Unfavorable Cardiovascular Risk Profile Research Articles

The association between migraine and cardiovascular events in women is modified by baseline vascular risk status

Introduction: Migraine has been associated with increased risk of ischemic stroke, particularly in women [1–4]. This association is more evident for migraine with aura (MA) than for migraine without aura (MO) [1,5]. Neuroimaging studies have found higher prevalence of silent cerebellar infarcts in migraineurs compared with controls, and an increased number of white matter lesions in women with migraine [6]. Migraine also has been associated with an increased risk of cardiac ischemic events in both women and men [7,8]. Several mechanisms for these associations have been proposed, including vasospasm, endothelial dysfunction, and increased platelet aggregation [9,10]. In a large population-based study, migraine patients—in particular those with MA—were more likely to have unfavorable cardiovascular risk profi les compared with controls [11]. Patent foramen ovale, which is associated with increased risk of stroke in young adults, is twice as common in MA as in nonmigraine controls [12]. In this study, Kurth and colleagues examined whether the association between MA and cardiovascular events in women is modifi ed by the patient’s vascular risk status.

Enhanced complement activation is part of the unfavourable cardiovascular risk profile in South Asians

South Asian immigrants in western societies exhibit a high burden of diabetes and subsequent vascular complications. Diabetic vascular complications are associated with vascular inflammation. We hypothesize that enhanced complement activation is involved. Therefore, levels of complement C3 and SC5b-9 - the soluble end product of complement activation - in a group of 200 South Asians were compared with an age- and sex-matched control group of native Caucasians. In addition, the association between complement levels and albuminuria, an indicator of renal damage and a cardiovascular risk marker, was assessed in the diabetic South Asian group. Compared with native Caucasians, South Asians had significantly higher levels of both serum C3 and plasma SC5b-9, even when only non-diabetic South Asians were considered. Diabetic South Asians had significantly higher C3 levels compared with non-diabetic South Asians. In diabetic South Asians, higher levels of SC5b-9 were associated with an increased prevalence of albuminuria (odds ratio 5.4, 95% confidence interval 1.8-15.8). These results suggest that enhanced complement activation is part of the unfavourable cardiovascular risk profile in South Asians.

Cardiovascular risk in young apparently healthy descendents from Asian Indian migrants in the Netherlands: the SHIVA study

BACKGROUND.: Asian Indian migrants in the Western world are highly susceptible for ischaemic heart disease (IHD). Until now, most IHD risk studies were performed in first and second generation Asian Indian expatriates. For optimal prevention, knowledge of the cardiovascular risk profile of younger generations is crucial. METHOD.: In a cross-sectional study we assessed the prevalence of conventional IHD risk factors and Framingham risk score in asymptomatic third to seventh generation Asian Indian descendants, compared with Europeans. Subjects were classified as asymptomatic if they did not have documented IHD, diabetes, hypertension or high cholesterol. RESULTS.: A total of 1790 Asian Indians (45% men, age 35.9+/-10.7 years) and 370 native Dutch hospital employees (23% men, age 40.8+/-10.1 years) were recruited. Asian Indians had higher levels of total cholesterol, low-density lipoprotein, triglycerides, and lower high-density lipoprotein levels than the Dutch. Glucose intolerance was present in 7.1 vs. 0.5% men, and in 6.1 vs. 1.4% women (both p<0.001). Asian Indian women were more frequently obese (12 vs. 5%; p<0.001), and centrally obese (44 vs. 25%; p<0.001) as compared with the Dutch women. Prevalence of most of the conventional and modifiable cardiovascular risk factors in each ten-year age group was higher in Asian Indians compared with controls, which reflected in higher Framingham risk scores. CONCLUSION.: This study demonstrates the persistence of an unfavourable cardiovascular risk profile in young, third to seventh generation migrated Asian Indians and supports an aggressive screening and intervention strategy. (Neth Heart J 2009;17:155-61.).

