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Optimal CV health linked to sex steroids, SHBG in older adults
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Women with lower levels of testosterone and free androgen index and higher levels of sex hormone-binding globulin and men with higher levels of sex hormone-binding globulin may be more likely to reach optimal cardiovascular health, according to an analysis of Rotterdam Study data.
In 2010, the American Heart Association introduced the concept of CV health as broader than the absence of disease, based on a range of seven health factors, including cholesterol, glucose, blood pressure, physical activity, smoking status, BMI and diet.
Maryam Kavousi, MD, PhD, of the department of epidemiology at Erasmus University Medical Centre in Rotterdam, the Netherlands, and colleagues evaluated data on 1,647 men (mean age, 68.6 years) and 1,564 postmenopausal women (mean age, 69.6 years) to determine the link between estradiol, testosterone, SHBG and free androgen index to CV health.
CV health was defined as poor, intermediate or ideal; ideal CV health included three health factors (total cholesterol < 200 mg/dL; fasting plasma glucose < 100 mg/dL; BP < 120 mm Hg/< 80 mm Hg) and four health behaviors (75-150 minutes of moderate or vigorous physical activity per week; nonsmoking; BMI < 25 kg/m2; healthy diet).
Total CV health score was based on which category a participant fell into for each of the seven health factors: poor yielded 0 points; intermediate yielded 1 point and ideal yielded 2 points, with a maximum score of 14 points. The score was divided into two categories: optimal CV health (11-14 points) or nonoptimal CV health (0-10 points).
Overall, no participant reached a CV health score of 14 points, whereas optimal CV health was reached by 9.3% of men and 10.4% of women.
Prevalence of optimal CV health was nonsignificantly higher in men with estradiol in the middle tertile. Among women with estradiol in the lowest tertile, the prevalence of optimal CV health was slightly higher, although not significant.
Men with testosterone in the highest tertile (43.1%) and women with testosterone in the lowest tertile (43.8%) had the highest prevalence of optimal CV health. High levels of SHBG were also linked to the highest prevalence of optimal CV health (men, 47.1%; women, 48.1%). Women with the lowest free androgen index also had a significantly higher prevalence of optimal CV health (52.5%).
Optimal CV health was linked to higher levels of SHBG (OR = 4.55; 95% CI, 2.99-6.94) and lower levels of testosterone (OR = 0.69; 95% CI, 0.48-1) and free androgen index (OR = 0.43; 95% CI, 0.32-0.57) in women and with higher levels of SHBG (OR = 2.56; 95% CI, 1.45-4.49) after adjustment for potential confounders.
“Using the concept of [CV] health, instead of merely the presence or absence of disease or focus on separate [CV] risk factors, allowed us to assess the role of [estradiol], [testosterone], SHBG and [free androgen index] in the [CV] system in a comprehensive manner, and the implications may extend beyond the [CV] system to other health domains,” the researchers wrote. “To facilitate the development of preventive and treatment strategies, the complexity and temporality of the interrelation between [estradiol], [testosterone], SHBG, and [free androgen index] and the cardiometabolic profile, and the role of body fat distribution in particular, warrants further investigation.” – by Amber Cox
Disclosure: Kavousi reports receiving support from the NOW VENI grant. Please see the full study for a list of all other authors’ relevant financial disclosures.
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