Relative androgen excess and increased cardiovascular risk after menopause: A hypothesized relation

Many studies have investigated the role of estrogen during menopause; howev er, less attention has been paid to the role of androgen. Given the possibl e opposite effects of estrogen and androgen on cardiovascular disease risk, it is suggested that relative androgen excess may better predict the incre ased risk of cardiovascular disease in women over the age of 50 years than estrogen levels alone. Three phases of hormonal milieu changes are hypothes ized as a better way to identify the hormone-cardiovascular disease risk as sociation. A first phase prepause, occurs before estrogen levels decline (a pproximately 2 years before menopause). A second phase: interpause, occurs from the end of prepause until approximately age 55. A third phase, postpau se, occurs after interpause. The duration of the interpause phase, characte rized by relative androgen excess, may be an independent risk factor of car diovascular disease. This hypothesis could provide a basis for further clin ical and epidemiologic research, and it could have important implications f or establishing the initiation and duration of estrogen replacement therapy use as a means to prevent cardiovascular disease.