Sex hormone-binding globulin may predict stroke risk in postmenopausal women
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Sex hormone-binding globulin, or SHBG, may be used as a risk stratification tool to predict ischemic stroke in women based on the inverse association between both factors, according to data presented at the International Stroke Conference.
Findings from this study were also published in Stroke.
“Though we need more data to better understand the link between SHBG and stroke, this study — as well as others — points to the need to approach stroke prevention through a sex-specific lens,” Tracy E. Madsen, MD, ScM, assistant professor in the department of emergency medicine and associate director of the division of sex and gender in emergency medicine at Brown University Warren Alpert Medical School, told Healio. “This means understanding that optimal stroke prevention and management in women requires consideration of biological differences between women and men far beyond just differences in sex organs, but differences that affect cells and tissues throughout the body. Clinically, this means being aware of risk factors that are more common in and/or specific to women and that affect stroke risk differently by sex.”
Researchers analyzed data from 13,192 patients (mean age, 63 years; 67% non-Hispanic white; 19% black; 8% Hispanic; 5% Asian) from the Women’s Health Initiative who were free from stroke at baseline. SHBG was measured in ancillary case-control studies. The outcome of interest was defined as ischemic stroke during follow-up, which was conducted for a mean of 11.6 years.
During follow-up, 768 ischemic stroke events occurred.
Compared with women in the highest quintile of SHBG, those in the lowest quintile had a higher risk for ischemic stroke after adjusting for demographic variables (HR = 1.88; 95% CI, 1.47-2.41). This continued after adjusting for additional factors including hypertension, BMI, smoking status and alcohol use (HR = 1.69; 95% CI, 1.3-2.2) and for reproductive risk factors and physical activity (HR = 1.61; 95% CI, 1.19-2.19; P for trend for all models < .05).
The association between SHBG and the risk for ischemic stroke was attenuated when potential mediators such as estradiol, diabetes and testosterone were included, although it did not eliminate the significant inverse associations.
“The purpose of our study was to demonstrate a link or association between low SHBG and ischemic stroke,” Madsen said in an interview. “Before recommending any changes to clinical practice, we must conduct further studies that determine whether there is a cause/effect type relationship between low SHBG and stroke. We are also planning to work on studies to evaluate whether adding hormonal biomarkers like SHBG to existing stroke risk scores may improve the prediction of stroke in women.” – by Darlene Dobkowski
References:
Madsen TE, et al. Abstract 72. Presented at: International Stroke Conference; Feb. 19-21, 2020; Los Angeles.
Madsen TE, et al. Stroke. 2020;doi:10.1161/STROKEAHA.120.028905.
Disclosures: The authors report no relevant financial disclosures.