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Wang Z, Hu K, Wu M, Feng L, Liu C, Ding F, Li X, Ma B. Factors associated with secondary coronary artery disease in rheumatoid arthritis patients: A systematic review and meta-analysis based on observational studies. Musculoskeletal Care 2023. [PMID: 38047752 DOI: 10.1002/msc.1850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE The main objective of this systematic review was to investigate the factors influencing the development of coronary artery disease (CAD) in patients with rheumatoid arthritis (RA). METHODS PubMed, Embase, Web of Science, Wan Fang Date, CBM, CNKI, and VIP databases were systematically searched to select the relevant literature. The quality of the incorporated studies was assessed with reference to the Newcastle-Ottawa Scale. Stata16 was adopted to summarise the odds ratios, risk ratios, hazard ratios, and 95% confidence intervals for meta-analysis. RESULTS A total of 29 studies were included in this analysis, wherein the average age of RA patients was 50.5-81 years and the proportion of women was 44.4%-92%. The present meta-analysis suggested that increased CAD risk in RA patients was associated with age, male gender, smoking, glucocorticoids, Health Assessment Questionnaire scores, hyperlipidaemia, hypertension, diabetes, and C-reactive protein concentration. CONCLUSION The present systematic review revealed the influencing factors of secondary CAD in RA patients, some of which could reduce the risk of secondary CAD through effective interventions, such as smoking cessation, exercise, and medications. However, the effects of age, RA severity, and different medication subgroups on CAD risk stratification warrant further investigation.
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Affiliation(s)
- Zhe Wang
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Kaiyan Hu
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Mei Wu
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Liyuan Feng
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Chen Liu
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Fengxing Ding
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Xiaohui Li
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Bin Ma
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, Gansu, China
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Farland LV, Rice MS, Degnan WJ, Rexrode KM, Manson JE, Rimm EB, Rich-Edwards J, Stewart EA, Cohen Rassier SL, Robinson WR, Missmer SA. Hysterectomy With and Without Oophorectomy, Tubal Ligation, and Risk of Cardiovascular Disease in the Nurses' Health Study II. J Womens Health (Larchmt) 2023; 32:747-756. [PMID: 37155739 PMCID: PMC10354306 DOI: 10.1089/jwh.2022.0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Background: Hysterectomy, oophorectomy, and tubal ligation are common surgical procedures. The literature regarding cardiovascular disease (CVD) risk after these surgeries has focused on oophorectomy with limited research on hysterectomy or tubal ligation. Materials and Methods: Participants in the Nurses' Health Study II (n = 116,429) were followed from 1989 to 2017. Self-reported gynecologic surgery was categorized as follows: no surgery, hysterectomy alone, hysterectomy with unilateral oophorectomy, and hysterectomy with bilateral oophorectomy. We separately investigated tubal ligation alone. The primary outcome was CVD based on medical-record confirmed fatal and nonfatal myocardial infarction, fatal coronary heart disease, or fatal and nonfatal stroke. Our secondary outcome expanded CVD to include coronary revascularization (coronary artery bypass graft surgery, angioplasty, stent placement). Cox proportional hazard models were used to calculate hazard ratios (HR) and 95% confidence intervals (CIs) and were adjusted a priori for confounding factors. We investigated differences by age at surgery (≤50, >50) and menopausal hormone therapy usage. Results: At baseline, participants were on average, 34 years old. During 2,899,787 person-years, we observed 1,864 cases of CVD. Hysterectomy in combination with any oophorectomy was associated with a greater risk of CVD in multivariable-adjusted models (HR hysterectomy with unilateral oophorectomy:1.40 [95% CI: 1.08-1.82]; HR hysterectomy with bilateral oophorectomy:1.27 [1.07-1.51]). Hysterectomy alone, hysterectomy with oophorectomy, and tubal ligation were also associated with an increased risk of combined CVD and coronary revascularization (HR hysterectomy alone: 1.19 [95% CI: 1.02-1.39]; HR hysterectomy with unilateral oophorectomy: 1.29 [1.01-1.64]; HR hysterectomy with bilateral oophorectomy: 1.22 [1.04-1.43]; HR tubal ligation: 1.16 [1.06-1.28]). The association between hysterectomy/oophorectomy and CVD and coronary revascularization risk varied by age at gynecologic surgery, with the strongest association among women who had surgery before age 50 years. Conclusion: Our findings suggest that hysterectomy, alone or in combination with oophorectomy, as well as tubal ligation, may be associated with an increased risk of CVD and coronary revascularization. These findings extend previous research finding that oophorectomy is associated with CVD.
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Affiliation(s)
- Leslie V. Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Megan S. Rice
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - William J. Degnan
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
- Department of Community, Environment, and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Kathryn M. Rexrode
- Divisions of Women's Health and Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - JoAnn E. Manson
- Divisions of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Eric B. Rimm
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Janet Rich-Edwards
- Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth A. Stewart
- Department of Obstetrics and Gynecology, Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - Sarah L. Cohen Rassier
- Department of Obstetrics and Gynecology, Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - Whitney R. Robinson
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Stacey A. Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
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Aribas E, Roeters van Lennep JE, De Rijke YB, Laven JSE, Ikram MA, Peeters RP, Kavousi M. Sex steroids and sex steroid-binding globulin levels amongst middle-aged and elderly men and women from general population. Eur J Clin Invest 2022; 52:e13866. [PMID: 36038500 PMCID: PMC9787498 DOI: 10.1111/eci.13866] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/20/2022] [Accepted: 08/06/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Availability of age- and sex-specific reference values for sex steroids and sex steroid-binding globulin (SHBG) levels allows for appropriate interpretation of research findings and their clinical applications. We report the sex-specific distribution and reference levels of sex steroids, including total estradiol, total testosterone and (calculated) free androgen index (cFAI), SHBG and other androgens dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulphate (DHEAS) and androstenedione across age. METHODS Using data from 3291 participants from the prospective population-based Rotterdam Study (2006-2008), we visualised the distribution of sex steroids and SHBG levels by calculating and depicting the 5th, 25th, 50th, 75th and 95th percentiles per year and per age-year across 5-year age bands to provide reference value ranges in men and women. Total estradiol and SHBG were measured using automated immunoassay and androgens using liquid chromatography-mass spectrometry (LC-MS/MS). RESULT Mean age was 56.8 (range 45.6-79.9) years in men and 56.9 (range 45.7-79.9) years in women. Amongst men, total estradiol and SHBG showed an increasing trend from 45 years onwards. In women, total estradiol and SHBG showed a decreasing trend from 45 years until the age of 60. From 60 years onwards, SHBG showed an increasing trend. For total testosterone, a clear declining trend was observed amongst men but not women. Other androgens showed a similar decreasing trend in both sexes from 45 years onwards. DISCUSSION AND CONCLUSION Our study underlines sex-specific trends in sex steroids and SHBG levels with ageing. This warrants taking into account sex- and age-specific reference values for sex steroids and SHBG when investigating their impact on health outcomes to prevent controversial results and allow for their appropriate clinical application.
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Affiliation(s)
- Elif Aribas
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Yolanda B De Rijke
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Mohammad Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Vaura F, Palmu J, Aittokallio J, Kauko A, Niiranen T. Genetic, Molecular, and Cellular Determinants of Sex-Specific Cardiovascular Traits. Circ Res 2022; 130:611-631. [PMID: 35175841 DOI: 10.1161/circresaha.121.319891] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Despite the well-known sex dimorphism in cardiovascular disease traits, the exact genetic, molecular, and cellular underpinnings of these differences are not well understood. A growing body of evidence currently points at the links between cardiovascular disease traits and the genome, epigenome, transcriptome, and metabolome. However, the sex-specific differences in these links remain largely unstudied due to challenges in bioinformatic methods, inadequate statistical power, analytic costs, and paucity of valid experimental models. This review article provides an overview of the literature on sex differences in genetic architecture, heritability, epigenetic changes, transcriptomic signatures, and metabolomic profiles in relation to cardiovascular disease traits. We also review the literature on the associations between sex hormones and cardiovascular disease traits and discuss the potential mechanisms underlying these associations, focusing on human studies.
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Affiliation(s)
- Felix Vaura
- Department of Internal Medicine (F.V., J.P., A.K., T.N.), University of Turku, Finland
| | - Joonatan Palmu
- Department of Internal Medicine (F.V., J.P., A.K., T.N.), University of Turku, Finland
| | - Jenni Aittokallio
- Department of Anesthesiology and Intensive Care (J.A.), University of Turku, Finland.,Division of Perioperative Services, Intensive Care and Pain Medicine (J.A.), Turku University Hospital, Finland
| | - Anni Kauko
- Department of Internal Medicine (F.V., J.P., A.K., T.N.), University of Turku, Finland
| | - Teemu Niiranen
- Department of Internal Medicine (F.V., J.P., A.K., T.N.), University of Turku, Finland.,Division of Medicine (T.N.), Turku University Hospital, Finland.,Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland (T.N.)
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5
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Aribas E, Kavousi M, Laven JSE, Ikram MA, Roeters van Lennep JE. Aging, Cardiovascular Risk, and SHBG Levels in Men and Women From the General Population. J Clin Endocrinol Metab 2021; 106:2890-2900. [PMID: 34197576 PMCID: PMC8475196 DOI: 10.1210/clinem/dgab470] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Indexed: 12/16/2022]
Abstract
AIMS Prior studies have reported inconsistent results for the association between sex hormone-binding globulin (SHBG) and cardiovascular disease among men and women. Although it is suggested that SHBG levels change with aging, the exact trend of SHBG across age and cardiovascular risk and the underlying mechanisms of these changes remain to be elucidated. METHODS Using data of 3264 men and women from a large population-based cohort study, we first visualized the distribution of serum SHBG levels across age. Second, we computed a cardiovascular risk factor sum score and investigated the mean SHBG levels across categories of the risk factor sum score and stratified per age-category. Next, linear regression models were used to investigate the associations between serum SHBG levels and age and potential regulators of SHBG, including body mass index (BMI), fasting insulin, sex steroids, thyroxine, and triglycerides. RESULTS Among men, a linear increase in SHBG levels with age and among women a U-shaped pattern was observed. Participants with larger number of cardiovascular risk factors had lower SHBG levels. When stratified by age, older participants had higher SHBG levels. A multivariate model including total testosterone and triglyceride levels in men and total testosterone, triglycerides, BMI, and fasting insulin in women explained, respectively, 46.2% and 31.8% of the variance in SHBG levels. CONCLUSION We observed a clear sex-specific pattern for SHBG levels with age. Our findings highlight the importance of taking into account the age-related changes in SHBG levels to avoid controversial results in the assessment of the cardiovascular risk associated with SHBG.
