Androgenic profile and cardiometabolic health among post-menopausal women: the Buffalo OsteoPerio study

Objective: Postmenopausal women have higher testosterone levels than estradiol levels. We explored how the androgenic hormone milieu of correlated sex steroids relate to cardiometabolic health. Methods: We measured serum testosterone, estradiol, sex hormone binding globulin, and dehydroepiandrosterone sulfate among 599 postmenopausal women from the Buffalo OsteoPerio Study. Their mean age was 65.5 ± 6.7 years and none had a history of coronary heart disease or stroke. We created an androgenicity profile index from biomarker z-scores. Using linear and quantile regression, we related the index and its components to Framingham 10-year risk of coronary heart disease and homeostasis model assessment for insulin resistance, adjusting for potential confounding factors. Effect modification by age, exogenous menopausal hormone use, and body fat was also assessed. We used Bayesian kernel machine regression to estimate nonlinear, interactive mixture effects of these biomarkers. Results: The index was significantly associated with 4% (95% confidence interval 1% to 6%) higher predicted risk of coronary heart disease and 5% (1% to 8%) higher risk of insulin resistance. A similar but inverse association was observed for sex hormone binding globulin, but not for other components. These associations were higher with lower levels of high-density lipoprotein cholesterol and poorer adiposity measures. The association with coronary heart disease risk was strongest above the 90th percentile. The biomarker mixture was positively associated with both outcomes. Conclusions: An androgenic hormone milieu was positively associated with the risk of both coronary heart disease and insulin resistance, and was more pronounced in those at higher cardiometabolic risk.