Follicle-Stimulating Hormone, Its Association with Cardiometabolic Risk Factors, and 10-Year Risk of Cardiovascular Disease in Postmenopausal Women

Ningjian Wang, Hongfang Shao, Yi Chen, Fangzhen Xia, Chen Chi, Qin Li, Bing Han, Yincheng Teng, Yingli Lu, Ningjian Wang, Hongfang Shao, Yi Chen, Fangzhen Xia, Chen Chi, Qin Li, Bing Han, Yincheng Teng, Yingli Lu

Abstract

Background: Cardiovascular disease is the leading cause of mortality in postmenopausal women. Follicle-stimulating hormone (FSH) shows negative associations with obesity and diabetes mellitus in postmenopausal women. We aimed to study the associations between FSH and 10-year risk of atherosclerotic cardiovascular disease (ASCVD) in postmenopausal women.

Methods and results: SPECT-China (the Survey on Prevalence in East China for Metabolic Diseases and Risk Factors) is a 22-site, population-based study conducted during 2014-2015. This study included 2658 postmenopausal women. A newly developed effective tool for 10-year ASCVD risk prediction among Chinese was adopted. Regression analyses were performed to assess the relationship among FSH, 10-year ASCVD risk, and multiple cardiometabolic risk factors. With the increase in FSH quartiles, the mean 10-year ASCVD risk in postmenopausal women decreased from 4.9% to 3.3%, and most metabolic parameters were significantly ameliorated (all P for trend <0.05). In regression analyses, a 1-SD increment in ln-FSH was negatively associated with continuous (B -0.12, 95% confidence interval, -0.16, -0.09, P<0.05) and categorical (odds ratio 0.65, 95% confidence interval, 0.49, 0.85, P<0.05) 10-year ASCVD risk. These significant associations existed in subgroups with or without medication use, obesity, diabetes mellitus, hypertension, and dyslipidemia. Body mass index and waist circumference (both B -0.35, 95% confidence interval, -0.40, -0.30, P<0.05) had the largest associations of all metabolic measures, and blood pressure had the smallest association.

Conclusions: Serum FSH levels were negatively associated with 10-year ASCVD risk in postmenopausal women. Among cardiometabolic factors, obesity indices had the largest associations with FSH. These results indicated that a low FSH might be a risk factor or a biomarker for cardiovascular disease risk in postmenopausal women.

Keywords: cardiovascular disease risk factors; endocrinology; follicle‐stimulating hormone; menopause.

© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Figures

Figure 1
Figure 1
Flowchart of participants from East China. CVD indicates cardiovascular disease; FSH, follicle‐stimulating hormone; SHBG, sex hormone binding globulin.
Figure 2
Figure 2
Associations of follicle‐stimulating hormone with 10‐y ASCVD risk and cardiometabolic measures in postmenopausal women. They were analyzed using linear regression models with each measure as the outcome and follicle‐stimulating hormone as the explanatory variable. To facilitate comparisons across parameters, association magnitudes are reported in SD units of parameters per 1‐SD increment in ln‐follicle‐stimulating hormone. The model controls for age, total testosterone, estradiol, luteinizing hormone, economic status, and body mass index (but not included for body mass index and waist circumference in regression model). The results are expressed as unstandardized coefficients (95% confidence interval). ASCVD indicates atherosclerotic cardiovascular disease; HbA1c, glycated hemoglobin; HOMA‐IR, homeostasis model assessment index of insulin resistance.
Figure 3
Figure 3
Subgroup analyses of associations between follicle‐stimulating hormone and 10‐y atherosclerotic cardiovascular disease (ASCVD) risk in postmenopausal women. Medication use included lipid‐, glucose‐, and blood pressure–lowering drugs and cortisone (n=552). Association magnitudes are reported in SD units of 10‐y ASCVD risk per 1‐SD increment in follicle‐stimulating hormone. Linear regression analysis was used. The model controls for age, total testosterone, estradiol, luteinizing hormone, economic status and body mass index. The results are expressed as unstandardized coefficients (95% confidence interval).
Figure 4
Figure 4
Associations of follicle‐stimulating hormone with high 10‐y ASCVD risk and metabolic diseases in postmenopausal women. They were analyzed using logistic regression models with each disease as the outcome and follicle‐stimulating hormone as the explanatory variable. Adjusted ORs for each 1‐SD increment of ln‐follicle‐stimulating hormone associated with corresponding diseases are shown. The model controls for age, total testosterone, estradiol, luteinizing hormone, economic status, and body mass index (but not included for overweight, obesity, and central obesity in regression model). The results were expressed as odds ratios (95% confidence interval). ASCVD indicates atherosclerotic cardiovascular disease; OR, odds ratio.

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