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Affiliation(s)
- Elif Aribas
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands
| | - Jeanine E Roeters van Lennep
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands
- Correspondence: Jeanine E. Roeters van Lennep, MD, PhD, Department of Internal Medicine, Erasmus Medical Center, Rotterdam 3015 GD, The Netherlands.
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6
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Cano-Marquina AJ, García-Pérez MÁ, Tarín JJ, Maceira AM, Cosín-Sales J, Cano A. Variants translating reduced expression of the beta estrogen receptor gene were associated with increased carotid intima media thickness: A cross-sectional study in late postmenopausal women. Medicine (Baltimore) 2021; 100:e26216. [PMID: 34115005 PMCID: PMC8202648 DOI: 10.1097/md.0000000000026216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 05/17/2021] [Indexed: 01/04/2023] Open
Abstract
There is debate on the role of estrogens in modulating the risk for atherosclerosis in women. Our purpose was to investigate whether the size of the estrogenic impact was independently associated with variation of carotid intima-media thickness (IMT) in healthy late postmenopausal women. The levels of circulating estrogens have been used in previous studies but the influence of SNPs of the estrogen receptors (ER) α and β have not been investigated.We performed a crossed-sectional study of 91 women in a university hospital. We used a double approach in which, in addition to the measurement of estradiol levels by ultrasensitive methods, genetic variants (SNPs) associated with differing expression of the ER α and β genes were assessed. Multivariable analysis was used to examine the association of candidate factors with the value of IMT and plaque detection at both the carotid wall and the sinus.A genotype combination translating reduced gene expression of the ERβ was directly associated with IMT at both the carotid wall (P = .001) and the sinus (P = .002). Other predictors of IMT were the levels of glucose, positively associated with IMT at both the carotid wall (P < .001) and the sinus (P = .001), age positively associated with IMT at the sinus (P = .003), and levels of vitamin D, positively associated with IMT at the carotid wall (P = .04).Poorer estrogenic impact, as concordant with a SNP variant imposing reduced expression of the ERβ, was directly associated with IMT at both the carotid wall and the sinus. Glucose level, vitamin D only for the carotid wall, and age only for the sinus, also emerged as independent factors in the IMT variance.
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Affiliation(s)
| | - Miguel-Ángel García-Pérez
- Department of Genetics and INCLIVA Biomedical Research Institute, University of Valencia, Av Menéndez y Pelayo, Valencia
| | - Juan J. Tarín
- Department of Cellular Biology, Functional Biology and Physical Anthropology, University of Valencia, Burjassot
| | - Alicia M. Maceira
- Cardiovascular Unit, ASCIRES, Valencia and Department of Medicine, Health Sciences School, CEU Cardenal Herrera, Av Seminari, s/n, Alfara del Patriarca
| | - Juan Cosín-Sales
- Department of Cardiology, Hospital Arnau Vilanova, Valencia and Department of Medicine, Health Sciences School, CEU Cardenal Herrera, Av Seminari, s/n, Alfara del Patriarca
| | - Antonio Cano
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia and Service of Obstetrics and Gynecology, INCLIVA, Av Menéndez y Pelayo, Valencia, Spain
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Wang A, Gerstein HC, Lee SF, Hess S, Paré G, Rydén L, Mellbin LG. Testosterone and sex hormone-binding globulin in dysglycemic women at high cardiovascular risk: A report from the Outcome Reduction with an Initial Glargine Intervention trial. Diab Vasc Dis Res 2021; 18:14791641211002475. [PMID: 33752449 PMCID: PMC8481727 DOI: 10.1177/14791641211002475] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AIMS Total and free testosterone and sex hormone-binding globulin may affect cardiovascular prognosis in women. The objective was to study the association between sex hormones and prognosis in women with dysglycemia and high cardiovascular risk. METHODS This epidemiological report included dysglycemic women from the Outcome Reduction with an Initial Glargine Intervention trial (n = 2848) with baseline total testosterone and sex hormone-binding globulin. Free testosterone was calculated with the Vermeulen formula. Cox regression analyses adjusted for variables including age, previous diseases and pharmacological treatments were used to estimate the association between these levels and the composite cardiovascular outcome (death from cardiovascular causes, nonfatal myocardial infarction or nonfatal stroke) and all-cause mortality per one standard deviation. RESULTS Patients (73% post-menopausal) were followed for a median of 6.1 years during which 377 cardiovascular events and 389 deaths occurred. In Cox analyses, total and free testosterone were not associated with any outcomes, but sex hormone-binding globulin was related to all-cause mortality in age adjusted (HR 1.15; 95% CI 1.06-1.24; p < 0.01) and fully adjusted analyses (HR 1.14; 95% CI 1.05-1.24; p < 0.01). CONCLUSIONS Increasing levels of baseline sex hormone-binding globulin were associated with an increased risk of all-cause mortality in dysglycemic women at high cardiovascular risk. TRIAL REGISTRATION ClinicalTrials.gov no. NCT00069784.
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Affiliation(s)
- Anne Wang
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Anne Wang, Cardiology Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, 171 76, Sweden.
| | - Hertzel C Gerstein
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Shun Fu Lee
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Sibylle Hess
- R&D, Translational Medicine & Early Development, Biomarkers & Clinical Bioanalyses, Sanofi Aventis Deutschland GmbH, Frankfurt, Germany
| | - Guillaume Paré
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Lars Rydén
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Linda G Mellbin
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
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8
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Mumusoglu S, Yildiz BO. Metabolic Syndrome During Menopause. Curr Vasc Pharmacol 2020; 17:595-603. [PMID: 30179134 DOI: 10.2174/1570161116666180904094149] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/12/2018] [Accepted: 08/15/2018] [Indexed: 11/22/2022]
Abstract
The metabolic syndrome (MetS) comprises individual components including central obesity, insulin resistance, dyslipidaemia and hypertension and it is associated with an increased risk of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). The menopause per se increases the incidence of MetS in aging women. The effect(s) of menopause on individual components of MetS include: i) increasing central obesity with changes in the fat tissue distribution, ii) potential increase in insulin resistance, iii) changes in serum lipid concentrations, which seem to be associated with increasing weight rather than menopause itself, and, iv) an association between menopause and hypertension, although available data are inconclusive. With regard to the consequences of MetS during menopause, there is no consistent data supporting a causal relationship between menopause and CVD. However, concomitant MetS during menopause appears to increase the risk of CVD. Furthermore, despite the data supporting the association between early menopause and increased risk of T2DM, the association between natural menopause itself and risk of T2DM is not evident. However, the presence and the severity of MetS appears to be associated with an increased risk of T2DM. Although the mechanism is not clear, surgical menopause is strongly linked with a higher incidence of MetS. Interestingly, women with polycystic ovary syndrome (PCOS) have an increased risk of MetS during their reproductive years; however, with menopausal transition, the risk of MetS becomes similar to that of non-PCOS women.
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Affiliation(s)
- Sezcan Mumusoglu
- Department of Obstetrics and Gynecology, School of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey
| | - Bulent Okan Yildiz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey
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9
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Scarabin PY. Endogenous sex hormones and cardiovascular disease in postmenopausal women: new but conflicting data. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:448. [PMID: 30603636 DOI: 10.21037/atm.2018.11.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Pierre-Yves Scarabin
- INSERM U1018, Center for Research in Epidemiology and Population Health, France and Paris-Sud University, Villejuif, France
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10
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El Khoudary SR, Thurston RC. Cardiovascular Implications of the Menopause Transition: Endogenous Sex Hormones and Vasomotor Symptoms. Obstet Gynecol Clin North Am 2018; 45:641-661. [PMID: 30401548 DOI: 10.1016/j.ogc.2018.07.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The menopause transition (MT) is a critical period of women's lives marked by several physiologic changes and menopause-related symptoms that have implications for health. Risk for cardiovascular disease, the leading cause of death in women, increases after menopause, suggesting a contribution of the MT to its development. This article focuses on the relationship between 2 main features of the MT and women's cardiovascular health: (1) dynamic alterations of sex hormones, particularly endogenous estradiol and follicle-stimulating hormone, and (2) vasomotor symptoms, the cardinal symptom of the menopause. Limitations and future directions are discussed.
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Affiliation(s)
- Samar R El Khoudary
- Department of Epidemiology, Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, 4420 Bayard Street, Suite 600, Pittsburgh, PA 15260, USA.
| | - Rebecca C Thurston
- Departments of Psychiatry and Epidemiology, School of Medicine, Graduate School of Public Health, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
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11
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Thurston RC, Bhasin S, Chang Y, Barinas-Mitchell E, Matthews KA, Jasuja R, Santoro N. Reproductive Hormones and Subclinical Cardiovascular Disease in Midlife Women. J Clin Endocrinol Metab 2018; 103:3070-3077. [PMID: 29788255 PMCID: PMC6276700 DOI: 10.1210/jc.2018-00579] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/11/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Reproductive hormones are important to the pathophysiology of cardiovascular disease (CVD) in women. However, standard estradiol (E2) and testosterone (T) assays lack sensitivity at the levels of postmenopausal women. OBJECTIVE Investigate relations of mass spectrometry-assessed estrone (E1), E2, and T and SHBG and subclinical CVD in women. DESIGN, SETTING, AND PARTICIPANTS Three hundred and four perimenopausal and postmenopausal women aged 40 to 60 years underwent subclinical CVD measurements. E1, E2, and T were assayed using liquid chromatography-tandem mass spectrometry; free T (FT) was estimated using ensemble allostery models. Regression models were adjusted for CVD risk factors. MAIN OUTCOME MEASURES Carotid artery intima media thickness, interadventitial diameter (IAD), and plaque; brachial flow mediated dilation (FMD). RESULTS Higher E1 was related to higher FMD [β(SE) = 0.77 (0.37), P = 0.04], indicating better endothelial function. Higher E2 was related to lower IAD [β(SE) = -0.07 (0.02), P = 0.004], indicating less carotid remodeling. Higher SHBG was related to higher FMD [β(SE) = 1.31 (0.40), P = 0.001], yet higher IAD [β(SE) = 0.15 (0.06), P = 0.02] and plaque [OR (95% CI) = 1.84 (1.16 to 2.91), P = 0.009]; FT showed a similar yet inverse pattern of relations as SHBG. Thus, higher SHBG and lower FT were associated with better endothelial function, yet greater carotid remodeling and plaque. CONCLUSIONS Endogenous E1 levels were related to endothelial function and E2 to vascular remodeling, suggesting distinct roles of these estrogens. SHBG and FT have complex roles depending on the vessel under study.
