Relations between endogenous androgens and estrogens in postmenopausal women with suspected ischemic heart disease.
BACKGROUND
Because androgens are obligatory precursors of estrogens, it is reasonable to assume that their serum concentrations would exhibit positive correlations. If so, then epidemiologic studies that examine the association between androgens and pathological processes should adjust the results for the independent effect of estrogens.


OBJECTIVE
The objective of the study was to examine the interrelationships among testosterone (T), androstenedione, estradiol (E2), estrone, and SHBG in postmenopausal women.


METHODS
This was a cross-sectional study of women participating in the National Heart, Blood, and Lung Institute-sponsored Women's Ischemia Syndrome Evaluation study.


METHODS
The study was conducted at four academic medical centers.


METHODS
A total of 284 postmenopausal women with chest pain symptoms or suspected myocardial ischemia.


METHODS
Post hoc analysis of the relationships among sex steroid hormones with insulin resistance, body mass index (BMI), and presence or absence of coronary artery disease as determined by coronary angiography.


RESULTS
BMI was significantly associated with insulin resistance, total E2, free E2, bioavailable E2, and free T. Highly significant correlations were found for total T, free T, and androstenedione with total E2, free E2, bioavailable E2, and estrone and persisted after adjustment for BMI and insulin resistance. A significant relationship was present between total and free T and the presence of coronary artery disease after adjustment for the effect of E2.


CONCLUSIONS
Serum levels of androgens and estrogens track closely in postmenopausal women referred for coronary angiography for suspected myocardial ischemia. Epidemiological studies that relate sex steroid hormones to physiological or pathological processes need to control for the independent effect of both estrogens and androgens.
Braunstein
Glenn D
GD
Department of Medicine, Room 2119, Plaza Level, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, California 90048, USA. braunstein@cshs.org
Johnson
B Delia
BD
Stanczyk
Frank Z
FZ
Bittner
Vera
V
Berga
Sarah L
SL
Shaw
Leslee
L
Hodgson
T Keta
TK
Paul-Labrador
Maura
M
Azziz
Ricardo
R
Merz
C Noel Bairey
CN
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000728:Androgens / Q000097:blood*; D000735:Androstenedione / Q000097:blood; D015992:Body Mass Index; D002637:Chest Pain / Q000209:etiology; D017023:Coronary Angiography; D003430:Cross-Sectional Studies; D004958:Estradiol / Q000097:blood; D004967:Estrogens / Q000097:blood*; D004970:Estrone / Q000097:blood; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood* / Q000175:diagnosis*; D017698:Postmenopause; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism; D013739:Testosterone / Q000097:blood
D000728:Androgens; D004967:Estrogens; D012738:Sex Hormone-Binding Globulin; D004970:Estrone; D013739:Testosterone; D000735:Androstenedione; D004958:Estradiol