESA), a prospective cohort study of 6814 women and men (black, white, Hispanic, and Chinese), between 45 and 84 years old, recruited from 6 US centers. All subjects were free of CVD at baseline. After eliminating any subjects who were not female and postmenopausal, and who were missing relevant covariates such as sex hormone measurements, the final sample size totaled 2834.

After analyses, the results suggest that a higher ratio of testosterone to estradiol is associated with an increased risk for adverse CV events. The study investigators conclude that “sex hormone levels, especially higher total testosterone versus estrogen after menopause, may contribute to women’s increased CVD risk later in life. However, in the absence of supportive interventional studies, the best strategy to modify sex hormone levels to affect CVD risk is still uncertain. Nonetheless, a more androgenic sex hormone profile may identify a woman at higher risk for CVD who may benefit from other risk-reducing strategies.”

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Zhao D, Guallar E, Ouyang P, et al. Endogenous sex hormones and incident cardiovascular disease in post-menopausal women [published online May 28, 2018]. J Am Coll Cardiol. doi: 10.1016/j.jacc.2018.01.083