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Affiliation(s)
- Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh School of Medicine,
Pittsburgh, Pennsylvania
- Department of Epidemiology, University of Pittsburgh Graduate School of Public
Health, Pittsburgh, Pennsylvania
- Correspondence and Reprint Requests: Rebecca C. Thurston, PhD, University of Pittsburgh, 3811 O’Hara Street,
Pittsburgh, Pennsylvania 15213. E-mail:
| | - Shalender Bhasin
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper
Older Americans Independence Center, Harvard Medical School, Brigham and Women’s Hospital,
Boston, Massachusetts
| | - Yuefang Chang
- Department of Neurosurgery, University of Pittsburgh School of Medicine,
Pittsburgh, Pennsylvania
| | - Emma Barinas-Mitchell
- Department of Epidemiology, University of Pittsburgh Graduate School of Public
Health, Pittsburgh, Pennsylvania
| | - Karen A Matthews
- Department of Psychiatry, University of Pittsburgh School of Medicine,
Pittsburgh, Pennsylvania
- Department of Epidemiology, University of Pittsburgh Graduate School of Public
Health, Pittsburgh, Pennsylvania
| | - Ravi Jasuja
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper
Older Americans Independence Center, Harvard Medical School, Brigham and Women’s Hospital,
Boston, Massachusetts
- Function Promoting, LLC, Waltham, Massachusetts
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of
Medicine, Denver, Colorado
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12
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Li XS, Li S, Kellermann G. Simultaneous determination of three estrogens in human saliva without derivatization or liquid-liquid extraction for routine testing via miniaturized solid phase extraction with LC-MS/MS detection. Talanta 2017; 178:464-472. [PMID: 29136849 DOI: 10.1016/j.talanta.2017.09.062] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 12/23/2022]
Abstract
Accurate quantitation of estrogens (i.e, estrone (E1), estradiol (E2) and estriol (E3)) is valuable for clinical assessment of human health and disease. Alterations in estrogen levels have been implicated in numerous pathological conditions. However, inadequacies in sensitivity and specificity, cumbersome sample preparation and invasive specimen collection hamper the usability of available methods for clinical applications. Herein, a simple, rapid, highly sensitive and specific LC-MS/MS method was developed and validated for the simultaneous determination of three estrogens in human saliva providing a non-invasive alternative to conventional blood samples. For the first time, a 96-well hydrophilic-lipophilic-balanced (HLB) microplate was employed for clean-up and enrichment of estrogens in a single extraction without the requirements of derivatization, evaporation, liquid-liquid extraction and online extraction. A rapid LC chromatographic separation with a turnaround time of 5.0min was achieved on a BEH C18 XP column. The use of 0.1mM ammonium fluoride (NH4F) as LC additive, and integration of summated and scheduled multiple reaction monitoring (MRM) transitions substantially improved the sensitivity to 1pg/mL, allowing the accurate quantitation of trace levels of three estrogens in one run. The assay was fully validated with good performance for extraction efficiency (67.0-85.6%), matrix effect (89.6-100.2%), linearity (from 1.0pg/mL up to 1000pg/mL), accuracy (98.9-112.4%) and precision (≤7.4%). Additionally, the assay was unaffected by 34 structurally-similar, potentially interfering substances tested at high clinical concentrations. The applicability of the assay was demonstrated by assessing the reference intervals of authentic saliva samples from healthy adult males, pre- and post-menopausal females. The easy sample preparation, fast LC and multi-analyte MS/MS detection utilizing noninvasive saliva as a specimen delivers a simple, practical, sensitive and accurate tool suitable for the high throughput measurement of E1, E2 and E3 in clinical laboratories.
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Affiliation(s)
| | - Shu Li
- Pharmasan Labs, Inc., 373 280th Street, Osceola, WI 54020, USA
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13
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El Khoudary SR. Gaps, limitations and new insights on endogenous estrogen and follicle stimulating hormone as related to risk of cardiovascular disease in women traversing the menopause: A narrative review. Maturitas 2017; 104:44-53. [PMID: 28923176 DOI: 10.1016/j.maturitas.2017.08.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/03/2017] [Accepted: 08/04/2017] [Indexed: 02/07/2023]
Abstract
While it is known that estrogen protects heart health in women prior to menopause, its role after menopause and during the menopause transition is far less apparent. Previous reviews summarizing the literature on the impact of endogenous estrogen on risk of cardiovascular disease (CVD) have focused on postmenopausal women and have not come to a clear conclusion. No previous review has summarized the associations between follicle stimulating hormone (FSH), a proxy measure of the menopause transition, and CVD risk. The main purpose of this narrative review is to highlight gaps and limitations in the literature on endogenous estrogen and FSH as related to CVD risk. Future directions are addressed in light of recent findings in the field. When studying the relationship of estrogen to cardiovascular risk, it is critical to separate endogenously produced estrogen from exogenously administered estrogen. Moreover, other reproductive hormones such as FSH should be assessed, since growing evidence suggests a potential contribution of this hormone. Evaluation of estrogen changes over time allows a separation of women based on their hormone trajectories. These individual trajectories correlate with subclinical CVD and thus indicate that it is much more important to observe a woman over time rather than ascribe risk to a single determination at a single time point. As women progress through menopause and the ovary stops producing estradiol, the nature of the relationship between estrogens and subclinical CVD markers also appears to undergo a switch. Studies are needed to examine the midlife course of endogenous estradiol, FSH and CVD risk. These studies should also consider other hormones, including androgens, with an eye towards helping women modify their cardiovascular risk in midlife, when prevention is most likely possible.
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Affiliation(s)
- Samar R El Khoudary
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, USA.
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14
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Wang H, Li Y, Wang X, Bu J, Yan G, Lou D. Endogenous sex hormone levels and coronary heart disease risk in postmenopausal women: A meta-analysis of prospective studies. Eur J Prev Cardiol 2017; 24:600-611. [PMID: 28326829 DOI: 10.1177/2047487317693133] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Haihui Wang
- Department of Geriatrics, Shanghai Municipal Hospital of Traditional Chinese Medicine, China
| | - Yuehua Li
- Department of Geriatrics, Shanghai Municipal Hospital of Traditional Chinese Medicine, China
| | - Xinlu Wang
- Department of Geriatrics, Shanghai Municipal Hospital of Traditional Chinese Medicine, China
| | - Jianhong Bu
- Department of Geriatrics, Shanghai Municipal Hospital of Traditional Chinese Medicine, China
| | - Guoliang Yan
- Department of Geriatrics, Shanghai Municipal Hospital of Traditional Chinese Medicine, China
| | - Danfei Lou
- Department of Geriatrics, Shanghai Municipal Hospital of Traditional Chinese Medicine, China
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15
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Jaspers L, Kavousi M, Erler NS, Hofman A, Laven JS, Franco OH. Fertile lifespan characteristics and all-cause and cause-specific mortality among postmenopausal women: the Rotterdam Study. Fertil Steril 2017; 107:448-456.e1. [DOI: 10.1016/j.fertnstert.2016.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/03/2016] [Accepted: 11/03/2016] [Indexed: 12/17/2022]
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16
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de Kat AC, Dam V, Onland-Moret NC, Eijkemans MJC, Broekmans FJM, van der Schouw YT. Unraveling the associations of age and menopause with cardiovascular risk factors in a large population-based study. BMC Med 2017; 15:2. [PMID: 28049531 PMCID: PMC5210309 DOI: 10.1186/s12916-016-0762-8] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/30/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Although the association between menopause and cardiovascular disease (CVD) risk has been studied extensively, the simultaneous role of chronological aging herein remains underexposed. This study aims to disentangle the relationships of menopausal status and chronological aging with CVD risk factors in the largest study population to date. METHODS In this cross-sectional study, CVD risk factors were compared between women with a different menopausal status within the same yearly age strata. The study population comprised female participants of the baseline visit of the population-based LifeLines Cohort Study. A total of 63,466 women, aged between 18 and 65 years, was included. Of them, 39,379 women were considered to be premenopausal, 8669 were perimenopausal, 14,514 were naturally postmenopausal, and 904 were surgically postmenopausal. RESULTS Compared to postmenopausal women aged 45 years, average total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-c) were 0.5 and 0.4 mmol/L higher, respectively, in postmenopausal women aged 50. Systolic and diastolic blood pressure levels were 4 and 1 mmHg higher, respectively. At all ages between 46 and 55 years, and after adjustment for confounders, naturally postmenopausal women had 0.2 to 0.4 mmol/L higher TC and 0.1 to 0.3 mmol/L higher LDL-c levels compared to premenopausal women in the same age range. Systolic blood pressure levels were up to 4 mmHg lower in naturally post- compared to premenopausal women at all ages between 29 and 52 years. Body mass index levels were up to 3.2 kg/m2 higher in women with surgical menopause compared to all other women between the ages 32 and 52 years. All aforementioned results were statistically significant. CONCLUSIONS Chronological age and menopausal status are both independently associated with CVD risk factors. Based on the comparatively smaller observed differences associated with menopausal status than with chronological aging, the significance of a more unfavorable lipid profile in a later reproductive stage may be less obvious than previously thought.
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Affiliation(s)
- A C de Kat
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, The Netherlands
| | - V Dam
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, The Netherlands
| | - N C Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, The Netherlands
| | - M J C Eijkemans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, The Netherlands
| | - F J M Broekmans
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, The Netherlands
| | - Y T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, The Netherlands.
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17
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Botelho JC, Ribera A, Cooper HC, Vesper HW. Evaluation of an Isotope Dilution HPLC Tandem Mass Spectrometry Candidate Reference Measurement Procedure for Total 17-β Estradiol in Human Serum. Anal Chem 2016; 88:11123-11129. [PMID: 27744701 DOI: 10.1021/acs.analchem.6b03220] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The inaccuracy of 17-β estradiol (E2) measurements affects its use as a biomarker in patient care and research. Clinical and research communities called for accurate and standardized E2 measurements. Reference Measurement Procedures (RMPs), part of the CDC Hormone Standardization Program (HoSt), are essential in addressing this need and ensuring that methods are accurate and comparable across testing systems, laboratories, and over time. A candidate RMP (cRMP) was developed for the measurement of total E2 in serum using liquid chromatography-tandem mass spectrometry (LC-MS/MS) without derivatization. The cRMP meets suggested performance criteria for accuracy and precision through the use of isotope dilution, calibrator bracketing, and gravimetric measurements. The cRMP demonstrated high agreement with certified reference materials (no significant bias to BCR576, 577, and 578) and established RMPs (slope 1.00, 95% CI 1.00-1.01; intercept 0.02, 95% CI -0.01 to 0.06). The cRMP is highly precise with intra-assay, interassay, and total percent CVs of 2.7%, 1.3%, and 2.4%, respectively. A higher specificity was achieved by measuring E2 without derivatization, compared to methods using derivatization agents. The cRMP can serve as a higher-order standard for establishing measurement traceability and provides an accuracy base against which routine methods can be compared in HoSt.
