American Journal of Epidemiology Vol. 155, No. 5 : 437-445
Copyright © 2002 by The Johns Hopkins University School of Hygiene and Public Health
ORIGINAL CONTRIBUTIONS |
Endogenous Postmenopausal Hormones and Carotid Atherosclerosis: A Case-Control Study of the Atherosclerosis Risk in Communities Cohort
1 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
2 Department of Medicine, University of Wisconsin School of Medicine, Milwaukee, WI.
3 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
4 Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC.
5 Department of Medicine, University of Pittsburgh School of Public Health, Pittsburgh, PA.
6 Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD.
Studies examining the relation between endogenous postmenopausal hormone levels and cardiovascular disease have yielded conflicting results. After excluding women with a history of hormone replacement therapy (HRT) use, the authors conducted a US case-control study in 1987–1992 comparing endogenous postmenopausal hormone levels in women with and without significant carotid atherosclerosis in the Atherosclerosis Risk in Communities (ARIC) cohort. Atherosclerosis was assessed by using B-mode ultrasound to measure carotid artery intimal-medial thickness (IMT). Cases (n = 182) were postmenopausal women with average IMT measurements 
the 95th percentile. Controls (n = 182) were frequency matched to cases on age and ARIC center and had IMT measurements < the 75th percentile. After adjustment for cardiovascular risk factors, no association was found between the odds of atherosclerosis and increasing quartiles of estrone, dehydroepiandrosterone sulfate, or androstenedione. Compared with participants in the lowest quartile of sex hormone-binding globulin (SHBG), those in the highest quartile had a significantly lower odds of atherosclerosis (odds ratio = 0.48, 95% confidence interval: 0.24, 0.97). Similarly, participants in the highest quartile of total testosterone had a lower odds of atherosclerosis (odds ratio = 0.38, 95% confidence interval: 0.20, 0.74). The authors found higher total testosterone and SHBG to be inversely related to carotid atherosclerosis, suggesting their potential importance in reducing atherosclerotic risk in postmenopausal women not using HRT.
androgens; cardiovascular diseases; carotid arteries; estrogen replacement therapy; estrogens; postmenopause; sex hormone-binding globulin
Abbreviations: ADIOL, 5-androstene-3ß, 17ß-diol; ARIC, Atherosclerosis Risk in Communities; CI, confidence interval; DHEA-S, dehydroepiandrosterone sulfate; HDL, high density lipoprotein; OR, odds ratio; SHBG, sex hormone-binding globulin
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