Influence of sex and hormone status on circulating natriuretic peptides

Carolyn S.P. Lam, Susan Cheng, Karen Choong, Martin G. Larson, Joanne M. Murabito, Christopher Newton-Cheh, Shalender Bhasin, Elizabeth L. McCabe, Karen K. Miller, Margaret M. Redfield, Ramachandran S. Vasan, Andrea D. Coviello, Thomas J. Wang

Research output: Contribution to journalArticlepeer-review

88 Scopus citations


Objectives: The aim of this study was to assess the relationship between sex hormones and natriuretic peptide levels in community-based adults. Background: Women have higher circulating natriuretic peptide concentrations than men, but the mechanisms for these sex-related differences and the impact of hormone therapy are unclear. Experimental studies suggest that androgens may suppress natriuretic peptide secretion. Methods: We measured N-terminal proB-type natriuretic peptide (NT-proBNP), total testosterone, and sex hormonebinding globulin plasma levels in 4,056 men and women (mean age 40 ± 9 years) from the Framingham Heart Study Third-Generation cohort. Sex/hormone status was grouped as: 1) men; 2) post-menopausal women not receiving hormone replacement therapy; 3) pre-menopausal women not receiving hormonal contraceptives; 4) post-menopausal women receiving hormone replacement therapy; and 5) pre-menopausal women receiving hormonal contraceptives. Results: Circulating NT-proBNP levels were associated with sex/hormone status (overall p < 0.0001). Men had lower NT-proBNP levels than women of all menopause or hormone groups, and women receiving hormonal contraceptives had higher NT-proBNP levels than women who were not receiving hormone therapy (all p < 0.0001). These relationships remained significant after adjusting for age, body mass index, and cardiovascular risk factors. Across sex/hormone status groups, free testosterone (FT) levels decreased and sex hormonebinding globulin levels increased in tandem with increasing NT-proBNP levels. In sex-specific analyses, NT-proBNP levels decreased across increasing quartiles of FT in men (p for trend <0.01) and women (p for trend <0.0001). Adjustment for FT markedly attenuated the association between sex/hormone status and NT-proBNP concentrations. Conclusions: These findings suggest that lower levels of circulating androgens and the potentiating effect of exogenous female hormone therapy contribute to the higher circulating NT-proBNP concentrations in women.

Original languageEnglish (US)
Pages (from-to)618-626
Number of pages9
JournalJournal of the American College of Cardiology
Issue number6
StatePublished - Aug 2 2011


  • hormones
  • natriuretic peptides
  • sex

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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