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Affiliation(s)
- Julianne Cook Botelho
- Centers For Disease Control And Prevention , National Center For Environmental Health, Division of Laboratory Sciences, Clinical Chemistry Branch, 4770 Buford Highway NE, Atlanta, Georgia 30341, United States
| | - Ashley Ribera
- Centers For Disease Control And Prevention , National Center For Environmental Health, Division of Laboratory Sciences, Clinical Chemistry Branch, 4770 Buford Highway NE, Atlanta, Georgia 30341, United States
| | - Hans C Cooper
- Centers For Disease Control And Prevention , National Center For Environmental Health, Division of Laboratory Sciences, Clinical Chemistry Branch, 4770 Buford Highway NE, Atlanta, Georgia 30341, United States
| | - Hubert W Vesper
- Centers For Disease Control And Prevention , National Center For Environmental Health, Division of Laboratory Sciences, Clinical Chemistry Branch, 4770 Buford Highway NE, Atlanta, Georgia 30341, United States
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18
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Daan NMP, Muka T, Koster MPH, Roeters van Lennep JE, Lambalk CB, Laven JSE, Fauser CGKM, Meun C, de Rijke YB, Boersma E, Franco OH, Kavousi M, Fauser BCJM. Cardiovascular Risk in Women With Premature Ovarian Insufficiency Compared to Premenopausal Women at Middle Age. J Clin Endocrinol Metab 2016; 101:3306-15. [PMID: 27300572 DOI: 10.1210/jc.2016-1141] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT A young age at menopause has been associated with increased cardiovascular disease (CVD) risk. OBJECTIVE To compare the cardiovascular risk profile between women with premature ovarian insufficiency (POI) and premenopausal controls of comparable age. DESIGN Cross-sectional case control study. SETTING Two university medical centers. PARTICIPANTS Women above 45 years of age who were previously diagnosed with POI (n = 83) and premenopausal population controls of comparable age (n = 266). MAIN OUTCOME MEASURES Blood pressure, body mass index, waist circumference, electrocardiogram, bilateral carotid intima media thickness, estradiol, T, androstenedione, dehydroepiandrosterone sulfate, SHBG, insulin, glucose, lipids, TSH, free T4, N-terminal pro-B-type natriuretic peptide, C-reactive protein, uric acid, creatinine, and homocysteine were measured. Potential associations between POI status and subclinical atherosclerosis were assessed. RESULTS Women with POI exhibited an increased waist circumference (β = 5.7; 95% confidence interval [CI], 1.6, 9.9), C-reactive protein (β = 0.75; 95% CI, 0.43, 1.08), free T4 levels (β = 1.5; 95% CI, 0.6, 2.4), and lower N-terminal pro-B-type natriuretic peptide (β = -0.35; 95% CI, -0.62, -0.08), estradiol (β = -1.98; 95% CI, -2.48, -1.48), T (β = -0.21; 95% CI, -0.37, -0.06), and androstenedione (β = -0.54; 95% CI, -0.71, -0.38) concentrations compared to controls, after adjusting for confounders. After adjustment, a trend toward increased hypertension (odds ratio = 2.1; 95% CI, 0.99; 4.56) and decreased kidney function was observed in women with POI (creatinine β = 3.5; 95% CI, -0.05, 7.1; glomerular filtration rate β = -3.5; 95% CI, -7.5, 0.46). Women with POI exhibited a lower mean carotid intima media thickness (β = -0.17; 95% CI, -0.21, -0.13) and decreased odds of plaque presence compared to controls (odds ratio = 0.08; 95% CI, 0.03; 0.26). CONCLUSIONS Women with POI exhibited an unfavorable cardiovascular risk profile, including higher abdominal fat, elevated chronic inflammatory factors, and a trend toward increased hypertension and impaired kidney function compared to controls. However, we observed no signs of increased subclinical atherosclerosis in women with POI. Additional studies are required to identify specific determinants of long-term CVD risk in women with POI.
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Affiliation(s)
- Nadine M P Daan
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - Taulant Muka
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - Maria P H Koster
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - Jaenine E Roeters van Lennep
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - Cornelis B Lambalk
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - Joop S E Laven
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - Clemens G K M Fauser
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - Cindy Meun
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - Yolanda B de Rijke
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - Bart C J M Fauser
- Department of Reproductive Medicine and Gynecology (N.M.P.D., M.P.H.K., B.C.J.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Epidemiology (T.M., O.H.F., M.K.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Internal Medicine (J.E.R.v.L.), Division Vascular Medicine, Erasmus Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (C.B.L.), VU University Medical Center Amsterdam, 1081 HV Amsterdam, The Netherlands; Department of Obstetrics and Gynecology (J.S.E.L., C.M.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; Department of Cardiology (C.G.K.M.F.), University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; Department of Clinical Chemistry (Y.B.d.R.), Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; and Department of Cardiology (E.B.), Erasmus MC, University Medical Center Rotterdam, Cardiovascular Research School Erasmus University Rotterdam, 3015 CE Rotterdam, The Netherlands
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19
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Kim C, Cushman M, Kleindorfer D, Lisabeth L, Redberg RF, Safford MM. A review of the relationships between endogenous sex steroids and incident ischemic stroke and coronary heart disease events. Curr Cardiol Rev 2015; 11:252-60. [PMID: 25563292 PMCID: PMC4558357 DOI: 10.2174/1573403x1103150515110749] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 12/22/2014] [Accepted: 12/25/2014] [Indexed: 12/22/2022] Open
Abstract
For decades, it has been recognized that men have a higher age-adjusted risk of ischemic cardiovascular (CVD) events compared to women, thus generating hypotheses that sex steroids contribute to CVD risk. Potential mechanisms include genomic and non-genomic effects of sex steroids as well as mediation through classic CVD risk factors and obesity. However, results from randomized studies suggest that sex steroid supplementation in men and women do not result in improved CVD outcomes and may increase CVD risk. In contrast, prospective observations from endogenous sex steroid studies, i.e. among participants not using sex steroids, have suggested the opposite relationship. We reviewed the findings of prospective observational studies in men (17 studies) and women (8 studies) that examined endogenous sex steroids and CVD risk. These studies suggested a lack of association or that lower levels of testosterone or dihydrotestosterone are associated with higher CVD risk in both men and women. Higher, rather than lower, estradiol levels were associated with higher CVD risk in women. There were several significant gaps in the literature. First, it is unclear whether more sensitive measures of sex steroid levels might detect significant differences. Second, there are few prospective studies in women. Similarly, no studies report outcomes for high-risk groups such as African-Americans and Hispanics. Finally, few studies report upon ischemic coronary disease as opposed to ischemic stroke separately, although relationships between sex steroids and CVD may vary by vascular bed. Future investigations need to examine high risk groups and to distinguish between subtypes of CVD.
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Affiliation(s)
- Catherine Kim
- 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109, USA.
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20
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Daan NMP, Jaspers L, Koster MPH, Broekmans FJM, de Rijke YB, Franco OH, Laven JSE, Kavousi M, Fauser BCJM. Androgen levels in women with various forms of ovarian dysfunction: associations with cardiometabolic features. Hum Reprod 2015; 30:2376-86. [PMID: 26269538 DOI: 10.1093/humrep/dev195] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/23/2015] [Indexed: 01/28/2023] Open
Abstract
STUDY QUESTION Are differences in androgen levels among women with various forms of ovarian dysfunction associated with cardiometabolic abnormalities? SUMMARY ANSWER Androgen levels differed substantially between women with and without ovarian dysfunction, and increased androgen levels were associated with impaired cardiometabolic features in all women irrespective of their clinical condition. WHAT IS KNOWN ALREADY Sex steroid hormones play important roles in the development of cardiovascular diseases (CVD). Extremes of low as well as high androgen levels have been associated with increased CVD risk in both men and women. STUDY DESIGN, SIZE, DURATION This cross-sectional study included 680 women with polycystic ovary syndrome (PCOS), premature ovarian insufficiency (POI), natural post-menopausal women (NM), or regular menstrual cycles (RC) (170 women per group). PARTICIPANTS/MATERIALS, SETTING, METHODS Measurements of serum testosterone, androstenedione and dehydroepiandrosterone sulfate were performed using liquid chromatography-tandem mass spectrometry. Assessments were taken of body mass index (BMI), blood pressure, lipid profiles, glucose, insulin and SHBG, and the bioactive fraction of circulating testosterone was calculated using the free androgen index (FAI). MAIN RESULTS AND THE ROLE OF CHANCE PCOS women were hyperandrogenic [median FAI = 4.9 (IQR 3.6-7.4)], and POI women were hypoandrogenic [FAI = 1.2 (0.8-1.7)], compared with RC women [FAI = 1.7 (1.1-2.8)], after adjustment for age, ethnicity, smoking and BMI (P < 0.001). After adjustment for age, there were no significant differences in androgens between POI and NM (P = 0.15) women and between NM and RC (P = 0.27) women, the latter indicating that chronological aging rather than ovarian aging influences the differences between pre- and post-menopausal women. A high FAI was associated with elevated triglycerides (β log FAI for PCOS: 0.45, P < 0.001, POI: 0.25, P < 0.001, NM: 0.20, P = 0.002), insulin (β log FAI for PCOS: 0.77, POI: 0.44, NM: 0.40, all P < 0.001), HOMA-IR (β log FAI for PCOS: 0.82, POI: 0.46, NM: 0.47, all P < 0.001) and mean arterial pressure (β log FAI for PCOS: 0.05, P = 0.002, POI: 0.07, P < 0.001, NM: 0.04, P = 0.04) in all women; with increased glucose (β log FAI for PCOS: 0.05, P = 0.003, NM: 0.07, P < 0.001) and decreased high-density lipoprotein (β log FAI for PCOS: -0.23, P < 0.001, NM: -0.09, P = 0.03) in PCOS and NM women; and with increased low-density lipoprotein (β log FAI for POI: 0.083, P = 0.041) in POI women. Adjustment for BMI attenuated the observed associations. Associations between FAI and cardiometabolic features were the strongest in PCOS women, even after adjustment for BMI. LIMITATIONS, REASONS FOR CAUTION Associations between androgen levels and cardiometabolic features were assessed in PCOS, POI and NM women only, due to a lack of available data in RC women. Due to the cross-sectional design of the current study, the potential associations between androgen levels and actual future cardiovascular events could not be assessed. WIDER IMPLICATIONS OF THE FINDINGS This study affirms the potent effect of androgens on cardiometabolic features, indicating that androgens should indeed be regarded as important denominators of women's health. Future research regarding the role of androgens in the development of CVD and potential modulatory effects of BMI is required. STUDY FUNDING/COMPETING INTERESTS N.M.P.D. is supported by the Dutch Heart Foundation (grant number 2013T083). L.J. and O.H.F. work in ErasmusAGE, a center for aging research across the life course, funded by Nestlé Nutrition (Nestec Ltd), Metagenics Inc. and AXA. M.K. is supported by the AXA Research Fund. Nestlé Nutrition (Nestec Ltd), Metagenics Inc. and AXA had no role in the design and conduct of the study; the collection, management, analysis and interpretation of the data; or the preparation, review or approval of the manuscript. J.S.E.L. has received fees and grant support from the following companies (in alphabetical order): Ferring, Merck-Serono, Merck Sharpe & Dome, Organon, Schering Plough and Serono. In the last 5 years, B.C.J.M.F. has received fees and grant support from the following companies (in alphabetic order); Actavis, COGI, Euroscreen, Ferring, Finox, Genovum, Gedeon-Richter, Merck-Serono, OvaScience, Pantharei Bioscience, PregLem, Roche, Uteron and Watson laboratories. With regard to potential conflicts of interest, there is nothing further to disclose.
