Higher Serum Testosterone Concentration in Older Women is Associated with Insulin Resistance, Metabolic Syndrome, and Cardiovascular Disease

Patel, Shalin; Ratcliffe, Sarah J.; Reilly, Muredach P.; Weinstein, Rachel; Bhasin, Shalender; Blackman, Marc R.; Cauley, Jane A.; Sutton-Tyrrell, Kim; Robbins, John A.; Fried, Linda P.; Cappola, Anne R.

doi:10.1210/jc.2009-0740

Cited by 119 publications

(80 citation statements)

References 46 publications

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“…In addition, a significant association was found between total and free testosterone and an adverse metabolic profile, i.e. insulin resistance and abdominal obesity (13). In accordance were the findings of Page-Wilson et al, who studied 200 nondiabetic postmenopausal women, 98 of them with CVD and 102 serving as matched controls.…”

Section: Risk Of Cardio-and Cerebro-vascular Diseasesupporting

confidence: 82%

“…In the recent large study of Sievers et al (32) assessing 2914 women followed for 4.5 years, it was demonstrated that women with the Table 1 Cumulative results of studies investigating associations of endogenous estrogen and androgen levels with cardio-and cerebrovascular disease risk in postmenopausal women (reference in parenthesis). Prospective case-control 297 No independent association of E with CVD risk (12) Case-control 400 No independent association of E and A with CVD risk (13) Cross-sectional 344 Positive association of total testosterone with threefold higher CHD risk (14) Case-control 200 Positive association of A with CVD (21) Case-control 112 Inverse association of A with carotid atherosclerosis (22) Cross-sectional 101 Inverse association of A with carotid atherosclerosis (23) Case-control 364 Inverse association of total testosterone with carotid atherosclerosis (25) 12-year FU, population-based 639 U-shaped association of A with CHD risk FU, follow-up; E, estrogen; A, androgen; CVD, cardiovascular disease; CHD, coronary heart disease.…”

Section: Severity and Mortality Of Cardio-and Cerebro-vascular Diseasementioning

confidence: 99%

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MECHANISMS IN ENDOCRINOLOGY: Endogenous sex steroids and cardio- and cerebro-vascular disease in the postmenopausal period

Παππά

Alevizaki

2012

European Journal of Endocrinology

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Objective: Cardio-and cerebro-vascular diseases are two leading causes of death and long-term disability in postmenopausal women. The acute fall of estrogen in menopause is associated with increased cardiovascular risk. The relative contribution of androgen to this risk is also being recognized. The use of more sensitive assays for estradiol measurement and the study of receptor and carrier protein gene polymorphisms have provided some new information on the clinical relevance of endogenous sex steroids. We provide an update on the role of endogenous sex steroids on cardio-and cerebro-vascular disease in the postmenopausal period. Design and methods: We performed a PubMed search using the terms 'endogenous estrogen', 'androgen', 'cardiovascular disease', 'cerebro-vascular disease', 'stroke', 'carotid artery disease', and 'subclinical atherosclerosis'. Results: The majority of studies show a beneficial effect of endogenous estrogen on the vasculature; however, there are a few studies reporting the contrary. A significant body of literature has reported associations of endogenous estrogen and androgen with early markers of atherosclerosis and metabolic parameters. Data on the relevance of endogenous sex steroids in heart disease and stroke are inconclusive. Conclusions: Most studies support a beneficial role of endogenous estrogens and, probably, an adverse effect of androgens in the vasculature in postmenopausal women. However, the described associations may not always be considered as causal. It is possible that circulating estrogen might represent a marker of general health status or alternatively reflect the sum of endogenous androgens aromatized in the periphery. Elucidating the role of sex steroids in cardio-and cerebro-vascular disease remains an interesting field of future research.

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Section: Risk Of Cardio-and Cerebro-vascular Diseasesupporting

confidence: 82%

Section: Severity and Mortality Of Cardio-and Cerebro-vascular Diseasementioning

confidence: 99%

MECHANISMS IN ENDOCRINOLOGY: Endogenous sex steroids and cardio- and cerebro-vascular disease in the postmenopausal period

Παππά

Alevizaki

2012

European Journal of Endocrinology

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“…Studies on postmenopausal, middle-aged, and elderly women have shown that there was a significantly increased age-adjusted risk for incident CHD and events for the highest quintiles of total, bioavailable, and free testosterone relative to the median and bottom quintiles (6,7). Although these studies did not distinguish between women with a history of irregular menses or PCOS, the above data have implications for the cardiometabolic role of hyperandrogenemia, which persists after menopause in PCOS women (8).…”

Section: Introductionmentioning

confidence: 94%

MECHANISMS IN ENDOCRINOLOGY: Recent advances in cardiovascular aspects of polycystic ovary syndrome

Sathyapalan

Atkin²

2012

European Journal of Endocrinology

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Polycystic ovary syndrome (PCOS) has been associated with increased cardiovascular risk (CVR) markers, but population studies have not clarified whether there is an increase in cardiovascular morbidity and mortality. Four different PCOS phenotypes resulted from the Rotterdam criteria that may differ in their CVR potential, thus introducing further complexity. This has led to studies using surrogate CVR markers including biomarkers in blood and imaging such as flow-mediated vasodilatation. In PCOS, both peripheral and central insulin resistance (IR) have been shown. Weight loss has been shown to improve IR and visceral fat, while insulin sensitizer therapies with metformin or thiazolidinediones improve IR and endothelial dysfunction. IR is also found in non-alcoholic fatty liver disease that in turn is very common in PCOS; studies have suggested that IR may be improved by treatment with metformin and omega-3 fish oils. PCOS patients have a more dyslipidemic phenotype that is worse in 'classical PCOS' associated with a higher CVR. Studies with atorvastatin and simvastatin have reported a decrease in the lipid parameters and an improvement in CVR indices including IR, but it is unclear whether this is due to their lipid-lowering action or a pleiotropic effect of the statin. In this expert opinion review, the relevant literature published during the last 2 years was considered. It focuses on some recent important data that has emerged while also exposing the gaps that remain in our knowledge that need to be addressed.

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“…Higher levels of endogenous androgens are associated with increased risk for MetS in women [84]. Androgens are independent predictors of MetS in PCOS [17,18].…”

Section: Androgens In the Pathogenesis Of Pcosmentioning

confidence: 94%

Reproduction and Metabolism: Insights from Polycystic Ovary Syndrome

Jasti

Dunaif

2012

Endocrinol Metab

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Higher Serum Testosterone Concentration in Older Women is Associated with Insulin Resistance, Metabolic Syndrome, and Cardiovascular Disease

Abstract: Higher levels of T are associated with IR, MetSyn, and CHD in elderly women. Whether T is a marker or mediator of cardiovascular disease in this population merits further investigation.

Cited by 119 publications

References 46 publications

MECHANISMS IN ENDOCRINOLOGY: Endogenous sex steroids and cardio- and cerebro-vascular disease in the postmenopausal period

MECHANISMS IN ENDOCRINOLOGY: Endogenous sex steroids and cardio- and cerebro-vascular disease in the postmenopausal period

MECHANISMS IN ENDOCRINOLOGY: Recent advances in cardiovascular aspects of polycystic ovary syndrome

Reproduction and Metabolism: Insights from Polycystic Ovary Syndrome

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