Elsevier

Metabolism

Volume 52, Issue 6, June 2003, Pages 784-790
Metabolism

Relationships in men of sex hormones, insulin, adiposity, and risk factors for myocardial infarction

https://doi.org/10.1016/S0026-0495(03)00072-6Get rights and content

Abstract

That sex hormones, insulin, and obesity all correlate with the constellation of risk factors for myocardial infarction (MI) that has come to be known as “syndrome X,” the ”insulin-resistance syndrome,” or the “metabolic syndrome” suggests that any one or more of them could underlie and link the risk factors to form the constellation. That sex hormones, insulin, and obesity also correlate with each other complicates their identification as an underlying link. To compare the likelihood of each being a link, we measured and determined the interrelationships of sex hormones, insulin, adiposity variables, and risk factors for MI in 80 apparently healthy men. Of the adiposity variables, visceral adipose tissue (VAT) correlated more strongly with the risk factors for MI than did body mass index (BMI), total adipose tissue (TAT), subcutaneous adipose tissue (SCAT), waist-to-hip ratio (WHR), and waist circumference (W). Controlling for VAT eliminated all of the other adiposity correlations that had been significant. VAT, therefore, was used as the measure of adiposity for further data analysis. VAT correlated more strongly with risk factors for MI than did sex hormones and insulin, and most of the correlations of sex hormones and insulin with risk factors for MI lost statistical significance after controlling for VAT. Testosterone and the ratio of estradiol-to-testosterone (E/T) correlated with insulin; on controlling for VAT, only the E/T-insulin correlation remained significant (r = .38, P < .001) and on multiple linear regression analysis, insulin was associated with estradiol (P = .01) and testosterone (P = .04) independently of VAT and age. In conclusion, (1) VAT in men may largely explain the correlations of sex hormones, insulin, and obesity with the risk factors for MI measured, (2) VAT may be the principal factor in men, independently of other measures of adiposity, that links risk factors for MI to form the constellation, and (3) estradiol may play a more important role in the sex hormone-insulin relationship in men than has generally been considered.

Section snippets

Patients and methods

Eighty adult males recruited from a multiethnic community through advertisements were studied. Inclusion required that the subject be healthy, not regularly participating in vigorous physical activity training programs, not having gained or lost > 10% of body weight within the past year, not having a history of drug or alcohol abuse, and not taking medications known to influence serum lipid levels or body composition. The health of the subjects was determined by history, physical examination,

Results

The means, SEMs, and ranges of the variables measured in the 80 men are shown in Table 1.

Table 2 shows the Pearson correlation coefficients of measures of adiposity with risk factors for MI, insulin, and sex hormones. Because W and WHR correlated so similarly with these variables and with each other (r = .86, P < .001), the data on W are not shown. Although VAT correlated with BMI (r = .65), TAT (r = .71), SCAT (r = .69), WHR (r = .78), and W (r = .81), all P < .001, VAT correlated more

Discussion

Sex hormones, insulin, and obesity have all been reported to correlate with risk factors for MI in men.11, 14, 15 Although a correlation does not by itself mean a cause and effect relationship or, if so, indicate which is the cause, each of these 3 variables has been suggested as the link that underlies the risk factors for MI to form the constellation.1, 2, 3, 4, 6, 7 In the present study, testosterone, FT, estradiol, estrone, insulin, 6 adiposity variables, and risk factors for MI were

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    Supported in part by National Institutes of Health Grant No. DK PO1-42618.

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