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Affiliation(s)
- N M P Daan
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, HP F05.126, PO Box 85500, 3584 CX Utrecht, The Netherlands
| | - L Jaspers
- Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M P H Koster
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, HP F05.126, PO Box 85500, 3584 CX Utrecht, The Netherlands
| | - F J M Broekmans
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, HP F05.126, PO Box 85500, 3584 CX Utrecht, The Netherlands
| | - Y B de Rijke
- Department of Clinical Chemistry, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - O H Franco
- Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J S E Laven
- Department of Obstetrics and Gynecology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Kavousi
- Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - B C J M Fauser
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, HP F05.126, PO Box 85500, 3584 CX Utrecht, The Netherlands
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21
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Taylor AE, Keevil B, Huhtaniemi IT. Mass spectrometry and immunoassay: how to measure steroid hormones today and tomorrow. Eur J Endocrinol 2015; 173:D1-12. [PMID: 25877990 DOI: 10.1530/eje-15-0338] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 04/15/2015] [Indexed: 11/08/2022]
Abstract
The recent onslaught of mass spectrometry (MS) to measurements of steroid hormones, including demands that they should be the only acceptable method, has confused clinicians and scientists who have relied for more than 40 years on a variety of immunoassay (IA) methods in steroid hormone measurements. There is little doubt that MS methods with their superior specificity will be the future method of choice in many clinical and research applications of steroid hormone measurement. However, the majority of steroid measurements are currently, and will continue to be, carried out using various types of IAs for several reasons, including their technical ease, cost and availability of commercial reagents. Speedy replacement of all IAs with MS is an unrealistic and unnecessary goal, because the availability of MS measurements is limited by cost, need of expensive equipment, technical demands and lack of commercial applications. Furthermore, IAs have multiple well-known advantages that vindicate their continuing use. The purpose of this article is to elucidate the advantages and limitations of the MS and IA techniques from two angles, i.e. promotion of MS and defence of IA. The purpose of the text is to give the reader an unbiased view about the current state and future trends of steroid analysis and to help him/her choose the correct assay method to serve his/her diagnostic and research needs.
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Affiliation(s)
- Angela E Taylor
- School of MedicineCentre for Endocrinology, Diabetes and Metabolism, University of Birmingham, Birmingham, UKDepartment of Clinical BiochemistryManchester Academic Health Science Centre, University Hospital of S Manchester, The University of Manchester, Manchester, UKDepartment of Surgery and CancerImperial College London, Institute of Reproductive and Developmental Biology, Hammersmith Campus, London W12 0NN, UKDepartment of PhysiologyInstitute of Biomedicine, University of Turku, 20520 Turku, Finland
| | - Brian Keevil
- School of MedicineCentre for Endocrinology, Diabetes and Metabolism, University of Birmingham, Birmingham, UKDepartment of Clinical BiochemistryManchester Academic Health Science Centre, University Hospital of S Manchester, The University of Manchester, Manchester, UKDepartment of Surgery and CancerImperial College London, Institute of Reproductive and Developmental Biology, Hammersmith Campus, London W12 0NN, UKDepartment of PhysiologyInstitute of Biomedicine, University of Turku, 20520 Turku, Finland
| | - Ilpo T Huhtaniemi
- School of MedicineCentre for Endocrinology, Diabetes and Metabolism, University of Birmingham, Birmingham, UKDepartment of Clinical BiochemistryManchester Academic Health Science Centre, University Hospital of S Manchester, The University of Manchester, Manchester, UKDepartment of Surgery and CancerImperial College London, Institute of Reproductive and Developmental Biology, Hammersmith Campus, London W12 0NN, UKDepartment of PhysiologyInstitute of Biomedicine, University of Turku, 20520 Turku, Finland School of MedicineCentre for Endocrinology, Diabetes and Metabolism, University of Birmingham, Birmingham, UKDepartment of Clinical BiochemistryManchester Academic Health Science Centre, University Hospital of S Manchester, The University of Manchester, Manchester, UKDepartment of Surgery and CancerImperial College London, Institute of Reproductive and Developmental Biology, Hammersmith Campus, London W12 0NN, UKDepartment of PhysiologyInstitute of Biomedicine, University of Turku, 20520 Turku, Finland
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22
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Genetic Variant in the CYP19A1 Gene Associated with Coronary Artery Disease. GENETICS RESEARCH INTERNATIONAL 2015; 2015:820323. [PMID: 25861479 PMCID: PMC4378698 DOI: 10.1155/2015/820323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/25/2015] [Accepted: 03/05/2015] [Indexed: 11/20/2022]
Abstract
The CYP19A1 gene encodes the enzyme aromatase, which is responsible for the biosynthesis of estrogens. The rs10046 polymorphism of CYP19A1 gene has been investigated in two studies on the occurrence of hypertension, but there are no studies on its correlation with coronary artery disease (CAD). We investigated 189 subjects who were hospitalized at “KAT” General Hospital of Athens and underwent coronary angiography. Of these, 123 were found with CAD with an average age of 60 years and constituted the patients group and 66 subjects with an average age of 58 years without damage in the coronary vessels and constituted the control group (healthy). The frequencies of genotypes CC, CT, and TT of rs10046 polymorphism are significantly different between the group of CAD patients and the control group (0.34, 0.48, and 0.18 versus 0.20, 0.48, and 0.32, resp., P = 0.034) as the frequency of C allele (0.58 versus 0.44, resp., OR = 1.771 and P = 0.010). We found similar results for men, but not for women (small sample). The results of this study show that the rs10046 (C/T) polymorphism of CYP19A1 gene exhibits correlation with CAD and that patients with C allele have an increased probability of manifesting the disease.
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23
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Grines CL, White DC, Schreiber T. Editorial: another reason for women to avoid estrogen? J Interv Cardiol 2014; 27:444-5. [PMID: 25250950 DOI: 10.1111/joic.12152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Cindy L Grines
- Detroit Medical Center Cardiovascular Institute, Detroit, Michigan
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24
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Yang SG, Mlček M, Kittnar O. Estrogen can modulate menopausal women's heart rate variability. Physiol Res 2014; 62:S165-71. [PMID: 24329696 DOI: 10.33549/physiolres.932612] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of our study was to compare the responses of heart rate variability (HRV) with two different types of hormonal substitution therapy (HT) in post-menopausal women (cross-sectional study) and to reveal an effect of HT shortly after beginning of its administration (follow-up study). To elucidate the influence of menopause and effects of different protocols of a HT on autonomic control of heart rate, we evaluated the heart rate variability (HRV) in 5 groups: premenopausal women (n=140), postmenopausal women without HT (n=360), women on HT with conjugated estrogen only (n=168), women on continuous combined estrogen-progesterone HT (n=117), and men (n=140). Frequency-domain of short-term stationary R-R intervals was performed to evaluate the total variance, low frequency power (LF; 0.04-0.15 Hz), high frequency power (HF; 0.15-0.40 Hz), portion of low frequency power (LF%) and ratio of LF to HF (LF/HF). Significantly lower portion of the LF was found in premenopausal women [46.9 (+/-2.7) nu] when compared to untreated postmenopausal women [54.3 (+/-2.9) nu] and men [55.2 (+/-3.0) nu]. Treatment by estrogen only was proved to decrease the LF% [40.1 (+/-2.1) nu] while no effect on HRV was observed in women treated with combination of estrogen and progesterone [57.2 (+/-3.1) nu]. Also the HF was lower in postmenopausal women [4.16 (+/-0.16) ms(2)] than in premenopausal women [4.79 (+/-0.22) ms(2)] and women treated with estrogen only [4.98 (+/-0.25) ms(2)] while in women treated with combined hormonal therapy the average value [3.99 (+/-0.21) ms(2)] did not significantly differ from that of untreated postmenopausal women. The follow-up study also proved increase of high frequency power already after two months of estrogen substitution therapy [4.86 (+/-0.14) ms(2) vs. 4.19 (+/-0.15) ms(2)]. These results suggest that higher vagal modulation of heart rate that seems typical for younger women becomes after menopause similar to that of men. We also proved a positive shift of HRV parameters toward more beneficial values as for a cardiovascular risk in postmenopausal women treated with estrogens but not in those treated by combined estrogen - progesterone substitution therapy.
