Influence of sex and hormone status on circulating natriuretic peptides.

Lam CS, Cheng S, Choong K, Larson MG, Murabito JM, Newton-Cheh C, Bhasin S, McCabe EL, Miller KK, Redfield MM, Vasan RS, Coviello AD, Wang TJ
J Am Coll Cardiol. 2011 58 (6): 618-26

PMID: 21798425 · PMCID: PMC3170816 · DOI:10.1016/j.jacc.2011.03.042

OBJECTIVES - The aim of this study was to assess the relationship between sex hormones and natriuretic peptide levels in community-based adults.

BACKGROUND - Women have higher circulating natriuretic peptide concentrations than men, but the mechanisms for these sex-related differences and the impact of hormone therapy are unclear. Experimental studies suggest that androgens may suppress natriuretic peptide secretion.

METHODS - We measured N-terminal pro-B-type natriuretic peptide (NT-proBNP), total testosterone, and sex hormone-binding globulin plasma levels in 4,056 men and women (mean age 40 ± 9 years) from the Framingham Heart Study Third-Generation cohort. Sex/hormone status was grouped as: 1) men; 2) post-menopausal women not receiving hormone replacement therapy; 3) pre-menopausal women not receiving hormonal contraceptives; 4) post-menopausal women receiving hormone replacement therapy; and 5) pre-menopausal women receiving hormonal contraceptives.

RESULTS - Circulating NT-proBNP levels were associated with sex/hormone status (overall p < 0.0001). Men had lower NT-proBNP levels than women of all menopause or hormone groups, and women receiving hormonal contraceptives had higher NT-proBNP levels than women who were not receiving hormone therapy (all p < 0.0001). These relationships remained significant after adjusting for age, body mass index, and cardiovascular risk factors. Across sex/hormone status groups, free testosterone (FT) levels decreased and sex hormone-binding globulin levels increased in tandem with increasing NT-proBNP levels. In sex-specific analyses, NT-proBNP levels decreased across increasing quartiles of FT in men (p for trend <0.01) and women (p for trend <0.0001). Adjustment for FT markedly attenuated the association between sex/hormone status and NT-proBNP concentrations.

CONCLUSIONS - These findings suggest that lower levels of circulating androgens and the potentiating effect of exogenous female hormone therapy contribute to the higher circulating NT-proBNP concentrations in women.

Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

MeSH Terms (16)

Adult Contraceptives, Oral Estrogens Female Humans Insulin Resistance Male Middle Aged Natriuretic Peptide, Brain Natriuretic Peptides Peptide Fragments Postmenopause Premenopause Sex Factors Sex Hormone-Binding Globulin Testosterone

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