Sex hormones as markers of cardiovascular organ damage in women with overweight and obesity

Background The sex hormone profile changes in women during midlife contribute to endothelial dysfunction and predispose to hypertension. Less is known about the relation with cardiovascular (CV) organ damage. Purpose To assess the association of free androgen index (FAI) and oestrogen:testosterone (O/T) ratio with CV organ damage in overweight and obese midlife women. Methods Data from 349 women in the FAT associated CardiOvasculaR dysfunction study was used. CV organ damage was identified as concentric left ventricular (LV) geometry or LV hypertrophy by echocardiography or as increased arterial stiffness by carotid-femoral pulse wave velocity >10 m/s, following current guidelines. Hypertension was identified as elevated 24-hour blood pressure (≥130/80 mmHg) or use of antihypertensive medication. Sex hormones were measured by liquid chromatography with tandem mass spectrometry in biobank serum samples. Menopause was considered present if >1 year since last menstruation, follicle stimulating hormone >40 IU/L and oestradiol <30 pg/mL. The association between FAI and O/T ratio with presence of CV organ damage was assessed in uni- and multivariable logistic regression analyses and reported as odds ratio (OR) and 95% confidence intervals (CI). Results Participants were on average 48 years old, 46% were postmenopausal, 64% were obese and 59% had hypertension. LV hypertrophy was present in 13%, concentric LV geometry in 12% and increased arterial stiffness in 6% of cases. In univariable analysis, higher FAI was associated with presence of concentric LV geometry (OR 1.74 [95% CI 1.24-2.44]) and LV hypertrophy (OR 1.41 [95% CI 1.00-1.98]), and lower O/T ratio with presence of concentric LV geometry (OR 0.77 [95% CI 0.60-1.00]) and increased arterial stiffness (OR 0.69 [95% CI 0.49-0.97]) (all p<0.05). In multivariable analyses, only the associations with higher FAI and lower O/T ratio with presence of concentric LV geometry remained significant (Table 1). Conclusion Higher FAI and lower O/T ratio are associated with concentric LV geometry in overweight and obese midlife women independent of blood pressure, hypertension treatment and menopausal status.