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Affiliation(s)
- S-G Yang
- Institute of Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
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25
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Auro K, Joensuu A, Fischer K, Kettunen J, Salo P, Mattsson H, Niironen M, Kaprio J, Eriksson JG, Lehtimäki T, Raitakari O, Jula A, Tiitinen A, Jauhiainen M, Soininen P, Kangas AJ, Kähönen M, Havulinna AS, Ala-Korpela M, Salomaa V, Metspalu A, Perola M. A metabolic view on menopause and ageing. Nat Commun 2014; 5:4708. [PMID: 25144627 DOI: 10.1038/ncomms5708] [Citation(s) in RCA: 173] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 07/16/2014] [Indexed: 12/12/2022] Open
Abstract
The ageing of the global population calls for a better understanding of age-related metabolic consequences. Here we report the effects of age, sex and menopause on serum metabolites in 26,065 individuals of Northern European ancestry. Age-specific metabolic fingerprints differ significantly by gender and, in females, a substantial atherogenic shift overlapping the time of menopausal transition is observed. In meta-analysis of 10,083 women, menopause status associates with amino acids glutamine, tyrosine and isoleucine, along with serum cholesterol measures and atherogenic lipoproteins. Among 3,204 women aged 40-55 years, menopause status associates additionally with glycine and total, monounsaturated, and omega-7 and -9 fatty acids. Our findings suggest that, in addition to lipid alterations, menopause may contribute to future metabolic and cardiovascular risk via influencing amino-acid concentrations, adding to the growing evidence of the importance of amino acids in metabolic disease progression. These observations shed light on the metabolic consequences of ageing, gender and menopause at the population level.
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Affiliation(s)
- Kirsi Auro
- 1] Public Health Genomics Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Biomedicum 1, Haartmaninkatu 8, Helsinki 00290, Finland [2] Institute for Molecular Medicine (FIMM), University of Helsinki, Biomedicum 2, Tukholmankatu 8, Helsinki 00290, Finland [3] Department of Obstetrics and Gynecology, Helsinki University Central Hospital and University of Helsinki, Haartmaninkatu 2, Helsinki 00290, Finland [4]
| | - Anni Joensuu
- 1] Public Health Genomics Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Biomedicum 1, Haartmaninkatu 8, Helsinki 00290, Finland [2] Institute for Molecular Medicine (FIMM), University of Helsinki, Biomedicum 2, Tukholmankatu 8, Helsinki 00290, Finland [3]
| | - Krista Fischer
- Estonian Genome Center, University of Tartu, Riia 23b, Tartu 51010, Estonia
| | - Johannes Kettunen
- 1] Public Health Genomics Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Biomedicum 1, Haartmaninkatu 8, Helsinki 00290, Finland [2] Institute for Molecular Medicine (FIMM), University of Helsinki, Biomedicum 2, Tukholmankatu 8, Helsinki 00290, Finland [3] Computational Medicine, Institute of Health Sciences, University of Oulu, Pentti Kaiteran katu 1, Oulu 90570, Finland
| | - Perttu Salo
- 1] Public Health Genomics Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Biomedicum 1, Haartmaninkatu 8, Helsinki 00290, Finland [2] Institute for Molecular Medicine (FIMM), University of Helsinki, Biomedicum 2, Tukholmankatu 8, Helsinki 00290, Finland
| | - Hannele Mattsson
- 1] Public Health Genomics Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Biomedicum 1, Haartmaninkatu 8, Helsinki 00290, Finland [2] Institute for Molecular Medicine (FIMM), University of Helsinki, Biomedicum 2, Tukholmankatu 8, Helsinki 00290, Finland
| | - Marjo Niironen
- Public Health Genomics Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Biomedicum 1, Haartmaninkatu 8, Helsinki 00290, Finland
| | - Jaakko Kaprio
- 1] Institute for Molecular Medicine (FIMM), University of Helsinki, Biomedicum 2, Tukholmankatu 8, Helsinki 00290, Finland [2] Departmentof Public Health, Hjelt Institute, University of Helsinki, PO Box 41 Mannerheimintie 172, Helsinki 00014, Finland [3] Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, PO Box 30 (Mannerheimintie 166), Helsinki 00300, Finland
| | - Johan G Eriksson
- 1] Chronic Disease Epidemiology and Prevention Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Mannerheimintie 166, Helsinki 00300, Finland [2] Department of General Practice and Primary Health Care, University of Helsinki, PL 20, Tukholmankatu 8B, Helsinki 00029, Finland [3] Vasa Central Hospital, Sandviksgatan 2-4, Vasa 65130, Finland [4] Folkhälsan Research Centre, Helsingfors Universitet, PB 63, Helsinki 00014, Finland [5] Unit of General Practice, Helsinki University Central Hospital, Haartmaninkatu 4, Helsinki 00290, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, University of Tampere School of Medicine, Tampere University, Kalevantie 4, Tampere 33014, Finland
| | - Olli Raitakari
- Department of Clinical Physiology and Nuclear Medicine, Research Centre of Applied and Preventive Cardiovascular Medicine, Turku University Hospital, University of Turku, Kiinamyllynkatu 4-8, Turku 20521, Finland
| | - Antti Jula
- Chronic Disease Epidemiology and Prevention Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Mannerheimintie 166, Helsinki 00300, Finland
| | - Aila Tiitinen
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital and University of Helsinki, Haartmaninkatu 2, Helsinki 00290, Finland
| | - Matti Jauhiainen
- 1] Public Health Genomics Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Biomedicum 1, Haartmaninkatu 8, Helsinki 00290, Finland [2] Institute for Molecular Medicine (FIMM), University of Helsinki, Biomedicum 2, Tukholmankatu 8, Helsinki 00290, Finland
| | - Pasi Soininen
- 1] Computational Medicine, Institute of Health Sciences, University of Oulu, Pentti Kaiteran katu 1, Oulu 90570, Finland [2] NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Yliopistonranta 1 PL 1627, Kuopio 70211, Finland
| | - Antti J Kangas
- 1] Computational Medicine, Institute of Health Sciences, University of Oulu, Pentti Kaiteran katu 1, Oulu 90570, Finland [2] NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Yliopistonranta 1 PL 1627, Kuopio 70211, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital and University of Tampere School of Medicine, Tampere University, Kalevantie 4, Tampere 33014, Finland
| | - Aki S Havulinna
- Chronic Disease Epidemiology and Prevention Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Mannerheimintie 166, Helsinki 00300, Finland
| | - Mika Ala-Korpela
- 1] Computational Medicine, Institute of Health Sciences, University of Oulu, Pentti Kaiteran katu 1, Oulu 90570, Finland [2] NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Yliopistonranta 1 PL 1627, Kuopio 70211, Finland [3] Oulu University Hospital, Kajaanintie 50, Oulu 90220, Finland [4] Computational Medicine, School of Social and Community Medicine and Medical Research Council Integrative Epidemiology Unit, University of Bristol, Senate House, Tyndall Avenue, Bristol, City of Bristol BS8 1TH, UK
| | - Veikko Salomaa
- Chronic Disease Epidemiology and Prevention Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Mannerheimintie 166, Helsinki 00300, Finland
| | - Andres Metspalu
- Estonian Genome Center, University of Tartu, Riia 23b, Tartu 51010, Estonia
| | - Markus Perola
- 1] Public Health Genomics Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Biomedicum 1, Haartmaninkatu 8, Helsinki 00290, Finland [2] Institute for Molecular Medicine (FIMM), University of Helsinki, Biomedicum 2, Tukholmankatu 8, Helsinki 00290, Finland [3] Estonian Genome Center, University of Tartu, Riia 23b, Tartu 51010, Estonia
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Scarabin-Carré V, Brailly-Tabard S, Ancelin ML, Maubaret C, Guiochon-Mantel A, Canonico M, Scarabin PY. Plasma estrogen levels, estrogen receptor gene variation, and ischemic arterial disease in postmenopausal women: the three-city prospective cohort study. J Clin Endocrinol Metab 2014; 99:E1539-46. [PMID: 24823458 DOI: 10.1210/jc.2013-4472] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND In older postmenopausal women, high levels of endogenous estrogen have been related to adverse health outcomes including ischemic arterial disease (IAD). Whether estrogen receptor-α (ESR1) and -β (ESR2) polymorphisms modulate the effects of estrogens on IAD has not been investigated. METHODS In the Three-City prospective cohort study among subjects older than 65 years, we used a case-cohort design in which plasma levels of total and bioavailable 17β-estradiol were measured. After exclusion of postmenopausal women using hormone therapy, a random subcohort of 533 women and 105 incident cases of first IAD events over 4 years of follow-up were analyzed. Five common polymorphisms of ESR1 and ESR2 were genotyped. Hazard ratios (HRs) of IAD for a 1-SD increase in hormones levels by the genotypes were estimated from Cox models after adjustment for cardiovascular risk factors and a correction for multiple testing. We also investigated the role of hemostasis and inflammation as potential mediators. RESULTS Neither estrogens nor IAD risk was significantly associated with estrogen receptor polymorphisms. Overall, IAD risk increased with total estradiol [HR1.40, 95% confidence interval (CI) 1.11-1.77]. Stratified analysis by genotypes showed that total estradiol was positively related to IAD risk in women with ESR1 rs9340799-AA genotype but not in women with the AG/GG genotype (HR 1.62, 95% CI 1.22-2.17 and HR 1.03, 95% CI 0.81-1.30, respectively; P for interaction <.05). An additional adjustment for hemostatic variables reduced the HR by about one third in women carrying the rs9340799-AA genotype (HR 1.41, 95% CI 1.06-1.90). CONCLUSION The ESR1 rs9340799 genotype may modify the IAD risk related to high endogenous estrogens levels in older postmenopausal women. Hypercoagulability may act as a mediator.
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Affiliation(s)
- Valérie Scarabin-Carré
- Center for Research in Epidemiology and Population Health (V.S.-C., M.C., P.-Y.S.), Unité 1018, Department of Hormones and Cardiovascular Disease, 94807 Villejuif, France; Unité Mixte de Recherche en Santé 1018 (V.S.-C., M.C., P.-Y.S.), Université Paris-Sud, 94276 Le Kremlin-Bicêtre, France; Service de Génétique Moléculaire, Pharmacogénétique, et Hormonologie (S.B.-T., A.G.-M.), Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, 94275 Le Kremlin-Bicêtre, France; INSERM Unité Mixte de Recherche en Santé 693 (S.B.-T., A.G.-M.), Université Paris-Sud, 94276 Le Kremlin-Bicêtre, France; INSERM Unité 1061 (M.-L.A.), University Montpellier, 34493 Montpellier, France; INSERM (C.M.), Institut de Santé Publique, d'Épidémiologie et de Développement, Center Unité 897, Department of Epidemiology-Biostatistic, 33076 Bordeaux, France; and Université Bordeaux (C.M.), 33076 Bordeaux, France
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Vesper HW, Botelho JC, Vidal ML, Rahmani Y, Thienpont LM, Caudill SP. High variability in serum estradiol measurements in men and women. Steroids 2014; 82:7-13. [PMID: 24407040 PMCID: PMC5699465 DOI: 10.1016/j.steroids.2013.12.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 12/10/2013] [Accepted: 12/19/2013] [Indexed: 11/18/2022]
Abstract
To reduce the variability in estradiol (E2) testing and to assure better patient care, standardization of E2 measurements has been recommended. This study aims to assess the accuracy and variability of E2 measurements performed by 11 routine immunological methods and 6 mass spectrometry methods using single donor serum materials and to compare the results to a reference method. The contribution of calibration bias, specificity or matrix effects, and imprecision on the overall variability of individual assays was evaluated. This study showed substantial variability in serum E2 measurements in samples from men and pre- and post-menopausal women. The mean bias across all samples, for each participant, ranged between -2.4% and 235%, with 3 participants having a mean bias of over 100%. The data suggest that calibration bias is the major contributor to the overall variability for nine assays. The analytical performances of most assays measuring E2 concentrations do not meet current needs in research and patient care. Three out of 17 assays would meet performance criteria derived from biological variability of ±12.5% bias at concentrations ≥20 pg/mL, and a maximum allowable bias of ±2.5 pg/mL at concentrations <20 pg/mL. The sensitivity differs highly between assays. Most assays are not able to measure E2 levels below 10 pg/mL. Standardization, specifically calibration to a common standard by using panels of individual patient samples, can reduce the observed variability and improve the utility of E2 levels in clinical settings.