Osteoprotegerin Levels in Women With Prior Gestational Diabetes Mellitus

Osteoprotegerin (OPG), an inhibitor of bone resorption, seems to be elevated in patients with diabetes as well as in nondiabetic subjects with cardiovascular disease (1). Following a pregnancy complicated by gestational diabetes mellitus (GDM), women present with an increased prevalence of glucose intolerance and an unfavorable cardiovascular risk profile, although definite cardiovascular diseases or late diabetes complications have only rarely been confirmed (2). Hence, our aim was to study OPG levels and their association with other cardiovascular risk factors in a sample of 30 former GDM (by World Health Organization criteria) and 14 age-matched women with normal glucose tolerance during pregnancy in an average 4 years after delivery. During the study investigation an assisted questionnaire was completed, followed by a detailed physical examination, …

The metabolic syndrome is amplified in hypothyroid rheumatoid arthritis patients: a cross-sectional study

Objectives:Rheumatoid arthritis (RA) patients are at increased risk of cardiovascular disease (CVD), which is even more pronounced in hypothyroid RA patients. An unfavourable cardiovascular risk profile conferred by a higher...

Identifying HIV patients with an unfavorable cardiovascular risk profile in the clinical practice: Results from the SIMONE study

To identify and characterize HIV-infected patients at higher cardiovascular risk in ordinary clinical settings. Multicenter, nationwide cross-sectional study. Consecutive HIV-patients, attending scheduled visits at facilities involved in the Italian coordination group for the study of allergies and HIV infection (CISAI), were included between February and April, 2005. Their 10-year probability of acute coronary events was calculated using the Framingham Risk Score (FRS) as well as 3 other cardiovascular algorithms ("PROCAM", "PROGETTO CUORE", "SCORE"); Metabolic Syndrome (MS) was diagnosed according to the National Cholesterol Education Program definitions. An estimated 10-year CVD >or=10% and/or MS led to the diagnosis of high CV risk. We compared selected clinical features between high- and low-risk patients. A total of 1230 HIV infected patients (72% males, mean age of 43+/-9 years), 185 of whom treatment-naive, were evaluated. FRS gave the highest estimate of CV risk. The mean 10-year risk for acute coronary events according to FRS was 7.4+/-7.0. MS was present in 22% of the observed patients. Accordingly, 443 patients (36%) were classified at high risk. Twelve percent of the patients (n=142) had both a FRS >or=10% and a diagnosis of MS. The main single predictor of increased cardiovascular risk was smoking (60% of whole sample). A higher prevalence of clinically evident lipodystrophy and a higher CD4 T-cell counts were found both in patients with higher FRS and in patients with high FRS and MS (both p<0.001). The worst estimation of CV risk was obtained with the FRS algorithm. Clinical evidence of lipodystrophy and higher CD4 T-cell counts were closely associated to a worse cardiovascular risk profile.

Risk Profile for Cardiovascular Morbidity and Mortality After Lung Transplantation

Transplant recipients have an unfavorable cardiovascular risk profile and experience more cardiovascular morbidity and mortality compared with the general population, primarily because of immunosuppressant-induced diabetes, hypertension, and hyperlipidemia. These discouraging prospects are even more ominous for lung transplant recipients who are more likely than other organ recipients to require intense immunosuppression and develop these conditions early and concomitantly. The purposes of this article are to heighten awareness of the prevalence, risk factors, and management of diabetes, hypertension, and hyperlipidemia in lung transplant patients, and to assist nurses to be proactive in helping recipients to reduce the likelihood of developing cardiovascular complications.

