Abstract 5102: Sex Hormones and the Risk of Coronary Artery Calcium Progression in the Multi-Ethnic Study of Atherosclerosis
Background: The association of sex hormones (SH) with subclinical atherosclerosis is controversial. Hormone replacement therapy (HRT) is associated with less coronary artery calcium (CAC) progression in some studies. HRT also raises estradiol (E2) levels. We evaluated the association of endogenous SH levels including E2 with CAC progression during followup in 1647 postmenopausal women not on HRT and 2698 men the Multi-Ethnic Study of Atherosclerosis (MESA).
Methods: CAC was quantified by computed tomography, and Testosterone (T), E2, dehydroepiandrosterone (DHEA), and SH binding globulin (SHBG) were measured at baseline. Followup CAC was measured in half the cohort (randomly selected) at the second exam and the other half at third exam, after an average of 1.6 and 3.2 years, respectively. We used relative risk regression to determine the risk of developing prevalent CAC(>0 Agatston units) at followup for those without CAC at baseline and robust linear regression to study change in CAC score for those with prevalent baseline CAC. Models were adjusted for age, ethnicity, BMI, systolic and diastolic blood pressure (BP), diabetes, total cholesterol, HDL-c, use of BP and cholesterol meds, smoking, alcohol, followup time, and other SH. Models were performed separately by sex.
Results: See table⇓. Among those without baseline CAC, only greater E2 in women was nearly associated with increased risk of developing CAC at followup. Among those with prevalent baseline CAC, greater T was associated with less CAC at followup in both men and women; while greater DHEA in women and greater SHBG in men were associated with increases in CAC.
Conclusion: In women without baseline CAC, higher E2 levels may be nearly associated with increased risk of developing CAC. In those with prevalent CAC, higher T levels may be protective against progression in both sexes while higher DHEA (in women) and SHBG (in men) may worsen progression.