Abstract
Objective: Increased testosterone and decreased sex hormone-binding globulin (SHBG) are associated with a number of adverse cardiovascular risk factors in postmenopausal women. The aim of this population-based study of women aged 25 to 50 was to assess the relationship between free androgen index (FAI) and cardiovascular risk factors in premenopausal women. Methods: A population-based survey of 396 premenopausal women with no hormonal treatment was undertaken as part of the Northern MONICA study. The study involved questionnaires, anthropometry and assays of testosterone and SHBG. Results: Increased FAI was associated with a number of cardiovascular risk factors in premenopausal women but this relationship was strongly affected by body mass index (BMI). After adjustment for age and BMI, FAI was significantly associated with increased systolic and diastolic blood pressures. Conclusion: Hyperandrogenism is associated with increased blood pressure and these findings emphasize the need to assess cardiovascular risk factors in women with hyperandrogenism of all ages.
Highlights
Testosterone is carried in peripheral blood bound to sex hormone binding globulin, with approximately 1% - 2% of testosterone free and the remaining testosterone loosely bound to albumin [1]
Increased free androgen index (FAI) was associated with a number of cardiovascular risk factors in premenopausal women but this relationship was strongly affected by body mass index (BMI)
After adjustment for age and BMI, FAI was significantly associated with increased systolic and diastolic blood pressures
Summary
Testosterone is carried in peripheral blood bound to sex hormone binding globulin, with approximately 1% - 2% of testosterone free and the remaining testosterone loosely bound to albumin [1]. The free androgen index (FAI), i.e. the ratio between testosterone and sex hormone binding globulin (SHBG), may be used as an approximation of biologically available androgens in women, and longitudinal studies in aging women indicate that SHBG levels decrease with increasing age, resulting in successively increasing amounts of biologically available androgen in healthy women [2]. Increased testosterone and decreased sex hormonebinding globulin (SHBG) have been strongly associated with a number of adverse cardiovascular disease (CVD) risk factors in postmenopausal women, such as central adiposity, decreased high-density lipoprotein (HDL) cholesterol levels and increased systolic and diastolic blood pressures [3,4,5,6]. In contrast to healthy women, we have previously shown that testosterone levels gradually decrease with increasing age in PCOS women [16], levels remain elevated in comparison with age-matched controls [17]
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