Low testosterone levels associated with increased CHD risk in postmenopausal women

Low levels of testosterone are associated with an increased risk of mortality from coronary heart disease (CHD) in postmenopausal women, reported Gail A. Laughlin, PhD.

Women's favorable cardiovascular risk compared with men is usually explained by endogenous estrogen levels. However, few studies have evaluated the role of naturally circulating testosterone in older women. Hyperandrogenemia in young women with polycystic ovary syndrome is associated with adverse cardiovascular risk factors, carotid atherosclerosis, and impaired vascular function, Dr. Laughlin said.

Using enrollees from the Rancho Bernardo Study, an ongoing population-based study of healthy aging in a Southern California community, researchers assessed the incidence of CHD events in 678 postmenopausal women aged 50 to 90 years over a follow-up of 20 years. Women were stratified into quintiles based on their testosterone levels, with those in the lowest quintile having testosterone levels of 80 pg/mL or less.

The study demonstrated that women with testosterone levels in the lowest quintile had a 2-fold increased risk of prevalent CHD, incident CHD (defined as a first-ever myocardial infarction or revascularization procedure), and CHD mortality. The findings were independent of the presence of CHD risk factors, diabetes, and metabolic syndrome.

"These results suggest that androgen deficiency may be a specific risk factor for atherosclerotic heart disease in postmenopausal women," said Dr. Laughlin, assistant adjunct professor of family and preventive medicine, University of California, San Diego, Calif. Whether the results apply only to women who are not current users of estrogen awaits further study.