Increased free androgen index is associated with hypertension in premenopausal women
Liselott Andersson, Mats Eliasson, Inger Sundström Poromaa
DOI: 10.4236/ojog.2011.14045   PDF   HTML     5,398 Downloads   9,090 Views  


Objective: Increased testosterone and decreased sex hormone-binding globulin (SHBG) are associated with a number of adverse cardiovascular risk factors in postmenopausal women. The aim of this population-based study of women aged 25 to 50 was to assess the relationship between free androgen index (FAI) and cardiovascular risk factors in premenopausal women. Methods: A population-based survey of 396 premenopausal women with no hormonal treatment was undertaken as part of the Northern MONICA study. The study involved questionnaires, anthropometry and assays of testosterone and SHBG. Results: Increased FAI was associated with a number of cardiovascular risk factors in premenopausal women but this relationship was strongly affected by body mass index (BMI). After adjustment for age and BMI, FAI was significantly associated with increased systolic and diastolic blood pressures. Conclusion: Hyperandrogenism is associated with increased blood pressure and these findings emphasize the need to assess cardiovascular risk factors in women with hyperandrogenism of all ages.

Share and Cite:

Andersson, L. , Eliasson, M. and Poromaa, I. (2011) Increased free androgen index is associated with hypertension in premenopausal women. Open Journal of Obstetrics and Gynecology, 1, 229-234. doi: 10.4236/ojog.2011.14045.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Burger, H.G. (2002) Androgen production in women. Fertility and Sterility, 77, S3-5. doi:10.1016/S0015-0282(02)02985-0
[2] Sowers, M.F., Zheng, H., McConnell, D., Nan, B., Karvonen-Gutierrez, C.A. and Randolph, J.F., Jr. (2009) Testosterone, sex hormone-binding globulin and free androgen index among adult women: chronological and ovarian aging. Human Reproduction, 24, 2276-2285. doi:10.1093/humrep/dep209
[3] Pugeat, M., Moulin, P., Cousin, P., Fimbel, S., Nicolas, M.H., Crave, J.C. and Lejeune, H. (1995) Interrelations between sex hormone-binding globulin (SHBG), plasma lipoproteins and cardiovascular risk. Journal of Steroid Biochemistry and Molecular Biology, 53, 567-572. doi:10.1016/0960-0760(95)00102-6
[4] Lambrinoudaki, I., Christodoulakos, G., Rizos, D., Economou, E., Argeitis, J., Vlachou, S., Creatsa, M., Kouskouni, E. and Botsis, D. (2006) Endogenous sex hormones and risk factors for atherosclerosis in healthy Greek postmenopausal women. European Journal of Endocrinology, 154, 907-916. doi:10.1530/eje.1.02167
[5] Haffner, S.M., Katz, M.S., Stern, M.P. and Dunn, J.F. (1989) Association of decreased sex hormone binding globulin and cardiovascular risk factors. Arteriosclerosis, 9, 136-143. doi:10.1161/01.ATV.9.1.136
[6] Haffner, S.M., Newcomb, P.A., Marcus, P.M., Klein, B.E. and Klein, R. (1995) Relation of sex hormones and dehydroepiandrosterone sulfate (DHEA-SO4) to cardiovascular risk factors in postmenopausal women. American Journal of Epidemiology, 142, 925-934.
[7] Rexrode, K.M., Manson, J.E., Lee, I.M., Ridker, P.M., Sluss, P.M., Cook, N.R. and Buring, J.E. (2003) Sex hormone levels and risk of cardiovascular events in postmenopausal women. Circulation, 108, 1688-1693. doi:10.1161/01.CIR.0000091114.36254.F3
[8] Haffner, S.M., Valdez, R.A., Morales, P.A., Hazuda, H.P. and Stern, M.P. (1993) Decreased sex hormone-binding globulin predicts noninsulin-dependent diabetes mellitus in women but not in men. Journal of Clinical Endocrinology and Metabolism, 77, 56-60. doi:10.1210/jc.77.1.56
[9] Goodman-Gruen, D. and Barrett-Connor, E. (1997) Sex hormone-binding globulin and glucose tolerance in postmenopausal women. The Rancho Bernardo Study. Diabetes Care, 20, 645-649. doi:10.2337/diacare.20.4.645
[10] Maturana, M.A. and Spritzer, P.M. (2002) Association between hyperinsulinemia and endogenous androgen levels in peri- and postmenopausal women. Metabolism, 51, 238-243. doi:10.1053/meta.2002.29997
[11] Korytkowski, M.T., Krug, E.I., Daly, M.A., Deriso, L., Wilson, J.W. and Winters, S.J. (2005) Does androgen excess contribute to the cardiovascular risk profile in postmenopausal women with type 2 diabetes? Metabolism, 54, 1626-1631. doi:10.1016/j.metabol.2005.06.011
