Relationship between Serum Sex Hormones and Coronary Artery Disease in Premenopausal Women – A Missing Link?

Abstract

Objectives: The reported incidence of coronary artery disease (CAD) is on the upsurge in middle-aged women of 35–54 years, whereas decreasing in similar aged matched men. The current clinical trial studies have revealed that attention is drawn away from estrogens and shifted toward androgens and sex hormone-binding globulin considered potential mediators of increasing cardiovascular risk in women at midlife. Data evaluating the endocrinological basis for CAD in premenopausal Indian women is infrequent. We aimed to assess the incidence of CAD among premenopausal women undergoing coronary angiography, identify the prevalence of various risk factors for CAD, and compare clinical characteristics and hormonal levels among premenopausal women with and without CAD to elucidate endocrinological explanations for CAD in premenopausal women. Materials and Methods: Ninety-nine consecutive premenopausal women undergoing coronary angiography between January 2014 and January 2017 were enrolled in this single-center and cross-sectional study. The reproductive hormone levels were quantified using commercially available electrochemiluminescence immunoassay. Results: Sixty-six (66.7%) premenopausal women had CAD on coronary angiography. Multivariate linear regression analysis was used, for diabetes mellitus (adjusted odds ratio [AOR] 16.46; P = 0.006 [95% confidence interval, CI: 2.21–122.41]), triglycerides (AOR 1.05; P = 0.002 [95% CI: 1.02–1.10]), progesterone (AOR 0.68; P = 0.015 [95% CI: 0.50–0.93]), and insulin (AOR 0.51; P < 0.0001 [95% CI: 0.38–0.70]) were observed to independently anticipate the development of CAD in premenopausal women. Conclusion: Approximately two-thirds of premenopausal women undergoing coronary angiography are detected to have CAD. Patients having diabetes, high serum triglyceride levels, low progesterone, and low insulin levels are considered in the high-risk category for developing CAD, thereby in premenopausal women providing a hormonal basis for the development of CAD.