Association of serum androgens and coronary artery calcium scores in women

Increased serum androgens relative to estrogens may have a weak but independent association with evidence of subclinical atherosclerosis, as measured by coronary artery calcium scores.

Volume 112, Issue 3, Pages 586–593


Courtney A. Penn, M.D., Jessica Chan, M.D., Clementina Mesaros, Ph.D., Nathaniel W. Snyder, Ph.D., Daniel J. Rader, M.D., Mary D. Sammel, Sc.D., Anuja Dokras, M.D., Ph.D.



To determine the association between serum androgens measured by high-resolution liquid chromatography–mass spectrometry and coronary artery calcium (CAC) scores.


Cross-sectional study.


Academic institution.


A total of 239 women, aged 40–75 years, with CAC testing and complete cardiovascular disease risk evaluation. Total T, DHEA, and androstenedione were measured using high-resolution liquid chromatography–mass spectrometry, whereas E2 and sex hormone–binding globulin were measured using commercial assays.



Main Outcome Measure(s)

Independent associations between CAC scores and sex steroids.


Overall, 164 subjects had a CAC score < 10, 48 had a CAC score between 10 and 100, and 27 had a score > 100. There were no differences in sex hormone levels between women with CAC scores > 10 vs. CAC scores ≤ 10. In multivariable models adjusting for age, body mass index, and low-density lipoprotein cholesterol, a higher T/E2 ratio was associated with an elevated CAC score, with an unadjusted odds ratio associated with 1-SD change in log-transformed T/E2 of 1.38 (95% confidence interval 1.01–1.89) and adjusted OR 1.02 (95% confidence interval 1.002–1.04). Total T, DHEA, androstenedione, sex hormone–binding globulin, and E2 levels were not associated with increased CAC.


In the general population, there are mixed reports regarding the relationship between serum androgens and risk factors for cardiovascular disease, and limited information on the relationship between androgens and subclinical atherosclerosis. Our study shows that increased androgens relative to estrogens may have a weak but independent association with subclinical atherosclerosis, as measured by CAC scores.

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