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Affiliation(s)
- Hubert W Vesper
- Centers for Disease Control and Prevention, 4770 Buford Highway, NE F25, Atlanta 30341-3724, Georgia.
| | - Julianne C Botelho
- Centers for Disease Control and Prevention, 4770 Buford Highway, NE F25, Atlanta 30341-3724, Georgia
| | - Meghan L Vidal
- Centers for Disease Control and Prevention, 4770 Buford Highway, NE F25, Atlanta 30341-3724, Georgia
| | - Yasamin Rahmani
- Centers for Disease Control and Prevention, 4770 Buford Highway, NE F25, Atlanta 30341-3724, Georgia
| | | | - Samuel P Caudill
- Centers for Disease Control and Prevention, 4770 Buford Highway, NE F25, Atlanta 30341-3724, Georgia
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Boffetta P, Islami F, Vedanthan R, Pourshams A, Kamangar F, Khademi H, Etemadi A, Salahi R, Semnani S, Emadi A, Abnet CC, Brennan P, Pharoah PD, Dawsey SM, Malekzadeh R. A U-shaped relationship between haematocrit and mortality in a large prospective cohort study. Int J Epidemiol 2013; 42:601-15. [PMID: 23569195 DOI: 10.1093/ije/dyt013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Only a limited number of studies have investigated the correlation between haematocrit (HCT) and mortality in the general population, and few of those studies have had data on a wide range of low and high levels of HCT. We investigated the association between baseline HCT and mortality in a prospective cohort study of 49,983 adult subjects in Iran with a broad spectrum of HCT values. METHODS Data on socio-demographic and life-style factors, past medical history, and levels of HCT were collected at enrollment. During a mean follow-up of 5 years (follow-up success rate ~99%), 2262 deaths were reported. Cox proportional hazards regression models were used to estimate hazard ratios and corresponding 95% confidence intervals. RESULTS There was a U-shaped relationship between categories of HCT and mortality in both sexes: both low and high levels of HCT were associated with increased overall mortality and mortality from cardiovascular disease. The U-shaped relationship persisted after several sensitivity analyses were done, including analyses restricted to non-smokers and non-users of opium; analyses excluding deaths from accidents and other external causes as well as deaths of persons with self-reported ischemic heart disease at the baseline interview for the study; and analyses excluding the first 2 years of follow-up. Self-reported past medical history and lack of data about lipids and other cellular blood components were the major limitations of the study. CONCLUSIONS Low and high levels of HCT are associated with increased mortality in the general population. The findings in the present study can be of particular importance for low- and middle-income countries in which a substantial proportion of the population lives with suboptimal levels of HCT.
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Affiliation(s)
- Paolo Boffetta
- Institute for Transitional Epidemiology and the Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Morozkina SN, Fidarov AF, Mushtukov AS, Selivanov SI, Starova GL, Shawa AG. Synthesis and studies of structure and biological properties of D-homoanalogs of steroid estrogens. RUSS J GEN CHEM+ 2013. [DOI: 10.1134/s1070363213100125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Crandall CJ, Barrett-Connor E. Endogenous sex steroid levels and cardiovascular disease in relation to the menopause: a systematic review. Endocrinol Metab Clin North Am 2013; 42:227-53. [PMID: 23702399 DOI: 10.1016/j.ecl.2013.02.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Heart disease remains a major cause of death among women in the United States. This article focuses on physiologic endogenous estrogen levels with a systematic review of literature related to endogenous sex steroid levels and coronary artery disease (CAD) among postmenopausal women with natural or surgical menopause. There is adequate reason to seek evidence for associations of circulating estrogen levels and CAD. In the future, even if ovarian senescence-associated hormonal changes are confirmed to be associated with CAD in cohort studies of postmenopausal women, there may be other components explaining the gender differences in CAD patterns.
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Affiliation(s)
- Carolyn J Crandall
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90024, USA.
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31
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Rosner W, Hankinson SE, Sluss PM, Vesper HW, Wierman ME. Challenges to the measurement of estradiol: an endocrine society position statement. J Clin Endocrinol Metab 2013; 98:1376-87. [PMID: 23463657 PMCID: PMC3615207 DOI: 10.1210/jc.2012-3780] [Citation(s) in RCA: 249] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate the current state of clinical assays for estradiol in the context of their applications. PARTICIPANTS The participants were appointed by the Council of The Endocrine Society and charged with attaining the objective using published data and expert opinion. EVIDENCE Data were gathered from published sources via online databases (principally PubMed, Ovid MEDLINE, Google Scholar), and the clinical and laboratory experience of the participants. CONSENSUS PROCESS The statement was an effort of the committee and was reviewed by each member. The Clinical Affairs Committee, the Council of The Endocrine Society, and JCEM reviewers reviewed the manuscript and made recommendations. CONCLUSIONS The measurement of estradiol in biological fluids is important in human biology from cradle to grave. In addition to its centrality in sexual development, it has significant effects on skin, blood vessels, bone, muscle, coagulation, hepatic cells, adipose tissue, the kidney, the gastrointestinal tract, brain, lung, and pancreas. Alterations in its plasma concentration have been implicated in coronary artery disease, stroke, and breast cancer. Although modern immunoassays and liquid chromatography/tandem mass spectrometry-based methods for estradiol are reasonably well suited to the diagnosis and management of infertility (nonetheless, imprecision and method-to-method differences remain problematic), the very low concentrations that appear to be crucial in nonreproductive tissues are a separate and more difficult issue. Such levels of estradiol are too low to be routinely measured accurately or precisely, and further evolution of analytical methods and the way in which estradiol is standardized is needed.
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Affiliation(s)
- William Rosner
- Department of Medicine, St. Luke's-Roosevelt Hospital Center, New York, NY 10019, USA.
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Morozkina SN, Abusalimov SN, Selivanov SI, Shavva AG. Synthesis and biological activity of some 8α-analogs of steroidal estrogens. RUSSIAN JOURNAL OF ORGANIC CHEMISTRY 2013. [DOI: 10.1134/s1070428013040180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Dong M, Guo F, Yang J, Liu S, Tao Z, Fang Y, Zhang C, Li J, Li G. Detrimental effects of endogenous oestrogens on primary acute myocardial infarction among postmenopausal women. Neth Heart J 2013; 21:175-80. [PMID: 23055054 DOI: 10.1007/s12471-012-0323-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Traditionally, oestrogens were considered to be protective for the cardiovascular system for premenopausal women. Therefore, we conducted a retrospective case-control study to examine the association between endogenous oestrogens and acute myocardial infarction (AMI) risk among postmenopausal women. METHODS A case-control study was performed among 30 primary AMI patients and 60 control subjects. Baseline characteristics data was collected and endogenous sex hormones levels were determined using chemoluminescence and radioimmunoassay methods. Conditional logistic regression models were developed with adjustment for confounders. RESULTS Compared with controls, the circulating oestrone, oestradiol, androstenedione and testosterone levels were significantly higher in AMI patients (P < 0.05) while the sex hormone binding globulin (SHBG) level was lower (P < 0.05). Spearman correlation coefficients showed oestradiol was positively correlated with body mass index (BMI) and waist-to-hip ratio (WHR) in cases, but not in controls. In univariable conditional logistic regression models, oestrone, oestradiol, testosterone, WHR, BMI, diabetes and hypertension were all found to be positively associated with AMI (P < 0.05). After adjusting for these factors, oestradiol (odds ratio (OR) = 4.75; 95 % confidence interval (CI) = 1.07-21.10; P = 0.04) and WHR (OR = 6.46; 95 % CI = 1.09-38.39; P = 0.04) continued to demonstrate strong positive associations with AMI. CONCLUSIONS A higher level of oestradiol was potentially associated with primary AMI risk among postmenopausal women.
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Affiliation(s)
- M Dong
- Department of Cardiology, Yuhuangding Hospital, Yantai City, Shang Dong Province, 264001, People's Republic of China
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Canonico M, Brailly-Tabard S, Gaussem P, Setiao J, Rouaud O, Ryan J, Carcaillon L, Guiochon-Mantel A, Scarabin PY. Endogenous oestradiol as a positive correlate of plasma fibrinogen among older postmenopausal women: a population-based study (the Three-City cohort study). Clin Endocrinol (Oxf) 2012; 77:905-10. [PMID: 22642405 DOI: 10.1111/j.1365-2265.2012.04448.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Plasma fibrinogen is a strong predictor of ischaemic arterial disease in women. Sex steroid hormones including hormone therapy may play an important role in the development of cardiovascular disease. However, whether endogenous sex steroid hormones influence the plasma fibrinogen concentrations among postmenopausal women remains unclear. OBJECTIVES To investigate the association of plasma fibrinogen levels with endogenous sex steroid hormones and sex hormone binding globulin (SHBG) among postmenopausal women. METHODS We used data from the French prospective Three-City cohort study that included 9294 noninstitutionalized men and women over 65 years of age. Total 17β-oestradiol (E2, pg/ml), total testosterone (T, ng/ml), SHBG (nm) and fibrinogen (g/l) were measured in stored plasmas in a subcohort of 602 randomly selected postmenopausal women who used neither hormone medication nor anticoagulation therapy. Multivariate linear regression models were used to estimate the regression coefficients assessed in fibrinogen unit by 1 SD increase in log-distribution of sex steroid hormones and SHBG. RESULTS E2 but neither T nor SHBG was positively associated with plasma fibrinogen levels (β = 0·148, P < 0·001). Adjustment for cardiovascular risk factors including diabetes made no substantial change to the results (β = 0·145, P < 0·001). The association of fibrinogen with E2 was stronger among women with body mass index over 25 kg/m(2) compared with those with normal weight (β = 0·156, P < 0·001 and β = 0·092, P = 0·02, respectively, P for interaction = 0·04). CONCLUSION E2 emerges as a positive and independent correlate of plasma fibrinogen among postmenopausal women, especially in subjects who are overweight. These findings suggest a deleterious effect of endogenous oestrogens on cardiovascular risk profile among postmenopausal women.
