Association Between Sex Hormone Levels And Macro/microvascular Complications In Diabetic Patients

Objective Vascular complications are the key to the treatment of diabetes.The effects of endogenous hormones on vascular remodeling vary widely among different races and genders.This article will analyze the prevalence of diabetes in Shanghai,China,and explore the association between serum total testosterone(TT),estradiol(E2)and dehydroepiandrosterone(DHEA)with macrovascular complications,diabetic kidney disease(DKD).Methods The project relies on the METAL study(ChiCTR1800017573,www.chictr.org.cn),which is based on the resident population of ≥18 years old with diabetes in Shanghai Huangpu and Pudong New District.Detection of common carotid artery(CCA)plaque and diameter are measured by ultrasound.Cardiaovascular disease(CVD)is defined by prior diagnosis of coronary heart disease,myocardial infarction,or stroke.DKD is defined according to the American Diabetes Association Guidelines(DKD1)and the Kidney Disease Outcome Quality Initiative(DKD2).Results(1)The prevalence of CVD and DKD was 36% and 27.9% in diabetic men and 39.6% and 28.5% in postmenopausal diabetic women,respectively.(2)In men,CVD was positively associated with E2 levels(OR 1.16,95%CI 1.002,1.25,p for trend 0.003)and negatively associated with DHEA levels(OR 0.826,95%CI 0.752,0.907 p for trend < 0.001).In postmenopausal women,TT levels were negatively associated with CCA diameter(regression coefficient(β)-0.041,95%CI-0.076,-0.005 p 0.026)and positively associated with CVD(OR 1.192,95%CI 1.039,1.368 p 0.012);DHEA levels were negatively associated with CVD(OR 0.903,95%CI 0.820,0.993 p 0.036).(3)Both in men and postmenopausal women,TT levels were negatively associated with logarithmic conversion of urinary albumin creatinine ratio(lnACR)and DKD(β-0.098,95%CI-0.154,-0.043 p 0.001 and OR 0.887,95%CI 0.790,0.997 p 0.044 vs β-0.084,95%CI-0.137,-0.031 p 0.002 and OR 0.822,95%CI 0.731,0.924 p 0.001),DHEA levels were positively associated with DKD(both p < 0.05).Conclusion Among community-dwelling diabetic male in Shanghai,macrovascular complications were positively correlated with E2 and negatively correlated with DHEA levels.DKD was negatively correlated with TT level and positively correlated with DHEA.Among community-dwelling diabetic postmenopausal women in Shanghai,macrovascular complications were positively correlated with TT and negatively correlated with DHEA.DKD is negatively correlated with TT and positively correlated with DHEA.The relevant mechanism remains to be further studied.