title: The relationship between sex hormones, sex hormone binding globulin and peripheral artery disease in older persons.
abstract: OBJECTIVE
  The prevalence of peripheral artery disease (PAD) increases with aging and is higher in persons with metabolic syndrome and diabetes. PAD is associated with adverse outcomes, including frailty and disability. The protective effect of testosterone and sex hormone binding globulin (SHBG) for diabetes in men suggests that the biological activity of sex hormones may affect PAD, especially in older populations.
  
  
  METHODS
  Nine hundred and twenty-one elderly subjects with data on SHBG, testosterone (T), estradiol (E2) were selected from InCHIANTI study. PAD was defined as an Ankle-Brachial Index (ABI) < 0.90. Logistic regression models adjusted for age (Model 1), age, BMI, insulin, interleukin-6, physical activity, smoking, chronic diseases including metabolic syndrome (Model 2), and a final model including also sex hormones (Model 3) were performed to test the relationship between SHBG, sex hormones and PAD.
  
  
  RESULTS
  The mean age (±SD) of the 419 men and 502 women was 75.0 ± 6.8 years. Sixty two participants (41 men, 21 women) had ABI < 0.90. Men with PAD had SHBG levels lower than men without PAD (p = 0.03). SHBG was negatively and independently associated with PAD in men (p = 0.028) but not in women. The relationship was however attenuated after adjusting for sex hormones (p = 0.07). The E2 was not significantly associated with PAD in both men and women. In women, but not in men, T was positively associated with PAD, even after adjusting for multiple confounders, including E2 (p = 0.01).
  
  
  CONCLUSIONS
  Low SHBG and high T levels are significantly and independently associated with the presence of PAD in older men and women, respectively.
authors.affiliation: Department of Clinical and Experimental Medicine, Section of Geriatrics, University of Parma, Italy. marcellomaggio2001@yahoo.it
authors.forename: M
authors.initials: M
authors.lastname: Maggio
authors.forename: C
authors.initials: C
authors.lastname: Cattabiani
authors.forename: F
authors.initials: F
authors.lastname: Lauretani
authors.forename: A
authors.initials: A
authors.lastname: Artoni
authors.forename: S
authors.initials: S
authors.lastname: Bandinelli
authors.forename: G
authors.initials: G
authors.lastname: Schiavi
authors.forename: A
authors.initials: A
authors.lastname: Vignali
authors.forename: R
authors.initials: R
authors.lastname: Volpi
authors.forename: G
authors.initials: G
authors.lastname: Ceresini
authors.forename: G
authors.initials: G
authors.lastname: Lippi
authors.forename: R
authors.initials: R
authors.lastname: Aloe
authors.forename: F
authors.initials: F
authors.lastname: De Vita
authors.forename: F
authors.initials: F
authors.lastname: Giallauria
authors.forename: M M
authors.initials: MM
authors.lastname: McDermott
authors.forename: L
authors.initials: L
authors.lastname: Ferrucci
authors.forename: G P
authors.initials: GP
authors.lastname: Ceda
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000097:blood; D055109:Ankle Brachial Index; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D015897:Comorbidity; D003430:Cross-Sectional Studies; D015536:Down-Regulation; D004958:Estradiol / Q000097:blood*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D058729:Peripheral Arterial Disease / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D012307:Risk Factors; D012737:Sex Factors; D012738:Sex Hormone-Binding Globulin / Q000032:analysis*; D013739:Testosterone / Q000097:blood*; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D012738:Sex Hormone-Binding Globulin; D013739:Testosterone; D004958:Estradiol