Associations of endogenous sex hormone levels with the prevalence and progression of valvular and thoracic aortic calcification in the Multi-Ethnic Study of Atherosclerosis (MESA). (January 2022)

• Record Type: Journal Article
• Authors: Sharma, Apurva; Ogunmoroti, Oluseye; Fashanu, Oluwaseun E.; Zhao, Di; Ouyang, Pamela; Budoff, Matthew J.; Thomas, Isac C.; Michos, Erin D.
• Is Part Of: Atherosclerosis. Volume 341(2022)
• Page Start: 71
• Page End: 79
• Publication Date: 2022-01
• Subjects: Endogenous sex hormones -- Testosterone -- Sex hormone binding globulin -- Extra coronary calcification -- Mitral annular calcification -- Descending thoracic aortic calcification; Arteriosclerosis -- Periodicals; Electronic journals; 616.136
• DOI: 10.1016/j.atherosclerosis.2021.11.009
• Languages: English
• ISSNs: 0021-9150

Abstract

Abstract: Background and aims: Sex hormones (SH) may contribute to sex differences in cardiovascular disease (CVD). High free testosterone (T) and low sex hormone binding globulin (SHBG) have been associated with progression of coronary artery calcification in women. We now examined the association of SH with extra-coronary calcification (ECC) prevalence and progression among MESA participants. Methods: We studied 2, 737 postmenopausal women and 3, 130 men free of clinical CVD with baseline SH levels. ECC measurements [ascending and descending thoracic aortic calcification (ATAC, DTAC), mitral annular calcification (MAC), aortic valve calcification (AVC)] were obtained by computed tomography at baseline and after 2.4 ± 0.9 years. We used multivariable Poisson regression to evaluate associations with ECC prevalence and incidence (Agatston scores >0) and linear mixed effects models for ECC progression, per 1-SD increment in log(SH) in women and men separately. Results: The mean age was 65 ± 9 and 62 ± 10 years for women and men, respectively. In women, greater free T and lower SHBG were associated with MAC incidence in a demographic-adjusted model only. In men, lower free T was associated with MAC prevalence, DTAC incidence and progression, while greater SHBG was associated with MAC prevalence and DTAC progression after further adjusting for CVD risk factors. Conclusions: In this diverse cohort free of CVD, we found some associations of SH with ECC measures. In particular, free T was inversely associated with prevalent MAC and DTAC progression in men independent of CVD risk factors. SH may influence vascular calcification, but further work is needed to understand clinical implications of these findings. Graphical abstract: Image 1 Highlights: Sex hormones (SH) may explain sex differences in cardiovascular disease (CVD). Extra coronary calcium (ECC) and its progression are markers of subclinical atherosclerosis and prognostic of CVD risk. In a multi-ethnic cohort free of baseline CVD, we examined the association of SH with ECC measured by cardiac CT. Associations of SH with ECC differed by sex and across vascular beds, although the clinical significance is uncertain. Our findings suggest SH may influence vascular calcification.