High progesterone levels are associated with family history of premature coronary artery disease in young healthy adult men

Early-onset or Premature Coronary Artery Disease

The aim of this review was to examine the literature regarding younger individuals without classical risk factors for atherosclerosis who develop coronary artery disease (CAD) prematurely at an early age. An extensive literature review was undertaken in Pubmed, Scopus, and Google Scholar regarding early-onset or premature atherosclerosis, CAD, its diagnosis, management, and prophylaxis. There are individuals of both genders, particularly in the younger age group of 20-40 years of age, who lack the traditional/ classical risk factors and still develop CAD and other manifestations of atherosclerosis. Even the 10-year age gap in manifesting CAD that is noted between women and men ascribable to a cardioprotective effect of sex hormones may not be noted under these circumstances. This indicates that the risk profile differs in young patients with nonclassical atherosclerotic risk factors, and factors such as genetics, inflammation, thrombosis, psychosocial, environmental, and other parameters play an important role in atherosclerosis and other mechanisms that lead to CAD in younger individuals. These patients are at risk of major adverse cardiac events, which determine their prognosis. Unfortunately, current major guidelines do not acknowledge that many patients who manifest premature CAD are at high risk, and as a consequence, many of these patients may not be receiving guideline-directed hypolipidemic and other therapies before they present with symptoms of CAD. Caretakers need to be more vigilant in offering efficacious screening and strategies of prevention for early-onset or premature CAD to younger individuals.

Obesity, Body Composition, and Sex Hormones: Implications for Cardiovascular Risk

Cardiovascular disease (CVD) continues to be the leading cause of death in adults, highlighting the need to develop novel strategies to mitigate cardiovascular risk. The advancing obesity epidemic is now threatening the gains in CVD risk reduction brought about by contemporary pharmaceutical and surgical interventions. There are sex differences in the development and outcomes of CVD; premenopausal women have significantly lower CVD risk than men of the same age, but women lose this advantage as they transition to menopause, an observation suggesting potential role of sex hormones in determining CVD risk. Clear differences in obesity and regional fat distribution among men and women also exist. While men have relatively high fat in the abdominal area, women tend to distribute a larger proportion of their fat in the lower body. Considering that regional body fat distribution is an important CVD risk factor, differences in how men and women store their body fat may partly contribute to sex-based alterations in CVD risk as well. This article presents findings related to the role of obesity and sex hormones in determining CVD risk. Evidence for the role of sex hormones in determining body composition in men and women is also presented. Lastly, the clinical potential for using sex hormones to alter body composition and reduce CVD risk is outlined. © 2022 American Physiological Society. Compr Physiol 12:1-45, 2022.

Sex Hormones in Men with Abdominal Aortic Aneurysm

BACKGROUND

Abdominal aortic aneurysm (AAA) primarily affects elderly men. The impact of sex on aneurysm development has been associated with an effect of sex hormones, through mechanisms that are not fully understood. This study aimed to examine the association between levels of sex hormones and the occurrence of AAA in elderly men.

METHODS

A prospective case-control study was conducted including 452, 65-year old men participating in screening for AAA, 2013-2019; 230 men with AAA and 222 men with an aortic diameter<30mm (controls). Questionnaires and blood samples were collected and stored consecutively. Serum levels of total testosterone, estradiol, progesterone, luteinizing hormone and sex hormone binding globulin were analyzed by electrochemiluminescent immunoassays. Multivariable logistic regression analysis was used to assess the association of sex hormones with AAA.

RESULTS

The median aneurysm diameter was 33mm. Men with AAA had higher estradiol and progesterone levels than controls (93pmol/L vs. 84pmol/L, p=.003 and 0.41nmol/L vs. 0.17nmol/L, p<.001). Testosterone levels were lower in men with AAA than in controls (13nmol/L vs. 14nmol/L, p=.026). AAA was associated with detectable levels of progesterone(OR 6.69, 95%CI 3.86-11.47), smoking(OR 5.26, 95%CI 3.12-8.85), coronary heart disease(OR 4.06, 95%CI 1.92-8.58) and body mass index>25(OR 2.26, 95%CI 1.34-3.82).

CONCLUSION

The observed higher levels of estradiol and progesterone in men with AAA, suggest an impact of sex hormones on aneurysm development. The association between progesterone levels and aortic diameter, stress the importance of focusing on the potential effect of this unconsidered female sex hormone on aneurysm formation.

Genetic and environmental factors associated with homocysteine concentrations in a population of healthy young adults. Analysis of the MAGNETIC study

BACKGROUND AND AIMS

Elevated homocysteine concentration is associated with a higher risk of cardiovascular disease. The aim of our study was to determine the environmental and genetic factors associated with serum homocysteine concentration in healthy young adults. Moreover, we aimed to determine the cutoff value of homocysteine concentration for predicting unfavorable MTHFR genotype and to investigate whether this association is modified by dietary patterns and serum folate status.

METHODS AND RESULTS

A total of 744 healthy individuals, aged 18-35 years, were included in the study. Diet quality was assessed by establishing diet quality scores and adherence to the pro-Healthy Diet Index (pHDI) and non-Healthy Diet Index (nHDI). Genotyping was performed using the TaqMan method. Multivariate analysis showed that pHDI, creatinine, folate concentrations, and the T/T genotype of the C677T polymorphism in MTHFR, as well as the interaction between the T/T genotype of MTHFR (C677T polymorphism) and folate level, were most strongly related to homocysteine concentrations. The specificity of a homocysteine >13.1 μmol/l in predicting T/T homozygous status was 76% (area under the curve 0.68).

CONCLUSION

Healthy dietary patterns, folate, and creatinine levels, as well as the C677T polymorphism, proved to be the strongest predictors of homocysteine concentrations. T/T genotype of MTHFR modifies the relationship between folate and homocysteine.