Endocrine Abstracts

Background: Cardiovascular diseases (CVD) present sex specific characteristics, suggesting sex-hormones playing a role in the pathophysiology of CVDs. Hyperandrogenemia (HA) is a common condition in fertile age women but whether HA is a risk factor for CVD is still controversial.

Aims: To clarify the association of HA with the development of hypertension and CVDs in women.

Study population and methods: A general population-based birth cohort (n=5889 women) followed at ages 1, 14, 31 and 46. We investigated the association of serum levels of testosterone (T, measured using LC-MS/MS) and free androgen index (FAI) at age 31 with blood pressure (BP), hypertension (HT, defined as B P≥ 140/90 mmHg and/or use of antihypertensive medication) at age 31 and with CVD risk [angina pectoris (AP) and/or acute myocardial infarction (AMI), and transitory cerebral ischemia (TIA) and/or stroke] with 22-year follow-up. After excluding women being pregnant (n=212) and those with lacking data, the final study population included 2820 women at age 31.

Results: After adjusting for body mass index (BMI), there was an independent positive association of T and FAI with systolic BP (T:β=1.93, 95% CI:0.93–2.93, FAI:β=1.68, 95% CI:0.67–2.70) and diastolic BP (T:β=1.80, 95% CI:0.93–2.67, FAI:β=1.96, 95%CI:1.10–2.82) at age 31. The prevalence of HT was significantly higher among women with elevated T (cut-off 2.3 nmol/l defined in this population) compared to normoandrogenic women (27.1% vs 11.9%, P=0.002). Conversely, women with HT at age 31 had significantly higher T levels (1.12 [0.82; 1.47] vs 0.97 [0.73; 1.25] nmol/l, P<0.001) and FAI (2.92 [1.95; 4.72] vs 2.16 [1.50; 3.09], P<0.001) compared to normoandrogenic women after adjusting for BMI. In logistic regression analysis, T and FAI associated positively and independently of BMI with HT (Odds ratio (OR) for T: 1.81, 95% CI:1.37–2.39, OR for FAI: 1.87, 95% CI:1.42–2.47). HA at age 31 did not associate significantly with TIA and/or stroke. Sex hormone binding globulin (SHBG) associated inversely [crude Hazard ratio (HR):0.97, 95% CI: 0.95–0.99] and FAI positively (crude HR:1.16, 95% CI: 1.04–1.30) with increased risk of incident CV events (AP/AMI) during the 22-years follow-up. However, after adjusting for BMI at age 31, the significances disappeared.

Conclusions: Women with HA at reproductive age had elevated risk for HT. They had a significantly increased CVD event risk during the 22-years follow-up, but this risk seemed to be mainly driven by BMI. A longer follow-up of this cohort is needed to clarify the long-lasting metabolic risks linked to HA.