Endogenous Postmenopausal Hormones and Serum Lipids: The Atherosclerosis Risk in Communities Study

Abstract

Previous studies have revealed that exogenous estrogen has a beneficial effect on the lipid profile; however, studies examining the relation between endogenous hormones and lipid profiles in postmenopausal women have yielded conflicting results. We sought to characterize the cross-sectional relationship between endogenous hormones and lipid parameters in postmenopausal women with significant (cases, n = 156) and minimal (controls, n = 172) carotid atherosclerosis not taking hormone therapy in the Atherosclerosis Risk in Communities Study. Endogenous hormone status was assessed by measuring levels of estrone, total testosterone, androstenedione, dehydroepiandrosterone sulfate, and SHBG. Free testosterone was estimated using the free androgen index (total testosterone/SHBG). Lipid parameters assessed included total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, and low-density lipoprotein (LDL) cholesterol. We found that SHBG was significantly associated with a more favorable lipid profile, including lower total and LDL cholesterol and triglycerides and higher HDL cholesterol among controls. This association was less prominent among cases where SHBG was only associated with higher triglycerides and lower HDL cholesterol. The free androgen index was associated with a more atherogenic lipid profile, including increased LDL cholesterol among controls and increased total and LDL cholesterol and triglycerides among cases. These relations were independent of demographic and metabolic factors and health behaviors. In contrast to controls, estrone was associated with higher total cholesterol and triglycerides among cases in multivariate analyses. Our data suggest that endogenous sex hormones may play a role in regulating lipid metabolism in postmenopausal women.

Testosterone, SHBG and cardiovascular health in postmenopausal women

“…Yasui et al 60 found that associations of SHBG with HDL-C and triglycerides were no longer significant after controlling for BMI. In another study, a similar lack of independence was observed for the association with HDL-C. 64 Conversely, in several studies associations between SHBG and triglycerides 5,6,55,64 and HDL-C 5,17 persisted after adjustment for BMI or WHR. In the study of Lambrinoudaki et al, 5 associations of TT and FT with triglycerides and HDL-C were not explained by BMI.…”

“…Insulin is known to exert a direct regulatory effect on HL and LPL. 107,108 Interestingly, only a few studies 6,52,56 adjusted for the effect of insulin. Mudali et al 6 showed that adjustments for insulin, BMI and other covariates did not significantly influence associations of SHBG with HDL-C and triglycerides.…”

“…107,108 Interestingly, only a few studies 6,52,56 adjusted for the effect of insulin. Mudali et al 6 showed that adjustments for insulin, BMI and other covariates did not significantly influence associations of SHBG with HDL-C and triglycerides. In contrast, Soler et al 52 found that associations between SHBG and triglycerides were lost after controlling for WHR, insulin and estradiol.…”

“…3 However, throughout the years, several observations have brought this theory into question. Studies examining associations between endogenous estrogen levels and CVD risk factors have yielded conflicting results [4][5][6] and available data on CVD events indicate a lack of association. 7,8 Furthermore, in contrast to other estrogen related diseases, the CVD rate does not show a sharp rise at time of menopause.…”

Endogenous sex hormones and risk factors for atherosclerosis in healthy Greek postmenopausal women

“…Concerning the association of endogenous estrogens with the lipid profile in postmenopausal women, studies have yielded conflicting results. Some authors have reported positive correlations between serum estrone or estradiol with HDL-cholesterol and triglycerides and inverse associations with total cholesterol and LDL-cholesterol (10)(11)(12)(13)(14), while others have reported higher total cholesterol (15) as well as lower triglycerides in women with higher endogenous estrogen levels (16). Finally, some investigators have found no significant association between estrogen and lipid levels (17)(18)(19).…”