Letter to the Editor: “Androgens, Irregular Menses, and Risk of Diabetes and Coronary Artery Calcification in the Diabetes Prevention Program”

We read with interest the results of the secondary analysis of the Diabetes Prevention Program and the Diabetes Prevention Program Outcomes Study regarding the possible effect of hyperandrogenism or irregular menses on cardiometabolic risk among women. Researchers studied 1422 midlife women who were glucose-intolerant and overweight and found that increased androgen concentrations or irregular menses did not additionally contribute to increased risk for diabetes or coronary artery calcification (1).

Several previous studies and a recent meta-analysis including 9556 women with polycystic ovary syndrome showed that hyperandrogenism was positively associated with metabolic syndrome, insulin resistance, and various other metabolic biomarkers that increase cardiovascular disease risk (2). However, a recent study published by our group provided evidence that the presence of adrenal hyperandrogenism, with dehydroepiandrosterone-sulfate (DHEAS) as the main representative, seems to prevent further deterioration of the metabolic profile, including glucose and lipid homeostasis, in young women with polycystic ovary syndrome (mean age, 23.5 years) (3). These findings are in accordance with those of a few other studies in both middle-aged and postmenopausal women (4, 5). A negative association between age and DHEAS concentration should also be underlined (3).

In the current study, premenopausal women with higher free androgen index levels also had higher levels of DHEAS than those with lower free androgen index levels (1). The possibility of higher DHEAS concentrations (in contrast to testosterone levels) exerting a protective role on the metabolic profile of these women should be added to both the statistical interpretation and the pathophysiological discussion of this very interesting paper. Furthermore, the clinical implications of using DHEAS as a possible therapeutic agent in the future are promising and of great importance.

Acknowledgments

Disclosure Summary: The authors have nothing to disclose.

Abbreviation:

Abbreviation:
 
• DHEAS

  dehydroepiandrosterone-sulfate.

References