Association between statin use and sex hormone in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort.

PURPOSE Based on the 2018 American College of Cardiology/American Heart Association cholesterol guidelines, the number of individuals eligible for statin therapy to reduce atherosclerotic cardiovascular disease risk has greatly expanded. Statins inhibit cholesterol biosynthesis, which may impair gonadal steroidogenesis. To evaluate the impact of statins on endogenous sex hormones in a large epidemiological study. METHODS There were 6814 MESA participants at the baseline exam. Of these, 6171 had measurement of serum sex hormones: dehydroepiandrosterone (DHEA), sex hormone binding globulin (SHBG), estradiol (E2), total and bioavailable testosterone (T). Multivariable linear regression models were used to assess the relationship of statin use with each sex hormone. RESULTS 345 women (17.4%) and 464 men (14.7%) were statin users with a mean age of 67 years, 41% were Whites, 29% Blacks, 11% Chinese and 19% Hispanics. Among statin users compared to non-users of statin, mean SHBG was 3.54 nmol/L (p <0.01) lower in women and 3.37 nmol/L (p <0.001) lower in men; mean DHEA was 1.06 nmol/L (p <0.05) lower in women and 0.70 nmol/L (p <0.01) lower in men, after adjustment for potential confounders. With further propensity score adjustment, mean DHEA and SHBG levels were 0.67 nmol/L (p <0.05) and 3.49 nmol/L (p <0.001) lower respectively, among statin users compared to non-users. No significant association was noted between E2, total T, bioavailable T and statin use. CONCLUSION Statin users have lower levels of SHBG and DHEA. This is particularly relevant in light of growing use of statin therapy.