Sex Steroids, Sex Hormone-Binding Globulin and Cardiovascular Health in Men and Postmenopausal Women: The Rotterdam Study

J Clin Endocrinol Metab. 2016 Jul;101(7):2844-52. doi: 10.1210/jc.2016-1435. Epub 2016 May 10.


Context: The concept of cardiovascular health was recently introduced. Sex steroids and sex hormone-binding globulin (SHBG) influence different health domains, but no studies assessed their role in cardiovascular health.

Objective: To assess the association between estradiol (E2), testosterone (T), SHBG, and free androgen index (FAI) with cardiovascular health.

Design, setting, and participants: Analyses included 1647 men (68.6 y) and 1564 naturally postmenopausal women (69.6 y) with available data on sex steroids and cardiovascular health from the population-based Rotterdam Study.

Exposures: E2, T, SHBG, and FAI.

Outcome: To define cardiovascular health, 7 metrics including 3 health factors (total cholesterol, fasting glucose, and blood pressure) and 4 health behaviors (physical activity, smoking, body mass index, and diet) were adopted. Three category levels of each metric were added up to a total score ranged 0-14. Logistic regression was performed to explore the association between E2, T, SHBG, and FAI and optimal cardiovascular health (OCH) (score of 11-14).

Results: OCH was reached by 153 men (9.3%) and 162 women (10.4%). The prevalence of OCH was higher in the lowest tertile of E2 (38.9%), and of T (43.8%), and the highest tertile of SHBG (48.1%) in women, and the highest tertile of T (43.1%) and SHBG (47.1%) in men. After adjustment for confounders, OCH was associated with lower T (odds ratio and 95% confidence interval, 0.69 [0.48-1.00]) and lower FAI (0.43 [0.32-0.57]) and higher levels of SHBG (4.55 [2.99-6.94]) among women and with higher levels of SHBG (2.56 [1.45-4.49]) in men.

Conclusions: OCH was associated with sex steroids and with SHBG in both men and women. The complexity and temporality of the interrelation between sex steroids, SHBG, and cardiovascular health requires further investigation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cardiovascular Diseases / blood*
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / etiology
  • Cardiovascular Physiological Phenomena*
  • Female
  • Gonadal Steroid Hormones / blood*
  • Health
  • Humans
  • Male
  • Netherlands / epidemiology
  • Postmenopause / blood*
  • Risk Factors
  • Sex Factors
  • Sex Hormone-Binding Globulin / analysis
  • Sex Hormone-Binding Globulin / metabolism*


  • Gonadal Steroid Hormones
  • Sex Hormone-Binding Globulin