Sex‐Specific Associations of Sex Steroid Hormones With Abdominal Aortic Calcification: A Population‐Based Cross‐Sectional Study

Background The purpose of our study was to examine the association of sex steroid hormones (serum total testosterone, sex hormone–binding globulin (SHBG), and estradiol) with abdominal aortic calcification (AAC) and severe AAC (SAAC) among American adults over the age of 40. Methods We used the National Health and Nutrition Examination Survey (NHANES) data from 2013 to 2014 to conduct this study. Based on male and female, the association between sex steroid hormones and risk of AAC and SAAC was examined using multivariable logistic regression analysis and restricted cubic spline (RCS) plots. Results Our analysis included 2564 participants. The RCS plots showed a U‐shaped curve association of estradiol with AAC, and SHBG and estradiol with the risk of SAAC in individuals who were male. Additionally, there was a negative association of serum total testosterone and SHBG with AAC risk and serum total testosterone with SAAC risk in individuals who were male. The estradiol and AAC risk also were shown to U‐curve relationship in participants who were female. Finally, with the increase of serum total testosterone, the risk of AAC showed a trend of first increasing and then decreasing. The serum total testosterone, SHBG, and estradiol were inversely associated with SAAC risk, while SHBG was positively associated with AAC risk. Conclusions Our findings suggest that sex steroid hormones play a role in known sex differences in AAC and SAAC in the American adult population over the age of 40.