[12] Sowers, M., Crawford, S.L., Cauley, J.A. and Stein, E. (2003) Association of lipoprotein(a), insulin resistance, and reproductive hormones in a multiethnic cohort of pre- and perimenopausal women (The SWAN Study). American Journal of Cardiology, 92, 533-537. doi:10.1016/S0002-9149(03)00720-3
[13] Sutton-Tyrrell, K., Wildman, R.P., Matthews, K.A., Chae, C., Lasley, B.L., Brockwell, S., Pasternak, R.C., Lloyd-Jones, D., Sowers, M.F. and Torrens, J.I. (2005) Sex-hormone-binding globulin and the free androgen index are related to cardiovascular risk factors in multiethnic premenopausal and perimenopausal women enrolled in the Study of Women Across the Nation (SWAN). Circulation, 111, 1242-1249. doi:10.1161/01.CIR.0000157697.54255.CE
[14] Sowers, M.R., Jannausch, M., Randolph, J.F., McConnell, D., Little, R., Lasley, B., Pasternak, R., Sutton-Tyrrell, K. and Matthews, K.A. (2005) Androgens are associated with hemostatic and inflammatory factors among women at the mid-life. Journal of Clinical Endocrinology and Metabolism, 90, 6064-6071. doi:10.1210/jc.2005-0765
[15] Teede, H.J., Hutchison, S., Zoungas, S. and Meyer, C. (2006) Insulin resistance, the metabolic syndrome, diabetes, and cardiovascular disease risk in women with PCOS. Endocrine, 30, 45-53. doi:10.1385/ENDO:30:1:45
[16] Hudecova, M., Holte, J., Moby, L., Olovsson, M., Stridsberg, M., Larsson, A., Berglund, L., Berne, C. and Sundstrom Poromaa, I. (2011) Androgen levels, insulin sensitivity, and early insulin response in women with polycystic ovary syndrome: A long-term follow-up study. Fertility and Sterility, 95, 1146-1148. doi:10.1016/j.fertnstert.2010.09.050
[17] Hudecova, M., Holte, J., Olovsson, M. and Sundstrom Poromaa, I. (2009) Long-term follow-up of patients with polycystic ovary syndrome: Reproductive outcome and ovarian reserve. Human Reproduction, 24, 1176-1183. doi:10.1093/humrep/den482
[18] Eliasson, M., Janlert, U., Jansson, J.H. and Stegmayr, B. (2006) Time trends in population cholesterol levels 1986-2004: Influence of lipid-lowering drugs, obesity, smoking and educational level. The northern Sweden MONICA study. Journal of Internal Medicine, 260, 551-559. doi:10.1111/j.1365-2796.2006.01730.x
[19] Mantzoros, C.S., Georgiadis, E.I., Young, R., Evagelopoulou, C., Khoury, S., Katsilambros, N. and Sowers, J.R. (1995) Relative androgenicity, blood pressure levels, and cardiovascular risk factors in young healthy women. American Journal of Hypertension, 8, 606-614. doi:10.1016/0895-7061(95)00051-P
[20] Sternfeld, B., Liu, K., Quesenberry, C.P., Jr., Wang, H., Jiang, S.F., Daviglus, M., Fornage, M., Lewis, C.E., Mahan, J., Schreiner, P.J., Schwartz, S.M., Sidney, S., Williams, O.D. and Siscovick, D.S. (2008) Changes over 14 years in androgenicity and body mass index in a biracial cohort of reproductive-age women. Journal of Clinical Endocrinology and Metabolism, 93, 2158-2165. doi:10.1210/jc.2007-2203
[21] Hudecova, M., Holte, J., Olovsson, M., Lind, L. and Poromaa, I.S. (2010) Endothelial function in patients with polycystic ovary syndrome: A long-term follow-up study. Fertility and Sterility, 94, 2654-2658. doi:10.1016/j.fertnstert.2010.02.048
[22] Rosner, W. (1991) Plasma steroid-binding proteins. Endocrinology and Metabolism Clinics of North America, 20, 697-720.
[23] Ding, E.L., Song, Y., Malik, V.S. and Liu, S. (2006) Sex differences of endogenous sex hormones and risk of type 2 diabetes: A systematic review and meta-analysis. Journal of the American Medical Association, 295, 1288-1299. doi:10.1001/jama.295.11.1288
[24] Kienitz, T. and Quinkler, M. (2008) Testosterone and blood pressure regulation. Kidney and Blood Pressure Research, 31, 71-79. doi:10.1159/000119417
[25] Lindholm, A., Bixo, M., Bjorn, I., Wolner-Hanssen, P., Eliasson, M., Larsson, A., Johnson, O. and Poromaa, I.S. (2008) Effect of sibutramine on weight reduction in women with polycystic ovary syndrome: A randomized, double-blind, placebo-controlled trial. Fertility and Sterility, 89, 1221-1228. doi:10.1016/j.fertnstert.2007.05.002
[26] Kopp, H.P., Krzyzanowska, K., Schernthaner, G.H., Kriwanek, S. and Schernthaner, G. (2006) Relationship of androgens to insulin resistance and chronic inflammation in morbidly obese premenopausal women: Studies before and after vertical banded gastroplasty. Obesity Surgery, 16, 1214-1220. doi:10.1381/096089206778392130

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.