Overweight and Cardiovascular Risk Factors in 4- to 18-Year-Olds

Background: The objective of this study was to investigate the relationships between overweight and high waist circumference and cardiovascular risk factors in children. Material and Methods: We carried out a secondary analysis of data from 1,944 participants of the ‘National Diet and Nutrition Survey: young people aged 4–18 years’. Blood pressure and blood lipid levels were compared in overweight versus non-overweight and high versus low waist circumference groups. Overweight was defined using international cut-offs for body mass index. High waist circumference was defined as ≧ 91st percentile of UK waist circumference charts. Analyses were done separately by sex and age group (4–10 and 11–18 years for overweight, and 11–17 years for waist circumference). Results: Overweight and high waist circumference were associated with increased systolic blood pressure, mean arterial pressure, low-density lipoprotein cholesterol (LDLC) and triacylglycerol, and decreased high-density lipoprotein cholesterol (HDLC). Those who were both overweight and had a high waist circumference had the highest blood pressure, plasma LDLC and triacylglycerol, and the lowest plasma HDLC. Conclusion: Overweight and high waist circumference were associated with increased blood pressure and a less favourable lipid profile. Children who were both overweight and had a high waist circumference had the most unfavourable cardiovascular risk profile. Both measurements may be useful in identifying children with increased health risks.

Plasma PAI-1 levels are independently related to fatty liver and hypertriglyceridemia in familial combined hyperlipidemia, involvement of apolipoprotein E

Background Familial combined hyperlipidemia (FCHL) is a genetic form of dyslipidemia, which is characterized by an increased cardiovascular risk. The current study was conducted to investigate the relation of endothelial, inflammatory and fibrinolysis markers with the presence of hypertriglyceridemia and fatty liver in FCHL, in order to advance insight in their contribution to the cardiovascular risk profile. Materials and methods Key plasma markers of low-grade inflammation, endothelial dysfunction and fibrinolysis were measured in 38 hypertriglyceridemic FCHL patients and 38 age and sex-matched spouses. The presence of fatty liver was determined with ultrasound. Results hsCRP, vWF, PAI-1, tPA and tPA/PAI-1 complex levels were significantly higher in hypertriglyceridemic FCHL patients compared to spouses ( p < 0.05). Subsequent analyses revealed that these increased levels were confined to FCHL patients with the fatty liver phenotype ( n = 25). Only PAI-1 and tPA levels were also elevated in the hypertriglyceridemic FCHL patients without fatty liver ( n = 13). Of interest, 11 hypertriglyceridemic non-FCHL patients with the E2/E2 genotype displayed significantly lower PAI-1 levels when compared to the overall FCHL population ( p = 0.001), implicating a role for apolipoprotein E in the relation of PAI-1 with plasma triglycerides. Conclusion Markers of fibrinolysis were increased in all hypertriglyceridemic FCHL patients, whereas an increased state of endothelial dysfunction and inflammation was particularly observed in those hypertriglyceridemic FCHL patients who also have fatty liver. These results demonstrate the complex genesis of the unfavourable cardiovascular risk profile that is present in FCHL, and illustrate the potential risk of fatty liver above, and beyond hypertriglyceridemia per se.

Migraine and Biomarkers of Cardiovascular Disease in Women

Migraine has been associated with an unfavourable cardiovascular risk profile and with increased risk of cardiovascular disease. In a cross-sectional analysis of 27,626 women aged >or=45 years, we evaluated the association of migraine and migraine aura status with elevated levels of total cholesterol, low- and high-density lipoprotein cholesterol (HDL-C), non-HDL-C, apolipoprotein (Apo) A-1 and B(100), lipoprotein (a), C-reactive protein (CRP), fibrinogen, intercellular adhesion molecule-1, homocysteine and creatinine. A total of 5087 (18.4%) women reported any history of migraine. Compared with women with no migraine history, women who reported any history of migraine had modestly increased adjusted odds ratios (95% confidence interval) of 1.09 (1.01, 1.18) for elevated total cholesterol, 1.14 (1.05, 1.23) for non-HDL-C, 1.09 (1.01, 1.18) for Apo B(100) and 1.13 (1.05, 1.22) for CRP. The increase did not meaningfully differ according to migraine aura status and migraine frequency. In this large cohort of women, only a modest association was found between migraine and adverse levels of certain cardiovascular biomarkers.

