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Sex Hormone-Binding Globulin and Insulin-Like Growth Factor-Binding Protein-1 as Indicators of Metabolic Syndrome, Cardiovascular Risk, and Mortality in Elderly Men

Departments of Obstetrics and Gynecology (T.K., R.K., M.H., M.L., P.L.) and Clinical Chemistry (M.S.), Helsinki University Central Hospital, FIN-00029 Helsinki, Finland; Jorvi Hospital (T.K.), FIN-02740 Espoo, Finland; Department of Epidemiology and Health Promotion, National Public Health Institute (Q.Q., A.N., J.T.), FIN-00300 Helsinki, Finland; Department of Neuroscience, Kuopio University Hospital (A.N.), FIN-70211 Kuopio, Finland; Department of Public Health, University of Helsinki (Q.Q., J.T.), FIN-00300 Helsinki, Finland; and South Ostrobotnia Central Hospital (J.T.), FIN-60220 Seinäjoki, Finland

Address all correspondence and requests for reprints to: Dr. Jaakko Tuomilehto, Diabetes and Genetic Epidemiology Unit, Department of Epidemiology and Health Promotion, National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland. E-mail: jaakko.tuomilehto{at}ktl.fi.

Two binding proteins, SHBG and IGF-binding protein-1 (IGFBP-1), are both down-regulated by insulin and therefore could serve as potential indicators of the metabolic syndrome and hyperinsulinemia-related cardiovascular risk. We compared serum SHBG and IGFBP-1 as potential markers of abnormal glucose tolerance, the metabolic syndrome, diabetes mellitus, cardiovascular risk factors, and total, cardiovascular, and coronary heart disease mortality in elderly men. Of the original cohort of 1711 men, 524 were alive on January 1, 1989, and 413 participated in the 30-yr examination, of whom 335 men, aged 70–89 yr, formed the study group for the present analysis. Low SHBG and IGFBP-1 were both associated with an increased prevalence of abnormal glucose tolerance and the metabolic syndrome, but only SHBG was associated with diabetes mellitus. SHBG was less influenced by body mass index than IGFBP-1. Low SHBG indicated increased cardiovascular and coronary disease mortality; the association remained after adjustment for abnormal glucose tolerance, but not after adjustment for prevalent cardiovascular disease. IGFBP-1 had no association with mortality. It is concluded that low SHBG is a better indicator of increased cardiovascular mortality than low or high IGFBP-1.

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