High testosterone in postmenopausal women may add CVD risk

This study offers new insights into the relationships between endogenous hormones and how they influence cardiovascular event risk, according to Virginia M. Miller, PhD, and Rekha Mankad, MD.

Previous observational studies have established that decreases in endogenous estrogen led to increases in cardiovascular event risk and incidence, Dr. Miller and Dr. Mankad said in an editorial referencing the study.

What’s less clear is the role of testosterone in cardiovascular risk and event incidence, both by itself and in relation to other endogenous hormones.

“Few studies have gone beyond singular associations of hormone levels with cardiovascular events,” the editorial authors wrote in the Journal of the American College of Cardiology.

The study by Zhao and her colleagues is unique in part because their analysis considers the ratio of testosterone to estradiol. In particular, they found that a higher testosterone to estradiol level was associated with a higher incidence of cardiovascular events overall and of coronary heart disease.

What was unexpected, according to Dr. Miller and Dr. Mankad, was a U-shaped association with incident heart failure. In subgroup analysis, investigators found a positive association between testosterone to estradiol ratio and heart failure with reduced ejection fraction but not with heart failure with preserved ejection fraction.

“By addressing a set of defined incident events, this study provides new information needed to develop mechanistic hypotheses of causal relationships of hormones with specific aspects of cardiac function,” the editorial authors wrote.

Dr. Miller and Dr. Mankad are both with the women’s health research center and department of cardiovascular disease at the Women’s Heart Clinic at the Mayo Clinic, Rochester, Minn. These comments are derived from their editorial in the Journal of the American College of Cardiology. Dr. Mankad had no disclosures, while Dr. Miller reported support from a National Institutes of Health grant.