Asymmetrical Dimethylarginine, Inflammatory and Metabolic Parameters in Women with Polycystic Ovary Syndrome before and after Metformin Treatment

Insulin resistance plays a significant role in the pathogenesis of the polycystic ovary syndrome (PCOS) and represents a link to the unfavorable cardiovascular risk profile frequently found in affected patients. The endogenous nitric oxide synthase inhibitor asymmetrical dimethyl-L-arginine (ADMA) is associated with atherosclerosis and represents an independent marker for cardiovascular morbidity and mortality. We investigated ADMA levels among other cardiovascular, metabolic, and hormonal parameters in women with PCOS and the effects of metformin treatment on these parameters. A cross-sectional study and clinical trial were performed. Women with PCOS (n = 83) compared with a control group of healthy women (n = 39) were studied. In a subgroup of patients with PCOS (n = 21), the effect of metformin was assessed after 6 months of treatment. ADMA, intima media thickness (IMT), metabolic and hormonal parameters, and markers of inflammation were investigated. ADMA levels were significantly higher in the PCOS group compared with controls (0.57 +/- 0.15 vs. 0.50 +/- 0.11; P = 0.024). Androgens, C-reactive protein, fasting C-peptide, area under the curve (AUC) insulin, AUC glucose, homeostatic assessment of insulin resistance, fasting insulin, glycosylated hemoglobin, cholesterol, low-density lipoprotein cholesterol, triglycerides, and IMT were significantly higher in women with PCOS compared with controls. In PCOS patients ADMA was found to be positively correlated with body mass index (BMI), waist to hip ratio, parameters of insulin sensitivity, hyperandrogenemia (free testosterone, free androgen index), and IMT. Treatment with metformin ameliorated hyperandrogenemia and decreased ADMA levels (0.53 +/- 0.06 vs. 0.46 +/- 0.09, P = 0.013). Decrease in ADMA levels subsequent to metformin treatment did not correlate with change in BMI or metabolic parameters. ADMA amd parameters of insulin sensitivity are elevated in women with PCOS and the degree of insulin resistance confers the greatest influence on ADMA level. Metformin treatment led to improvement of hormonal and metabolic parameters and decreased ADMA levels possibly independent of BMI and metabolic changes.

Relationship between plasma levels of soluble CD40L and insulin sensitivity and insulin secretion status in non-diabetic dyslipidemic patients

Objective We have measured circulating plasma sCD40L as well as the platelet-surface of CD40L and its receptor in a sample of non-diabetic dyslipidemic patients and then evaluated its relationship with the insulin resistance (IR) and insulin secretion (IS) status. Design and methods Anthropometric measurements, fasting glucose, insulin, lipids, and IR and IS [estimated by the homeostasis model assessment (HOMA)] were assessed in 86 dyslipidemic subjects. Circulating sCD40L were determined by ELISA. By flow cytometry, CD40L, CD40 and P-selectin were evaluated in the platelet-surface. Results Non-diabetic dyslipidemic IR patients (HOMA-IR ≥ 3.8) showed higher plasma sCD40L concentrations and a more unfavorable cardiovascular risk profile (higher BMI, waist, fasting insulin and mean triglyceride levels) than dyslipidemic patients with low IS (HOMA β-cell < 98). In a multivariable model, only measures of insulin sensitivity and higher waist remained significantly associated with increased plasma levels of sCD40L. Surface expression of CD40L on platelets decreased significantly and CD40 increased in IR patients, compared with patients with low IS. Conclusions IR dyslipidemic patients show increased plasma sCD40L and decreased platelet-membrane CD40L expression compared to dyslipidemic patients with low IS.

Epicardial Adipose Tissue As New Cardio-Metabolic Risk Marker and Potential Therapeutic Target in the Metabolic Syndrome

Increased visceral adiposity, is an emerging cardiovascular risk factor. There is now a compelling need to quantify visceral adipose tissue not only for diagnostic purposes, but also for therapeutic interventions with weight reduction drugs or pharmaceuticals targeted to adipose tissue, as well as anti-obesity medications, thiazolidinediones, fibrates, angiotensin receptor blockers, highly active antiretroviral therapy and hormone replacement therapy. Among visceral adipose tissues, growing evidences suggest that cardiac adiposity may play an important role in the development of an unfavorable cardiovascular risk profile. Recent papers suggest that epicardial fat, index of cardiac and visceral adiposity, could locally modulate the morphology and function of the heart. The close anatomical relationship between epicardial adipose tissue and the adjacent myocardium should readily allow local paracrine interactions between these tissues. Echocardiography has been recently proposed for the direct assessment of epicardial adipose tissue. Echocardiographic assessment of epicardial fat may be a helpful tool not only for diagnostic purposes, as marker of visceral adiposity and inflammation, but also for therapeutic interventions with drugs that can modulate the adipose tissue. In this article, epicardial adipose tissue's structure, function, method of assessment and reliability as a diagnostic tool and potential therapeutic target is reviewed.

