TY - JOUR
T1 - Association of endogenous sex hormone levels with coronary artery calcium progression among post-menopausal women in the Multi-Ethnic Study of Atherosclerosis (MESA)
AU - Subramanya, Vinita
AU - Zhao, Di
AU - Ouyang, Pamela
AU - Ying, Wendy
AU - Vaidya, Dhananjay
AU - Ndumele, Chiadi E.
AU - Heckbert, Susan R.
AU - Budoff, Matthew J.
AU - Post, Wendy S.
AU - Michos, Erin D.
N1 - Funding Information:
Dr. Subramanya was funded by grant 16SFRN27870000 from the American Heart Association Go Red for Women Strategically Focused Research Network (SFRN). Drs. Zhao, Guallar, Michos, Ouyang, Vaidya, Post and Ying also receive some funding from the AHA SFRN through grants 16SFRN27870000 and 16SFRN28680004 from AHA Go Red for Women SFRN . Dr. Michos and Dr. Zhao received additional funding through the Blumenthal Scholars Award in Preventive Cardiology at Johns Hopkins School of Medicine. This research was funded by R01 HL074406 and R01 HL074338 from the National Heart, Lung, and Blood Institute . The MESA study was supported by contracts HHSN268201500003I , N01-HC-95159 , N01-HC-95160 , N01-HC-95161 , N01-HC-95162 , N01-HC-95163 , N01-HC-95164 , N01-HC-95165 , N01-HC-95166 , N01-HC-95167 , N01-HC-95168 and N01-HC-95169 from the NHLBI , and by grants UL1-TR-000040 , UL1-TR-001079 , and UL1-TR-001420 from NCATS .
Funding Information:
Dr. Budoff has received grant support from General Electric healthcare. No other authors report any conflicts of interest related to this work.
Funding Information:
Dr. Subramanya was funded by grant 16SFRN27870000 from the American Heart Association Go Red for Women Strategically Focused Research Network (SFRN). Drs. Zhao, Guallar, Michos, Ouyang, Vaidya, Post and Ying also receive some funding from the AHA SFRN through grants 16SFRN27870000 and 16SFRN28680004 from AHA Go Red for Women SFRN. Dr. Michos and Dr. Zhao received additional funding through the Blumenthal Scholars Award in Preventive Cardiology at Johns Hopkins School of Medicine. This research was funded by R01 HL074406 and R01 HL074338 from the National Heart, Lung, and Blood Institute. The MESA study was supported by contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the NHLBI, and by grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from NCATS.
Publisher Copyright:
© 2018
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Background: Sex differences in the incidence and manifestation of cardiovascular disease (CVD) suggest the involvement of sex hormones in disease pathogenesis. Coronary artery calcium (CAC) and its progression, measured by non-contrast cardiac computed tomography, are markers of subclinical atherosclerosis and predict CVD, even among low-risk women. We hypothesized that sex hormone levels were associated with CAC progression among women in the Multi-Ethnic Study of Atherosclerosis. Methods: We studied 2759 post-menopausal women (age 65 ± 9 years), free of baseline CVD, with baseline serum sex hormones and CAC measured at Exam 1 (2000–2002). Of this sample, 2427 had ≥1 follow-up CAC measurement through Exam 5 (2010–2012). Using mixed effects linear regression methods, we tested change in log[CAC+1] score by log[sex hormone] levels (continuous, comparing the 90th versus 10th percentiles). Models adjusted for demographics, lifestyle factors, cardiovascular risk factors, hormone therapy, and years since menopause. Results: At baseline, we found no associations between sex hormones and prevalent CAC. Over a median of 4.7 years, in fully-adjusted models, women with higher free testosterone levels had relatively greater CAC progression [Ratio 1.26 (95% CI 1.01–1.56)], whereas higher sex hormone binding globulin (SHBG) was associated with lower progression risk [0.80 (0.64–0.99). No associations were seen for total testosterone, estradiol, or dehydroepiandrosterone. Conclusion: A more androgenic hormone profile of higher free testosterone and lower SHBG is associated with a greater CAC progression up to 10-years in post-menopausal women. Sex hormone levels may help identify women at increased risk for CVD who may benefit from additional risk-reducing strategies.
AB - Background: Sex differences in the incidence and manifestation of cardiovascular disease (CVD) suggest the involvement of sex hormones in disease pathogenesis. Coronary artery calcium (CAC) and its progression, measured by non-contrast cardiac computed tomography, are markers of subclinical atherosclerosis and predict CVD, even among low-risk women. We hypothesized that sex hormone levels were associated with CAC progression among women in the Multi-Ethnic Study of Atherosclerosis. Methods: We studied 2759 post-menopausal women (age 65 ± 9 years), free of baseline CVD, with baseline serum sex hormones and CAC measured at Exam 1 (2000–2002). Of this sample, 2427 had ≥1 follow-up CAC measurement through Exam 5 (2010–2012). Using mixed effects linear regression methods, we tested change in log[CAC+1] score by log[sex hormone] levels (continuous, comparing the 90th versus 10th percentiles). Models adjusted for demographics, lifestyle factors, cardiovascular risk factors, hormone therapy, and years since menopause. Results: At baseline, we found no associations between sex hormones and prevalent CAC. Over a median of 4.7 years, in fully-adjusted models, women with higher free testosterone levels had relatively greater CAC progression [Ratio 1.26 (95% CI 1.01–1.56)], whereas higher sex hormone binding globulin (SHBG) was associated with lower progression risk [0.80 (0.64–0.99). No associations were seen for total testosterone, estradiol, or dehydroepiandrosterone. Conclusion: A more androgenic hormone profile of higher free testosterone and lower SHBG is associated with a greater CAC progression up to 10-years in post-menopausal women. Sex hormone levels may help identify women at increased risk for CVD who may benefit from additional risk-reducing strategies.
KW - Cardiac computed tomography
KW - Coronary artery calcium
KW - Menopause
KW - Risk factors
KW - Sex hormones
KW - Testosterone
KW - Women
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U2 - 10.1016/j.jcct.2018.09.010
DO - 10.1016/j.jcct.2018.09.010
M3 - Article
C2 - 30297127
AN - SCOPUS:85054377008
VL - 13
SP - 41
EP - 47
JO - Journal of Cardiovascular Computed Tomography
JF - Journal of Cardiovascular Computed Tomography
SN - 1934-5925
IS - 1
ER -