Letter to the Editor: “Androgens, Irregular Menses, and Risk of Diabetes and Coronary Artery Calcification in the Diabetes Prevention Program”

Letter to the Editor: “Androgens, Irregular Menses, and Risk of Diabetes and Coronary Artery... We read with interest the results of the secondary analysis of the Diabetes Prevention Program and the Diabetes Prevention Program Outcomes Study regarding the possible effect of hyperandrogenism or irregular menses on cardiometabolic risk among women. Researchers studied 1422 midlife women who were glucose-intolerant and overweight and found that increased androgen concentrations or irregular menses did not additionally contribute to increased risk for diabetes or coronary artery calcification (1). Several previous studies and a recent meta-analysis including 9556 women with polycystic ovary syndrome showed that hyperandrogenism was positively associated with metabolic syndrome, insulin resistance, and various other metabolic biomarkers that increase cardiovascular disease risk (2). However, a recent study published by our group provided evidence that the presence of adrenal hyperandrogenism, with dehydroepiandrosterone-sulfate (DHEAS) as the main representative, seems to prevent further deterioration of the metabolic profile, including glucose and lipid homeostasis, in young women with polycystic ovary syndrome (mean age, 23.5 years) (3). These findings are in accordance with those of a few other studies in both middle-aged and postmenopausal women (4, 5). A negative association between age and DHEAS concentration should also be underlined (3). In the current study, premenopausal women with higher free androgen index levels also had higher levels of DHEAS than those with lower free androgen index levels (1). The possibility of higher DHEAS concentrations (in contrast to testosterone levels) exerting a protective role on the metabolic profile of these women should be added to both the statistical interpretation and the pathophysiological discussion of this very interesting paper. Furthermore, the clinical implications of using DHEAS as a possible therapeutic agent in the future are promising and of great importance. Acknowledgments Disclosure Summary: The authors have nothing to disclose. Abbreviation: Abbreviation: DHEAS dehydroepiandrosterone-sulfate. References 1. Kim C , Aroda VR , Goldberg RB , Younes N , Edelstein SL , Carrion-Petersen M . Ehrmann DA ; Diabetes Prevention Program Outcomes Study Group . Androgens, irregular menses, and risk of diabetes and coronary artery calcification in the Diabetes Prevention Program . J Clin Endocrinol Metab . 2017 ; 103 ( 2 ): 486 – 496 . Google Scholar CrossRef Search ADS 2. Yang R , Yang S , Li R , Liu P , Qiao J , Zhang Y . Effects of hyperandrogenism on metabolic abnormalities in patients with polycystic ovary syndrome: a meta-analysis . Reprod Biol Endocrinol . 2016 ; 14 ( 1 ): 67 . Google Scholar CrossRef Search ADS PubMed 3. Paschou SA , Palioura E , Ioannidis D , Anagnostis P , Panagiotakou A , Loi V , Karageorgos G , Goulis DG , Vryonidou A . Adrenal hyperandrogenism does not deteriorate insulin resistance and lipid profile in women with PCOS . Endocr Connect . 2017 ; 6 ( 8 ): 601 – 606 . Google Scholar CrossRef Search ADS PubMed 4. Brahimaj A , Muka T , Kavousi M , Laven JS , Dehghan A , Franco OH . Serum dehydroepiandrosterone levels are associated with lower risk of type 2 diabetes: the Rotterdam Study . Diabetologia . 2017 ; 60 ( 1 ): 98 – 106 . Google Scholar CrossRef Search ADS PubMed 5. Shufelt C , Bretsky P , Almeida CM , Johnson BD , Shaw LJ , Azziz R , Braunstein GD , Pepine CJ , Bittner V , Vido DA , Stanczyk FZ , Bairey Merz CN . DHEA-S levels and cardiovascular disease mortality in postmenopausal women: results from the National Institutes of Health–National Heart, Lung, and Blood Institute (NHLBI)-sponsored Women’s Ischemia Syndrome Evaluation (WISE) . J Clin Endocrinol Metab . 2010 ; 95 ( 11 ): 4985 – 4992 . Google Scholar CrossRef Search ADS PubMed Copyright © 2018 Endocrine Society http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Clinical Endocrinology and Metabolism Oxford University Press

Letter to the Editor: “Androgens, Irregular Menses, and Risk of Diabetes and Coronary Artery Calcification in the Diabetes Prevention Program”