Advanced glycation end products and the absence of premature atherosclerosis in glycogen storage disease Ia

SummaryIntroductionDespite their unfavourable cardiovascular risk profile, patients with glycogen storage disease type Ia (GSD Ia) do not develop premature atherosclerosis. We hypothesized that this paradox might be related to a decreased formation of advanced glycation end products (AGEs) resulting from lifetime low plasma glucose levels and decreased oxidative stress.MethodsIn 8 GSD Ia patients (age 20–24 years) and 30 matched controls we measured carotid intima-media thickness (IMT), skin autofluorescence (AF; a non-invasive index for AGEs), and specific AGEs (pentosidine, N-(carboxymethyl)lysine (CML), N-(carboxyethyl)lysine (CEL)) and collagen linked fluorescence (CLF, measured at excitation/emission wavelength combinations of 328/378 and 370/440 nm) in skin samples.ResultsCarotid IMT was significantly lower in GSD Ia patients. Skin AF did not differ between patients and controls. The skin samples showed higher CEL levels in the patient group (p=0.008), but similar levels of pentosidine, CML, and CLF. In the total group, skin AF correlated with CML (r=0.39, p=0.031), CLF 328/378 nm (r=0.53; p=0.002) and CLF 370/440 nm (r=0.60; p=0.001). In the control group, AF also correlated with the maximum carotid IMT (r=0.6; p=0.004).ConclusionAlthough our data confirm that GSD Ia patients present with a reduced burden of atherosclerosis, this phenomenon cannot be explained by differences in AGE accumulation as measured in the skin.

Patent foramen ovale, stroke, and cardiovascular disease in migraine

We will review the literature on the association between migraine with patent foramen ovale, stroke, and coronary heart disease. The prevalence of patent foramen ovale in patients with migraine with aura is significantly higher than in nonmigraine controls and migraineurs without aura. However, there is currently no evidence to support a causal relationship. Migraine with aura has been consistently associated with increased risk of ischemic stroke in several epidemiologic studies. Migraine with aura is associated with a more unfavourable cardiovascular risk profile and recent data suggest that the association between migraine with aura and stroke may extend to overall cardiovascular disease. Identification of migraine patients at particular risk for stroke or other vascular events is impossible based on current knowledge. Migraine with aura and patent foramen ovale have higher coincidences than expected by chance only. It is possible that both conditions are inherited together. Until now there has been no evidence from placebo-controlled randomized trials that closure of patent foramen ovale improves migraine with aura. There is increasing evidence that migraine with aura is not only a risk factor for ischemic stroke but also for myocardial infarction and other ischemic vascular events.

Cardiac Fat as New Diagnostic Tool and Potential Therapeutic Target for Obesity Management and Treatment

Targeting adipose tissue via pharmaceutical intervention or lifestyle interventions is a concept of great interest and novelty. The importance of proximity of adipose tissue to the organs is also intriguing. In fact, a body of evidence shows that regional fat distribution, particularly the visceral fat compartment, plays a role in the development of an unfavourable cardio-metabolic profile, rather than overall adiposity. Intuitively, visceral adipose tissue, now clinically measurable by simple, accurate and reliable diagnostic tools, is the most desirable therapeutic target. Changes in regional fat distribution can be used to estimate drugs effectiveness and their mechanism of action. Among visceral adipose tissues, a body of evidence suggests that cardiac adiposity may play an important role in the development of an unfavorable cardiovascular risk profile. Epicardial and intra-cardiac fat are new and promising markers of cardiac and visceral adiposity and increased cardiovascular risk. This article briefly deals with the perspective and potential of epicardial and intracardiac adipose tissues as new diagnostic markers and therapeutic targets in obesity management and treatment along with related patents.

