Urinary sex hormone excretions in premenopausal women and coronary heart disease risk: A nested case-referent study in the DOM-cohort
Open accessAbstract
The low incidence of coronary heart disease (CHD) in premenopausal women is partly ascribed to protection by endogenous estrogen production. As a consequence, we hypothesized that premenopausal women with low endogenous estrogen production or high androgen production might be at increased risk for CHD. We studied the relationship between urinary sex hormone excretions and CHD risk by means of a nested case-referent study within a cohort of premenopausal (ages 40-49 yrs) women (n = 11,284). This cohort was formed at a breast cancer screening project in 1982-1986 (The Diagnostisch Onderzoek Mammacarcinoom [DOM] Project). Baseline data included self-administered questionnaires and anthropometric measurements. At the time of screening the women were instructed to collect an overnight urine sample on day 22 of three separate cycles. These urine samples were stored at -20 degrees C. Up to June 1991, 45 subjects were admitted to local hospitals on diagnosis of CHD (29 with myocardial infarction, and 16 with angiographically confirmed coronary disease). Referents were sampled from the cohort, matched for age and year of screening in a 1:3 ratio. In a follow-up study, menopausal state of the subjects was assessed yearly by mailed questionnaires. Urinary excretions of estrone-glucuronide, pregnanediol-glucuronide, and testosterone-glucuronide adjusted by creatinine were similar for cases and referents. Cases had no earlier menopause than referents, although cases had more anovulatory cycles. The occurrence of CHD in middle-aged women is not preceded by a low premenopausal endogenous estrogen production or high androgen production. Anovulatory cycles appear more frequently in women who develop CHD many years later.
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Two large epidemiological studies have reported increased prevalence of CVD among women with anovulation.
“Two large epidemiological studies have reported increased prevalence of CVD among women with anovulation; 90,91”
From Assessment and management of polycystic ovary syndrome: Summary of an evidence-based guideline (2011) · cites this paper as [91]
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- Authors
- Gorgels, W. J. M. J., Graaf, Y. V. D., Blankenstein, M. A., Collette, H. J. A., Erkelens, D. W., & Banga, J. D.
- Affiliations
- Utrecht University (NL)
- University Medical Center Utrecht (NL)
- Corresponding author
- Banga, J.D.
- ORCID
- Blankenstein, M.A.
- Venue
- Journal of Clinical Epidemiology
- Publisher
- Elsevier BV
- Published
- 1997-03
- Volume
- 50
- Issue
- 3
- Pages
- 275-281
- ISSN
- 0895-4356 (ISSN-L)
- OpenAlex
- W2160043529
- Cited by
- 35
- References
- 21
- Citations by year
- 2026: 1 · 2025: 2 · 2023: 2 · 2022: 1 · 2020: 1 · 2018: 1 · 2017: 1 · 2015: 1 · 2014: 2 · 2013: 1 · 2012: 1
- FWCI
- 0.47
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Journal of Clinical Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Radboud Repository (Radboud University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Estrogen and related hormone effects
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Keywords
- coronary artery disease, premenopausal women, endogenous estrogen, androgens, estrone glucuronide, pregnanediol glucuronide, testosterone glucuronide, myocardial infarction, anovulatory cycles, menopause
- MeSH terms
- Adult, Anovulation, Coronary Disease, Female, Humans, Middle Aged, Prospective Studies, Risk Factors, Gonadal Steroid Hormones, Case-Control Studies, Coronary Angiography, Premenopause
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