Glucose and insulin components of the metabolic syndrome are associated with hyperandrogenism in postmenopausal women: The atherosclerosis risk in communities study

• Published in: American journal of epidemiology Vol. 160; no. 6; pp. 540 - 548
• Main Authors: GOLDEN, Sherita Hill, JINGZHONG DING, SZKLO, Moyses, SCHMIDT, Maria Ines, DUNCAN, Bruce B, DOBS, Adrian
• Format: Journal Article
• Language: English
• Published: Cary, NC Oxford University Press 15.09.2004; Oxford Publishing Limited (England)
• Subjects: Androgens; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Carotid Artery Diseases - epidemiology; Carotid Artery Diseases - etiology; Case-Control Studies; Cross-Sectional Studies; Female; Glucose; Glucose - metabolism; Glucose Tolerance Test; Gynecology. Andrology. Obstetrics; Homeostasis; Humans; Hyperandrogenism - epidemiology; Hyperandrogenism - etiology; Hyperandrogenism - metabolism; Hyperglycemia - epidemiology; Hyperglycemia - etiology; Hyperglycemia - metabolism; Hyperinsulinism - epidemiology; Hyperinsulinism - etiology; Hyperinsulinism - metabolism; Insulin; Insulin - blood; Linear Models; Logistic Models; Medical sciences; Menopause; Metabolic diseases; Metabolic Syndrome - complications; Metabolic Syndrome - diagnosis; Metabolic Syndrome - epidemiology; Metabolic Syndrome - metabolism; Metabolism; Middle Aged; Miscellaneous; Multivariate Analysis; Obesity - complications; Obesity - epidemiology; Obesity - metabolism; Other metabolic disorders; Postmenopause - metabolism; Puberal and climacteric disorders (male and female); Risk Factors; Sex Hormone-Binding Globulin - metabolism; Testosterone - blood; United States - epidemiology; Women; Endocrinopathy; Human; Pancreatic hormone; Replacement therapy; Androgen; androgens; Menopause; Cardiovascular disease; Metabolic diseases; Glucose; Epidemiology; Insulin; Vascular disease; Target tissue resistance; Testosterone; Association; X Syndrome; Postmenopause; Hyperandrogenism; Hormone replacement therapy; Testicular hormone; Sex steroid hormone; Woman; insulin resistance
• ISSN: 0002-9262; 1476-6256; 0002-9262
• DOI: 10.1093/aje/kwh250

In 1990-1992, the authors investigated the association of total and free testosterone with the metabolic syndrome in postmenopausal US women not taking hormone replacement therapy (n=362) in a prevalent case-control study of carotid atherosclerosis. Free testosterone was estimated by using the free androgen index (FAI) (total testosterone/sex hormone-binding globulin ratio). The metabolic syndrome was defined as the presence of three or more of the following criteria: waist circumference > or =35 inches (88.9 cm), triglycerides > or =150 mg/dl, high density lipoprotein cholesterol <40 mg/dl, blood pressure >130/80 mmHg, fasting insulin > or =100 pmol/liter, or impaired glucose homeostasis (fasting glucose > or =110 mg/dl or diagnosed diabetes mellitus). FAI, but not total testosterone, was strongly associated with the metabolic syndrome. Compared with women in the lowest FAI quartile, those in the highest quartile had a fivefold greater odds of having the metabolic syndrome (odds ratio=5.38, 95% confidence interval: 2.70, 10.7) after adjustment for age, race, and carotid atherosclerosis status. In multivariate analyses, the three-component metabolic syndrome combinations that contained both hyperinsulinemia and hyperglycemia were most strongly associated with increased FAI (absolute increase=0.41-0.54 compared with that for women who did not have these combinations; all p's < 0.001). Higher FAI was associated with the hyperinsulinemia and hyperglycemia components of the metabolic syndrome. The role of androgens in glucose homeostasis in postmenopausal women requires further study.