Energy Expenditure, Epicardial Adipose Tissue and Cardiorespiratory Fitness in Morbidly Obese Adults

Visceral fat, rather than generalized adiposity, plays an important role in the development of an unfavorable metabolic and cardiovascular risk profile. Morbidly obese individuals have increased levels of epicardial adipose tissue (EAT); however, its relationship to total daily caloric expenditure (TDCE) and cardiorespiratory fitness (VO2 max) has not been previously described. PURPOSE: To examine TCE, exercise energy expenditure during exercise, VO2 max, body composition and EAT in morbidly obese women and men. METHODS: Participants (5 women and 2 men, mean age=46.8yr; BMI=48.3±3.8 kg/m2) underwent a transthoracic echocardiogram to evaluate epicardial adipose tissue thickness; energy expenditure during 30 minutes of exercise; body composition using dual energy x-ray absorptiomenty; and, VO2 max was measured on all subjects. RESULTS: Mean TDCE for all individuals was 2241 ± 138 kcal/day. Population demographics and variable outcomes are shown in the table below. Although TDCE correlated with fat-free mass (FFM) (r=0.937, p=0.002). There was a narrow range of measured EAT and this was not related to TCE.Table 1CONCLUSIONS: As expected, higher FFM was associated with increased daily caloric expenditure. No relationship between EAT, exercise energy expenditure or VO2 max was observed in this pilot study.

Endothelial dysfunction and cardiovascular risk profile in long-term withdrawing alcoholics

Rates of cardiovascular morbidity and mortality are greater in heavy alcoholics than in either teetotallers or light-to-moderate drinkers. On the assumption that factors leading to atherosclerotic damage remain operative even after long-term alcohol withdrawal, we studied the possible mechanisms of raised cardiovascular risk in former heavy alcoholics. Forty-two apparently disease-free, normotensive alcoholics detoxified for 37.1 +/- 31.9 (SD) months, median 24, participated in the study. They were compared with 39 lifetime alcohol-abstaining control subjects, carefully matched for age, sex, body mass index, smoking and dietary habits, physical activity, lipids and fasting glucose. Endothelial function (flow-mediated dilation of brachial artery, high-resolution ultrasound technique), blood pressure, and some parameters of endothelial activation, oxidative stress, vascular inflammation and insulin sensitivity were measured. The maximal percentage of flow-mediated dilatation was reduced in detoxified alcoholics (10.1 +/- 4.6 versus 14.9 +/- 7.4, P < 0.001) who also showed significantly higher blood pressure (systolic 127.5 +/- 12.9 versus 118.2 +/- 10.7 mmHg, P < 0.001; diastolic 79.4 +/- 7.1 versus 74.6 +/- 6.4 mmHg, P < 0.01; mean 95.4 +/- 8.2 versus 89.1 +/- 7.3 mmHg, P < 0.001), uric acid (5.0 +/- 1.1 versus 4.4 +/- 0.8 mg/dl, P < 0.05), high-sensitivity C-reactive protein (2.1 +/- 2.0 versus 1.0 +/- 0.9 mg/l, P < 0.01), endothelin-1 (0.38 +/- 0.11 versus 0.17 +/- 0.10 pg/ml, P < 0.001) and fasting insulin (10.4 +/- 4.5 versus 5.6 +/- 1.6 muU/ml, P < 0.001) with abnormal homeostasis model assessment index of insulin resistance (2.3 +/- 1.1 versus 1.2 +/- 0.4, P < 0.001). Previous heavy alcoholism, in spite of long-term withdrawal, is associated with endothelial dysfunction and a wide cluster of haemodynamic, vascular and metabolic abnormalities that indicate an unfavourable cardiovascular and metabolic risk profile even in apparently disease-free former alcoholics.