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Publisher
Endocrine Society
Copyright
Copyright © 2018 Endocrine Society
ISSN
0021-972X
eISSN
1945-7197
D.O.I.
10.1210/jc.2018-00018
Publisher site
See Article on Publisher Site

Abstract

We read with interest the results of the secondary analysis of the Diabetes Prevention Program and the Diabetes Prevention Program Outcomes Study regarding the possible effect of hyperandrogenism or irregular menses on cardiometabolic risk among women. Researchers studied 1422 midlife women who were glucose-intolerant and overweight and found that increased androgen concentrations or irregular menses did not additionally contribute to increased risk for diabetes or coronary artery calcification (1). Several previous studies and a recent meta-analysis including 9556 women with polycystic ovary syndrome showed that hyperandrogenism was positively associated with metabolic syndrome, insulin resistance, and various other metabolic biomarkers that increase cardiovascular disease risk (2). However, a recent study published by our group provided evidence that the presence of adrenal hyperandrogenism, with dehydroepiandrosterone-sulfate (DHEAS) as the main representative, seems to prevent further deterioration of the metabolic profile, including glucose and lipid homeostasis, in young women with polycystic ovary syndrome (mean age, 23.5 years) (3). These findings are in accordance with those of a few other studies in both middle-aged and postmenopausal women (4, 5). A negative association between age and DHEAS concentration should also be underlined (3). In the current study, premenopausal women with higher free androgen index levels also had higher levels of DHEAS than those with lower free androgen index levels (1). The possibility of higher DHEAS concentrations (in contrast to testosterone levels) exerting a protective role on the metabolic profile of these women should be added to both the statistical interpretation and the pathophysiological discussion of this very interesting paper. Furthermore, the clinical implications of using DHEAS as a possible therapeutic agent in the future are promising and of great importance. Acknowledgments Disclosure Summary: The authors have nothing to disclose. Abbreviation: Abbreviation: DHEAS dehydroepiandrosterone-sulfate. References 1. Kim C , Aroda VR , Goldberg RB , Younes N , Edelstein SL , Carrion-Petersen M . Ehrmann DA ; Diabetes Prevention Program Outcomes Study Group . Androgens, irregular menses, and risk of diabetes and coronary artery calcification in the Diabetes Prevention Program . J Clin Endocrinol Metab . 2017 ; 103 ( 2 ): 486 – 496 . Google Scholar CrossRef Search ADS 2. Yang R , Yang S , Li R , Liu P , Qiao J , Zhang Y . Effects of hyperandrogenism on metabolic abnormalities in patients with polycystic ovary syndrome: a meta-analysis . Reprod Biol Endocrinol . 2016 ; 14 ( 1 ): 67 . Google Scholar CrossRef Search ADS PubMed 3. Paschou SA , Palioura E , Ioannidis D , Anagnostis P , Panagiotakou A , Loi V , Karageorgos G , Goulis DG , Vryonidou A . Adrenal hyperandrogenism does not deteriorate insulin resistance and lipid profile in women with PCOS . Endocr Connect . 2017 ; 6 ( 8 ): 601 – 606 . Google Scholar CrossRef Search ADS PubMed 4. Brahimaj A , Muka T , Kavousi M , Laven JS , Dehghan A , Franco OH . Serum dehydroepiandrosterone levels are associated with lower risk of type 2 diabetes: the Rotterdam Study . Diabetologia . 2017 ; 60 ( 1 ): 98 – 106 . Google Scholar CrossRef Search ADS PubMed 5. Shufelt C , Bretsky P , Almeida CM , Johnson BD , Shaw LJ , Azziz R , Braunstein GD , Pepine CJ , Bittner V , Vido DA , Stanczyk FZ , Bairey Merz CN . DHEA-S levels and cardiovascular disease mortality in postmenopausal women: results from the National Institutes of Health–National Heart, Lung, and Blood Institute (NHLBI)-sponsored Women’s Ischemia Syndrome Evaluation (WISE) . J Clin Endocrinol Metab . 2010 ; 95 ( 11 ): 4985 – 4992 . Google Scholar CrossRef Search ADS PubMed Copyright © 2018 Endocrine Society

Journal

Journal of Clinical Endocrinology and MetabolismOxford University Press

Published: Mar 12, 2018

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