Cross‐sectional association of endogenous steroid hormone, sex hormone‐binding globulin, and precursor steroid levels with hemostatic factor levels in postmenopausal women

Unlabelled Box Essentials • Endogenous hormone levels' influence on hemostatic factor levels is not fully characterized. • We tested for associations of endogenous hormone with hemostatic factor levels in postmenopause. • Estrone levels were inversely associated with the natural anticoagulant, protein S antigen. • Dehydroepiandrosterone sulfate levels were inversely associated with thrombin generation. Summary Background Oral use of exogenous estrogen/progestin alters hemostatic factor levels. The influence of endogenous hormones on these levels is incompletely characterized. Objectives Our study aimed to test whether, among postmenopausal women, high levels of estradiol (E2), estrone (E1), testosterone (T), dehydroepiandrosterone sulfate (DHEAS), dehydroepiandrosterone (DHEA), and androstenedione, and low levels of sex hormone‐binding globulin (SHBG), are positively associated with measures of thrombin generation (TG), a normalized activated protein C sensitivity ratio (nAPCsr), and factor VII activity (FVIIc), and negatively associated with antithrombin activity (ATc) and total protein S antigen (PSAg). Methods This Heart and Vascular Health study cross‐sectional analysis included 131 postmenopausal women without a prior venous thrombosis who were not currently using hormone therapy. Adjusted mean differences in TG, nAPCsr, FVIIc, ATc and PSAg levels associated with differences in hormone levels were estimated using multiple linear regression. We measured E2, E1, total T, DHEAS, DHEA and androstenedione levels by mass spectrometry, SHBG levels by immunoassay, and calculated the level of free T. Results One picogram per milliliter higher E1 levels were associated with 0.24% lower PSAg levels (95% Confidence Interval [CI]: −0.35, −0.12) and 1 μg mL−1 higher DHEAS levels were associated with 40.8 nm lower TG peak values (95% CI: −59.5, −22.2) and 140.7 nm×min lower TG endogenous thrombin potential (ETP) (95% CI: −212.1, −69.4). After multiple comparisons correction, there was no evidence for other associations. Conclusions As hypothesized, higher E1 levels were associated with lower levels of the natural anticoagulant PSAg. Contrary to hypotheses, higher DHEAS levels were associated with differences in TG peak and ETP that suggest less generation of thrombin.