In a nationally representative analysis of 2,172 reproductive-aged U.S. women, higher sex hormone–binding globulin and total testosterone (TT) levels were significantly associated with lower odds of developing metabolic syndrome, according to a cross-sectional study.
Metabolic syndrome prevalence in the sample was 14.5%. A 1-unit increase in log-transformed sex hormone–binding globulin (SHBG) corresponded to a 77% reduction in the odds of metabolic syndrome (MetS) (adjusted odds ratio [OR] = 0.23, 95% confidence interval [CI] = 0.16–0.34), and a 1-unit increase in log-transformed TT was associated with a 42% reduction (adjusted OR = 0.58, 95% CI = 0.43–0.80).
“[The] findings suggest significant associations between [polycystic ovarian syndrome] (PCOS) features and MetS among a racially and ethnically diverse population of reproductive-aged women in the U.S.,” said lead study author Deepali K. Ernest, of the University of Texas Health Science Center at Houston, and colleagues.
The investigators analyzed 2011 to 2016 National Health and Nutrition Examination Survey data from nonpregnant women aged 12 to 49 years without diabetes who had complete MetS component data. Features examined included TT, SHBG, amenorrhea, and oral contraceptive pill (OCP) use.
Participants with MetS were older (mean age = 36.8 vs 29.2 years), had a higher body mass index, and exhibited lower mean SHBG (52.1 vs 81.9 nmol/L) and TT (22.4 vs 27.7 ng/dL) levels than those without MetS (P < .01 for all).
In adjusted analyses, amenorrhea was not significantly associated with overall MetS (adjusted OR = 1.10, 95% CI = 0.73–1.66), nor was OCP use (adjusted OR = 1.03, 95% CI = 0.81–1.33). However, amenorrhea was linked to a higher risk of low high-density lipoprotein (HDL) cholesterol (adjusted OR = 1.65, 95% CI = 1.18–2.32), and showed trends toward associations with central obesity and elevated triglycerides. OCP use demonstrated mixed associations across subgroups, including an increased risk of elevated fasting glucose in Hispanic/Latina women (adjusted OR = 1.88, 95% CI = 1.17–3.01) and central obesity in other/multirace women (adjusted OR = 3.11, 95% CI = 1.54–6.28).
Associations varied by race and ethnicity. Increased SHBG was generally protective against MetS in most groups, though not statistically significant among Asian participants (adjusted OR = 0.56, 95% CI = 0.10–3.26). Increased TT was protective only among non-Hispanic White women (adjusted OR = 0.47, 95% CI = 0.30–0.75).
MetS components in the population included central obesity (52.3%), low HDL cholesterol (29.9%), elevated fasting glucose (20.1%), elevated triglycerides (10.6%), and elevated blood pressure (8.4%).
The investigators noted limitations including the reliance on surrogate biomarkers (rather than confirmed PCOS diagnoses), the cross-sectional design that limits causal inference, and the possibility that widespread OCP use in the sample may have confounded associations with SHBG levels.
The authors concluded that hormonal and racial/ethnic profiles should be considered in metabolic risk screening among women with PCOS features. They recommended longitudinal research to establish causal pathways between reproductive hormone markers and cardiometabolic outcomes.
The authors reported no conflicts of interest.
Source: Women’s Health Reports
