Androgens, Bilateral Oophorectomy, and Cardiovascular Disease Mortality in Postmenopausal Women With and Without Diabetes: The Study of Osteoporotic Fractures

Abstract

OBJECTIVEDiabetes elevates cardiovascular disease (CVD) risk more markedly in women than in men. Because the high risk of CVD among women with type 2 diabetes (DM2) may be partly due to increased ovarian androgen production, we investigated whether a history of bilateral salpingo oophorectomy (BSO) is inversely associated with CVD mortality among women with DM2.RESEARCH DESIGN AND METHODSData were obtained from 7,977 women (a random subset of 564 had measurements of sex-steroid hormones) enrolled in the Study of Osteoporotic Fractures (SOF), a community-based, multicenter study that monitored women aged ≥65 years for a mean of 15.1 years. Adjusted hazard ratios (HRs) and 95% CIs were calculated using Cox proportional hazards regression.RESULTSThe average age at baseline was 71.5 years, with 6.3% and 18% of participants reporting a history of diabetes or BSO, respectively. In the subset of the SOF cohort with sex-steroid hormone measurements, those with DM2 had 43.6% significantly higher levels of free testosterone that were partly explained by age and adiposity, whereas total and free testosterone levels were lower in women with BSO than in those with intact ovaries. CVD mortality was elevated in women with DM2 without BSO (HR 1.95, 95% CI 1.62–2.35) as well as in women with DM2 and BSO (HR 2.56, 95% CI 1.79–3.65; P = 0.190 for interaction). Overall, BSO was not associated with CVD mortality (HR 1.05, 95% CI 0.89–1.23).CONCLUSIONSThe association of diabetes with CVD was not reduced by BSO, suggesting that ovarian hyperandrogenemia may not be a primary mechanism to explain the high risk for CVD among women with DM2.

Association of circular RNA hsa_circ_0124644 and incidence and severity of coronary heart disease in premenopausal women

“…The findings substantiated a significant association between hsacirc-0124644 and an elevated occurrence of CHD in middle-aged premenopausal women. These results deviated from those reported in prior studies [19][20][21][22][23][24][25][26][27]. The primary rationale behind this disparity could be the exclusion of older postmenopausal women from the present study.…”

“…Perimenopausal women are at an elevated risk of CHD due to the absence of oestrogen's protective effects [16][17][18]. Existing scholarly literature has identified several risk factors associated with CHD in women, such as family history [19,20], age [17,18], smoking [21,22], dyslipidaemia [23,24], diabetes [25,26], hypertension [27], and psychological factors [28,29]. Nevertheless, it is imperative to acknowledge that women exhibit notable variations in both physical and psychological aspects prior to and following menopause.…”

The many menopauses: searching the cognitive research literature for menopause types

“…92 In cardiovascular research, this greater specificity is viewed as important to understanding the outcomes of induced menopause; 6 for example, further covarying for age, race, education, BMI, and other health-related factors revealed an increased risk of diabetes in women with combined hysterectomy–oophorectomy compared with women who had spontaneous menopause or hysterectomy only. 101,102,103 This demonstrates that demographic specificity, even within a menopause type, strengthens the evidence for clinical evaluations and treatment.…”