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Published on: August 13, 2019
Androgen excess and cardiovascular risk
1Department of Clinical Medicine and Emerging Diseases, University of Palermo, Palermo, Italy.
Insights
Androgens may not directly increase cardiovascular risk in women. Metabolic factors and insulin resistance in conditions like polycystic ovary syndrome (PCOS) are more likely contributors to cardiovascular disease.
Area of Science:
- Cardiology
- Endocrinology
- Reproductive Health
Background:
- Cardiovascular diseases (CVD) are a leading cause of death globally, with significant gender disparities in morbidity and mortality rates until advanced age.
- Hormonal differences, particularly androgen levels, are hypothesized to contribute to gender-based CVD risk variations.
- Women with polycystic ovary syndrome (PCOS), characterized by hyperandrogenism, exhibit elevated cardiovascular risk despite their youth, prompting investigation into androgens' role.
Purpose of the Study:
- To investigate the controversial role of androgens in increasing cardiovascular risk.
- To clarify the association between hyperandrogenism and premature cardiovascular diseases in women with PCOS.
- To determine whether androgens are an independent risk factor for cardiovascular diseases.
Main Methods:
- Review of long-term studies examining cardiovascular disease prevalence in women with PCOS.
- Analysis of the relationship between androgen levels and cardiovascular outcomes.
- Evaluation of the contribution of metabolic components, insulin resistance, and adiponectin secretion to cardiovascular risk in PCOS.
Main Results:
- Long-term studies did not conclusively demonstrate a clear increased risk for cardiovascular morbidity and mortality in women with PCOS.
- The role of androgens as an independent risk factor for cardiovascular diseases remains controversial and not clearly recognized.
- Altered cardiovascular risk factors in PCOS appear primarily linked to metabolic dysregulation, including insulin resistance and reduced adiponectin.
Conclusions:
- Androgens seem to play a limited role in directly inducing cardiovascular risk.
- Metabolic components of PCOS, such as insulin resistance and altered adiponectin secretion, are the main drivers of cardiovascular risk in affected women.
- Further research is needed to fully elucidate the complex interplay of hormonal and metabolic factors in female cardiovascular health.
Abstract:
Cardiovascular diseases represent the major cause of death in most of developed countries and ultimately kill as many men as women. Both genders are exposed to the same risk factors but their rates of cardiovascular morbidity and mortality are very different until old age. This represents a crucial point; in fact, only at age 75 and over cardiovascular rates of women approximate those of men. It has been suggested that differences in hormonal status and mainly in androgen levels may explain such gender disparity. Consistently with this hypothesis, it has been shown that women with polycystic ovary syndrome (PCOS) have elevated cardiovascular risk despite their young age. However, the possibility that androgens may increase cardiovascular risk remains controversial. Hyperandrogenism, as isolated androgen excess, has not been clearly recognised so far as a risk factor for cardiovascular diseases. In addition, the risk of premature cardiovascular diseases in PCOS is at present uncertain. Long-term studies examining the prevalence of cardiovascular diseases among women with PCOS did not demonstrate a clear increased risk for cardiovascular morbidity and mortality. Thus, it seems that androgens have a limited role in inducing cardiovascular risk; the altered risk factors found in women with PCOS are mainly dependent on the metabolic components of this syndrome as well as on insulin resistance and reduced adiponectin secretion.
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