Abstract 13802: Association of Endogenous Sex Hormones and Coronary Calcification in Patients with no History of Coronary Heart Disease in the Multi-Ethnic Study of Atherosclerosis

Abstract

Objectives: There are conflicting results reported about the association of endogenous sex hormones and cardiovascular disease in men. The majority of studies were based on cardiovascular outcomes and event monitoring or invasive cardiovascular imaging. Studies correlating endogenous sex hormones with sub-clinical atherosclerosis measured by coronary artery calcium score (CACS) are lacking. We evaluated the correlation between endogenous sex hormones and CACS in the Multi-Ethnic Study of Atherosclerosis (MESA).

Methods: We included 3164 men (62±10 years) without known Coronary Heart Disease (CHD) from MESA and correlated their endogenous sex hormones with their CACS. We divided the sex hormone levels to lowest, mid and highest tertiles and correlated them with CACS. We also used 9.54, 10.4 and 12.14 nmol/l (275, 300, 350 ng/dl) as cut off for serum total testosterone (T) and evaluated the difference in CACS in men with total T below and above these thresholds. We adjusted the results for age and CHD risk factors.

Results: The mean CACS was significantly lower with higher total T levels after adjustment for age and CHD risk factors, using 9.54 and 10.4 nmol/l as cut off for total T (P < 0.001, P= 0.01 for age and P= 0.01, P= 0.029 for CHD risk factors) but not for 12.14 (P= 0.21 for age and 0.61 for CHD risk factors). Men with total T < 9.54 had significantly higher mean CACS compared to those with total T >12.14 (P= 0.002 and 0.031 for age and CHD risk factors). The mean CACS distribution was significantly different among lowest, mid and highest tertiles for bioavailable T (309.1±660.7, 211.0±481.1, 146.6±429.9 for lowest, mid and highest tertiles, P< 0.001), free T (289.5±621.3, 227.7±553.9, 150.0±406.2, P< 0.001), sex hormone binding globulin (158.9±429.8, 220.7±536.8, 286.5±620.2, P< 0.001), estradiol (256.0±585.6, 232.0±566.2, 175.7±441.1, P=0.002) and dehydroepiandrosterone (342.7±672.9, 199.3±519.9, 124.3±343.8, P< 0.001), but failed to reach significance for total T (254.5±587.4, 211.4±526.0, 200.9±493.3,P= 0.053).

Conclusions: In a multi-ethnic population of male subjects with no known CHD, low endogenous sex hormones and high sex hormone binding globulin are correlated with increased CACS, after adjustment for age and CHD risk factors.