Cardiac Adiposity and Cardiovascular Risk: Potential Role of Epicardial Adipose Tissue

Emerging evidence suggests that cardiac adiposity may play an important role in the development of an unfavorable cardiovascular risk profile. The concept of adiposity of the heart, as new cardiovascular risk factor and marker, is rapidly emerging. Recent papers suggest that epicardial fat, an index of cardiac visceral adiposity could locally modulate the morphology and function of the heart. The close anatomical relationship between epicardial adipose tissue and the adjacent myocardium should readily allow local paracrine interactions between these tissues. Epicardial fat may play a functional and mechanical role in left ventricular hypertrophy, atrial dilatation or diastolic dysfunction. Echocardiography has been recently proposed for the direct assessment of epicardial adipose tissue. Echocardiographic assessment of epicardial fat may be a helpful tool not only for diagnostic purposes, as marker of visceral adiposity and inflammation, but also for therapeutic interventions with weight reduction drugs or pharmaceuticals targeted to adipose tissue. Nevertheless the subject is in its infancy and further studies are needed. In fact it is difficult to determine whether epicardial fat has a direct pathogenic role in the development of cardiac changes. It also remains to be determined whether this location of fat is physiologically or pathologically important and whether it can be used to replace abdominal obesity, or its surrogate marker, waist circumference, as a cardiovascular risk factor. In this article, epicardial adipose tissues structure, function, method of assessment and reliability as a marker of visceral and cardiac adiposity is briefly reviewed.

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

To assess the association between endogenous sex hormones and risk factors for atherosclerosis in healthy postmenopausal women. Cross-sectional study in a university menopause clinic. Serum sex hormones and lipid-lipoprotein profile, arterial pressure, homocysteine and insulin resistance, measured by the homeostasis model assessment of insulin resistance (HOMA-IR), were assessed in 598 healthy postmenopausal women not on hormone therapy. Compared with women in the lowest testosterone quartile (Q), women in the highest testosterone quartile had higher total cholesterol (Q1: 225.2 +/- 41.3 vs Q4: 246.2 +/- 38.4 mg/dl, P < 0.01), low-density lipoprotein (LDL)-cholesterol (Q1: 146.9 +/- 37.2 vs Q4: 171.8 +/- 35.3 mg/dl, P < 0.001), atherogenic index of plasma (AIP) (Q1: -0.224 +/- 0.238 vs Q4: -0.087 +/- 0.254, P < 0.01), apolipoprotein B (ApoB) (Q1: 100.7 +/- 23.1 vs Q4: 113.9 +/- 23.8 mg/dl, P < 0.001) and higher high-density lipoprotein (HDL)-cholesterol (Q1: 60.7 +/- 14.5 vs Q4: 52.9 +/- 13.0 mg/dl, P < 0.01). Accordingly, women in the highest free androgen index (FAI) quartile had higher AIP (Q1: -0.232 +/- 0.254 vs Q4: -0.078 +/- 0.243, P < 0.001) and ApoB (Q1: 102.4 +/- 25.5 vs Q4: 114.2 +/- 25.8 mg/dl, P < 0.01) and lower HDL-cholesterol (Q1: 62.0 +/- 15.7 vs Q4: 51.9 +/- 11.6 mg/dl, P < 0.001) and apolipoprotein A (Q1: 159.6 +/- 25.6 vs Q4: 147.9 +/- 24.1 mg/dl, P < 0.01) compared with women in the lowest FAI quartile. These differences remained significant after adjustment for age, body mass index (BMI), insulin resistance and social habits. The free estrogen index (FEI) exhibited similar associations to the FAI. HOMA-IR showed an independent positive association with total testosterone (Q1: 2.00 +/- 1.36 vs Q4: 2.66 +/- 1.60, P < 0.01), FAI (Q1: 1.70 +/- 1.12 vs Q4: 3.04 +/- 1.66, P < 0.001) and FEI (Q1: 1.70 +/- 0.91 vs Q4: 3.08 +/- 1.77, P < 0.001). Increased androgenicity in healthy postmenopausal women is associated with an unfavorable cardiovascular risk profile. High endogenous estradiol is related to a pro-atherogenic lipid profile, an association which may, in part, be mediated by insulin resistance.