Association between sex hormone-binding globulin (SHBG) and metabolic syndrome among men
Keywords:
Sex hormone-binding globulin, Metabolic syndrome X, Men, Coronary artery disease, Coronary angiographyAbstract
CONTEXT AND OBJECTIVE: Metabolic syndrome consists of a set of factors that imply increased risk of cardiovascular diseases. The objective here was to evaluate the association between sex hormone-binding globulin (SHBG), sex hormones and metabolic syndrome among men. DESIGN AND SETTING: Retrospective analysis on data from the study “Endogenous oestradiol but not testosterone is related to coronary artery disease in men”, conducted in a hospital in São Paulo. METHODS: Men (aged 40-70) who underwent coronary angiography were selected. The age, weight, height, waist circumference, body mass index and prevalence of dyslipidemia, hypertension and diabetes of each patient were registered. Metabolic syndrome was defined in accordance with the criteria of the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (NCEP-ATPIII). Serum samples were collected to assess the levels of glucose, total cholesterol, HDL-cholesterol (high density lipoprotein), triglycerides, albumin, SHBG, estradiol and total testosterone (TT). The levels of LDL-cholesterol (low density lipoprotein) were calculated using Friedewald’s formula and free testosterone (FT) and bioavailable testosterone (BT) using Vermeulen’s formula. RESULTS: 141 patients were enrolled in the study. The prevalence of metabolic syndrome was significantly higher in the first SHBG tercile than in the second and third terciles. A statistically significant positive association between the SHBG and TT values was observed, but no such association was seen between SHBG, BT and FT. CONCLUSION: Low serum levels of SHBG are associated with higher prevalence of metabolic syndrome among male patients, but further studies are required to confirm this association.
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Reusch JE. Current concepts in insulin resistance, type 2 diabetes mellitus, and the metabolic syndrome. Am J Cardiol. 2002;90(5A):19G-26G.
Peiris AN, Stagner JI, Plymate SR, et al. Relationship of insulin secretory pulses to sex hormone-binding globulin in normal men. J Clin Endocrinol Metab. 1993;76(2):279-82.
Pasquali R, Casimirri F, De Iasio R, et al. Insulin regulates testosterone and sex hormone-binding globulin concentrations in adult normal weight and obese men. J Clin Endocrinol Metab. 1995;80(2):654-8.
Laaksonen DE, Niskanen L, Punnonen K, et al. Sex hormones, inflammation and the metabolic syndrome: a population-based study. Eur J Endocrinol. 2003;149(6):601-8.
Callou de Sá EQ, Feijó de Sá FC, e Silva R de S, et al. Endogenous oestradiol but not testosterone is related to coronary artery disease in men. Clin Endocrinol (Oxf ). 2011;75(2):177-83.
Expert Panel of Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486-97.
Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499-502.
Vermeulen A, Verdonck L, Kaufman JM. A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab. 1999;84(10):3666-72.
Ding EL, Song Y, Manson JE, et al. Sex hormone-binding globulin and risk of type 2 diabetes in women and men. N Engl J Med. 2009;361(12):1152-63.
Ding EL, Song Y, Malik VS, Liu S. Sex differences of endogenous sex hormones and risk of type 2 diabetes: a systematic review and meta- analysis. JAMA. 2006;295(11):1288-99.
Colangelo LA, Ouyang P, Liu K, et al. Association of endogenous sex hormones with diabetes and impaired fasting glucose in men: multi- ethnic study of atherosclerosis. Diabetes Care. 2009;32(6):1049-51.
Muller M, Grobbee DE, den Tonkelaar I, Lamberts SW, van der Schouw YT. Endogenous sex hormones and metabolic syndrome in aging men. J Clin Endocrinol Metab. 2005;90(5):2618-23.
Gannagé-Yared MH, Chedid R, Abs L. Relation between androgens and cardiovascular risk factors in a young population. Clin Endocrinol (Oxf ). 2011;74(6):720-5.
Bhasin S, Jasjua GK, Pencina M, et al. Sex hormone-binding globulin, but not testosterone, is associated prospectively and independently with incident metabolic syndrome in men: the framingham heart study. Diabetes Care. 2011;34(11):2464-70.
Heald AH, Anderson SG, Ivison F, et al. Low sex hormone binding globulin is a potential marker for the metabolic syndrome in different ethnic groups. Exp Clin Endocrinol Diabetes. 2005;113(9):522-8.
Chubb SA, Hyde Z, Almeida OP, et al. Lower sex hormone-binding globulin is more strongly associated with metabolic syndrome than lower total testosterone in older men: the Health in Men Study. Eur J Endocrinol. 2008;158(6):785-92.
Caldas ADA, Porto AL, Motta LDC, Casulari LA. Relação entre insulina e hipogonadismo em homens com síndrome metabólica [Relationship between insulin and hypogonadism in men with metabolic syndrome]. Arq Bras Endocrinol Metabol. 2009;53(8):1005-11.
Azziz R, Ehrmann D, Legro RS, et al. Troglitazone improves ovulation and hirsutism in the polycystic ovary syndrome: a multicenter, double blind, placebo-controlled trial. J Clin Endocrinol Metab. 2001;86(4):1626-32.
de Carvalho MH, Colaço AL, Fortes ZB. Citocinas, disfunção endotelial e resistência à insulina [Cytokines, endothelial dysfunction, and insulin resistance]. Arq Bras Endocrinol Metabol. 2006;50(2):304-12.
Kupelian V, Chiu GR, Araujo AB, et al. Association of sex hormones and C-reactive protein levels in men. Clin Endocrinol (Oxf ). 2010; 72(4):527-33.
Dunn JF, Nisula BC, Rodbard D. Transport of steroid hormones: binding of 21 endogenous steroids to both testosterone-binding globulin and corticosteroid-binding globulin in human plasma. J Clin Endocrinol Metab. 1981;53(1):58-68.
Zmuda JM, Cauley JA, Kriska A, et al. Longitudinal relation between endogenous testosterone and cardiovascular disease risk factors in middle-aged men. A 13-year follow-up of former Multiple Risk Factor intervention Trial participants. Am J Epidemiol. 1997;146(8):609-17.
Simon D, Charles MA, Nahoul K, et al. Association between plasma total testosterone and cardiovascular risk factors in healthy adult men: The Telecom Study. J Clin Endocrinol Metab. 1997;82(2):682-5.
Howell SJ, Radford JA, Adams JE, et al. Randomized placebo- controlled trial of testosterone replacement in men with mild Leydig cell insufficiency following cytotoxic chemotherapy. Clin Endocrinol (Oxf ). 2001;55(3):315-24.
Haddad RM, Kennedy CC, Caples SM, et al. Testosterone and cardiovascular risk in men: a systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clin Proc. 2007;82(1):29-39.
