American Journal of Epidemiology Vol. 154, No. 6 : 489-494
Copyright © 2001 by The Johns Hopkins University School of Hygiene and Public Health
COMMENTARY |
Relative Androgen Excess and Increased Cardiovascular Risk after Menopause: A Hypothesized Relation
1 Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
2 Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore, MD.
3 Department of Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD.
4 Division of Endocrinology, School of Medicine, Johns Hopkins University, Baltimore, MD.
Deceased.
Many studies have investigated the role of estrogen during menopause; however, less attention has been paid to the role of androgen. Given the possible opposite effects of estrogen and androgen on cardiovascular disease risk, it is suggested that relative androgen excess may better predict the increased risk of cardiovascular disease in women over the age of 50 years than estrogen levels alone. Three phases of hormonal milieu changes are hypothesized as a better way to identify the hormone-cardiovascular disease risk association. A first phase, prepause, occurs before estrogen levels decline (approximately 2 years before menopause). A second phase, interpause, occurs from the end of prepause until approximately age 55. A third phase, postpause, occurs after interpause. The duration of the interpause phase, characterized by relative androgen excess, may be an independent risk factor of cardiovascular disease. This hypothesis could provide a basis for further clinical and epidemiologic research, and it could have important implications for establishing the initiation and duration of estrogen replacement therapy use as a means to prevent cardiovascular disease.
androgens; cardiovascular diseases; estradiol; estrogen replacement therapy; estrogens; menopause; testosterone
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