Androgenicity in Young Women and Development of Metabolic Syndrome before Menopause: The CARDIA and CARDIA Women's Studies
Thanh-Huyen T Vu, Amber Pirzada, Cora E Lewis, Pamela J Schreiner, Kiang Liu, Barbara Sternfeld, Ronit Calderon-Margalit, Sharon S Merkin, Melissa Wellons, O Dale Williams, Catherine Kim, David S Siscovick, Martha L Daviglus- Endocrinology, Diabetes and Metabolism
Abstract
Context
There are no reported data from prospective long-term studies on relations of androgen levels in young women with development of metabolic syndrome (MetS) before menopause.
Objective
We investigated associations of androgens and SHBG with incident MetS during 23 years of follow-up.
Methods
We included 366 White and 375 Black women ages 20-32 participating in the CARDIA study and CARDIA Women’s study, free of MetS at baseline examination (1987-88), and premenopausal 23 years later. Androgens and SHBG were categorized into quartiles. MetS was defined according to the American Heart Association/National Heart, Lung, and Blood Institute 2009 Joint Scientific Statement. Cox proportional hazards models were used.
Results
By year 23, 30% of women developed MetS. Adjusting for baseline age, race, and education, hazard ratios (95% CI) of developing MetS were 1.46(1.02-2.10) and 2.22(1.53-3.21) for women in the highest vs. lowest total testosterone (T) and free T quartile, respectively. The hazards of developing MetS were 47%, 59%, and 53% lower for women with SHBG in the 2nd, 3rd, and 4th quartiles (vs. lowest quartile), respectively. Associations were attenuated for total T with further adjustments for smoking, physical activity, menstrual status, oral contraceptive/hormone (OCHM) use, insulin level, oligomenorrhea, and age at menarche; but remained statistically significant for free T and SHBG. Associations were similar for both Blacks and Whites, and OCHM non-users, but not for OCHM users.
Conclusion
High androgenicity in young premenopausal women is associated with higher risk of future metabolic syndrome, suggesting that early assessment of androgens may contribute to prevention.