Association Between Female Androgen Levels , Metabolic Syndrome, and Cardiovascular Disease: An NHANES Analysis (2013-2016)

Background: The impact of androgens on metabolic diseases, cardiovascular diseases (CVD), and long-term mortality in the general female population remains poorly understood. This study, utilizing data from the National Health and Nutrition Examination Survey (NHANES) database managed by the Centers for Disease Control and Prevention, seeks to elucidate the relationship between androgen levels and metabolic syndrome (MS), CVD, and mortality in adult women. Methods: After excluding ineligible individuals, descriptive analyses were conducted on demographic characteristics, metabolicrelated indicators, and disease prevalence, based on the presence of high androgenemia and androgen quartile grouping. Logistic regression models were developed to assess the associations of androgen markers, including total testosterone (TT), Free Androgen Index (FAI), with MS, CVD, and cox regression models were used to explore the relationships with mortality. Results: Our results show that, even without adjustment for age, age at menarche, marital status, and smoking status, both in patients with hyperandrogenemia and across the general population stratified by quartiles of FAI, higher androgen levels are associated with increased waist circumference, weight, Body Mass Index, fasting insulin, and the monocyte/high-density lipoprotein cholesterol ratio. In adjusted correlational analysis, MS remained positively correlated with FAI, even after controlling for age, tobacco use, and alcohol consumption. As FAI quartiles increased, the correlation strengthened, achieving an odds ratio (OR) of 1.45 (95% CI 1.04 to 2.02, P=0.03) in the highest quartile. This indicates that androgen levels are strongly associated with metabolic syndrome, with FAI proving more sensitive than TT. Conclusion: The greater sensitivity of FAI may be attributed to its ability to reflect bioavailable testosterone more accurately than TT, underscoring its potential utility in clinical assessments of metabolic risk. This study found no significant correlation between androgen levels and CVD or mortality.