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Affiliation(s)
- Marianne Canonico
- Hormones and Cardiovascular Disease, Univ Paris-Sud, Villejuif, France.
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P-wave parameters and cardiac repolarization indices: Does menopausal status matter? J Cardiol 2012; 60:333-7. [DOI: 10.1016/j.jjcc.2012.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 04/01/2012] [Accepted: 04/05/2012] [Indexed: 11/17/2022]
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Scarabin-Carré V, Canonico M, Brailly-Tabard S, Trabado S, Ducimetière P, Giroud M, Ryan J, Helmer C, Plu-Bureau G, Guiochon-Mantel A, Scarabin PY. High level of plasma estradiol as a new predictor of ischemic arterial disease in older postmenopausal women: the three-city cohort study. J Am Heart Assoc 2012; 1:e001388. [PMID: 23130139 PMCID: PMC3487322 DOI: 10.1161/jaha.112.001388] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 04/24/2012] [Indexed: 12/17/2022]
Abstract
Background Despite evidence that estrogens may be involved in atherothrombosis, the role of endogenous sex steroid hormones in ischemic arterial disease among postmenopausal women remains uncertain. Methods and Results In the Three-City prospective cohort study of subjects (n=9294) >65 years of age, we investigated the association of total 17β-estradiol, bioavailable 17β-estradiol, and total testosterone with the 4-year incidence of ischemic arterial disease among postmenopausal women who did not use any hormone therapy. We designed a case–cohort study including a random sample of 537 subjects and 106 incident cases of first cardiovascular events. Weighted Cox proportional-hazards models with age as the time scale were used to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) for ischemic arterial disease by a 1–standard deviation increase in sex steroid hormones. In univariate analysis, HR of ischemic arterial disease was positively and significantly associated with both total and bioavailable estradiol levels. These associations remained significant after adjustment for traditional cardiovascular risk factors, including body mass index, diabetes, hypercholesterolemia, hypertension, and smoking status (HR: 1.42, 95% CI: 1.12–1.79, P<0.01; and HR: 1.42, 95% CI: 1.12–1.78, P<0.01, respectively). Separate analysis for coronary heart disease yielded similar results (adjusted HR: 1.49, 95% CI: 1.10–2.02, P=0.01; and adjusted HR: 1.50, 95% CI: 1.11–2.04, P<0.01, respectively), and a borderline significant trend was observed for ischemic stroke (HR: 1.34, 95% CI: 0.95–1.89, P=0.08; and HR: 1.32, 95% CI: 0.94–1.84, P=0.11, respectively). By contrast, no significant association was found between total testosterone and ischemic arterial disease in both univariate and adjusted analyses. Conclusions High plasma level of endogenous estradiol emerges as a new predictor of ischemic arterial disease in older postmenopausal women. (J Am Heart Assoc. 2012;1:e001388 doi: 10.1161/JAHA.112.001388.)
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Affiliation(s)
- Valérie Scarabin-Carré
- Centre for Research in Epidemiology and Population Health, Inserm Unit 1018, Hormones and Cardiovascular Disease, Villejuif, France (V.S., M.C., G.P.-B., P.-Y.S.) ; Université Paris-Sud, UMR-S 1018, Villejuif, France (V.S., M.C., P.D., P.-Y.S.)
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de Padua Mansur A, Silva TCBF, Takada JY, Avakian SD, Strunz CMC, Machado César LA, Mendes Aldrighi J, Ramires JAF. Long-term prospective study of the influence of estrone levels on events in postmenopausal women with or at high risk for coronary artery disease. ScientificWorldJournal 2012; 2012:363595. [PMID: 22701354 PMCID: PMC3373154 DOI: 10.1100/2012/363595] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 02/29/2012] [Indexed: 12/24/2022] Open
Abstract
Background. The link between endogenous estrogen, coronary artery disease (CAD), and death in postmenopausal women is uncertain. We analyzed the association between death and blood levels of estrone in postmenopausal women with known coronary artery disease (CAD) or with a high-risk factor score for CAD. Methods. 251 postmenopausal women age 50–90 years not on estrogen therapy. Fasting blood for estrone and heart disease risk factors were collected at baseline. Women were grouped according to their estrone levels (<15 and ≥15 pg/mL). Fatal events were recorded after 5.8 ± 1.4 years of followup. Results. The Kaplan-Meier survival curve showed a significant trend (P = 0.039) of greater all-cause mortality in women with low estrone levels (<15 pg/mL). Cox multivariate regression analysis model adjusted for body mass index, diabetes, dyslipidemia, family history, and estrone showed estrone (OR = 0.45; P = 0.038) as the only independent variable for all-cause mortality. Multivariate regression model adjusted for age, body mass index, hypertension, diabetes, dyslipidemia, family history, and estrone showed that only age (OR = 1.06; P = 0.017) was an independent predictor of all-cause mortality. Conclusions. Postmenopausal women with known CAD or with a high-risk factor score for CAD and low estrone levels (<15 pg/mL) had increased all-cause mortality.
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Affiliation(s)
- Antonio de Padua Mansur
- Heart Institute-InCor, University of São Paulo Medical School, 05403-000 São Paulo, SP, Brazil.
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Huhtaniemi IT, Tajar A, Lee DM, O'Neill TW, Finn JD, Bartfai G, Boonen S, Casanueva FF, Giwercman A, Han TS, Kula K, Labrie F, Lean MEJ, Pendleton N, Punab M, Silman AJ, Vanderschueren D, Forti G, Wu FCW. Comparison of serum testosterone and estradiol measurements in 3174 European men using platform immunoassay and mass spectrometry; relevance for the diagnostics in aging men. Eur J Endocrinol 2012; 166:983-91. [PMID: 22423144 DOI: 10.1530/eje-11-1051] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The limitations of serum testosterone and estradiol (E(2)) measurements using non-extraction platform immunoassays (IAs) are widely recognized. Switching to more specific mass spectrometry (MS)-based methods has been advocated, but directly comparative data on the two methods are scarce. METHODS We compared serum testosterone and E(2) measurements in a large sample of middle-aged/elderly men using a common platform IA and a gas chromatography (GC)-MS method, in order to assess their limitations and advantages, and to diagnose male hypogonadism. Of subjects from the European Male Aging Study (n=3174; age 40-79 years), peripheral serum testosterone and E(2) were analyzed using established commercial platform IAs (Roche Diagnostics E170) and in-house GC-MS methods. RESULTS Over a broad concentration range, serum testosterone concentration measured by IA and MS showed high correlation (R=0.93, P<0.001), which was less robust in the hypogonadal range (<11 nmol/l; R=0.72, P<0.001). The IA/MS correlation was weaker in E(2) measurements (R=0.32, P<0.001, at E(2) <40.8 pmol/l, and R=0.74, P<0.001, at E(2) >40.8 pmol/l). Using MS as the comparator method, IA ascertained low testosterone compatible with hypogonadism (<11 nmol/l), with 75% sensitivity and 96.3% specificity. The same parameters with IA for the detection of low E(2) (<40.7 pmol/l) were 13.3 and 99.3%, and for high E(2) (>120 pmol/l) 88.4 and 88.6%. CONCLUSION A validated platform IA is sufficient to detect subnormal testosterone concentrations in the diagnosis of male hypogonadism. The IA used for E(2) measurements showed poor correlation with MS and may only be suitable for the detection of high E(2) in men.
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Affiliation(s)
- Ilpo T Huhtaniemi
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK.
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Brenner R, Weilenmann D, Maeder MT, Jörg L, Bluzaite I, Rickli H, De Pasquale G, Ammann P. Clinical characteristics, sex hormones, and long-term follow-up in Swiss postmenopausal women presenting with Takotsubo cardiomyopathy. Clin Cardiol 2012; 35:340-7. [PMID: 22488168 DOI: 10.1002/clc.21986] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Revised: 02/27/2012] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The overwhelming majority of patients with stress cardiomyopathy (SC) are postmenopausal women, suggesting an important pathophysiologic role of the female sex hormones. Preliminary data suggest that myocardial stunning might be provoked by estrogen deficiency. HYPOTHESIS We hypothesized that, compared with age- and gender-matched patients with myocardial infarction (MI) or patients with normal coronary arteries, patients with SC would exhibit altered levels of sex hormones. Furthermore, we aimed to describe the clinical course and the pattern of sex hormones of the SC patients during long-term follow-up. METHODS Blood samples obtained on hospital admission were analyzed for estradiol (E2), progesterone (P), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) in women with SC (n = 17), age-matched women with acute MI (n = 16), and women with normal coronary arteries (n = 15). Six years after the initial event, SC patients underwent a clinical and echocardiographic follow-up and reassessment of sex hormones. RESULTS Estrogen concentrations at hospital admission were significantly higher in the SC group compared with the MI and the control groups, with no difference in P, FSH, and LH concentrations. Follow-up E2 after 6 years in SC patients was lower than during the acute SC episode. Follow-up P in these patients was lower than P in the MI and control groups during the acute event, with a similar trend for E2. After a median follow-up of 6.4 years, 1 sudden cardiac death occurred and 2 patients suffered from SC recurrence. CONCLUSIONS During the acute event, E2 concentrations are elevated in postmenopausal SC patients compared with women with acute MI or with normal coronary arteries. The higher E2 concentrations might have exerted atheroprotective effects and thus diverted the stress response to SC rather than MI. Recurrence and/or sudden cardiac death remains a potential risk of SC.
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Affiliation(s)
- Roman Brenner
- Department of Cardiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
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Dai W, Li Y, Zheng H. Estradiol/Testosterone Imbalance: Impact on Coronary Heart Disease Risk Factors in Postmenopausal Women. Cardiology 2012; 121:249-54. [DOI: 10.1159/000337274] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 02/06/2012] [Indexed: 11/19/2022]
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