{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T22:22:16Z","timestamp":1793398936913,"version":"4.5.0"},"reference-count":61,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Sex differences in cardiovascular disease are well established, but the role of androgens and sex hormone\u2013binding globulin (SHBG) remains unclear. We investigated whether these hormones and SHBG mediate sex differences in the risk of stroke and myocardial infarction (MI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">Observational data from the German population\u2010based KORA (Cooperative Health Research in the Region of Augsburg) F4 study (n=1970; mean age, 54\u2009years; 58% men) were used as baseline examination. Incident stroke and incident MI cases were identified through regular follow\u2010ups until the end of 2016. Multivariable linear and Cox regression models were used to explore associations. Mediation analyses were performed to assess direct effects, indirect effects, and the mediating role of androgens (total testosterone, dihydrotestosterone, dehydroepiandrosterone, and dehydroepiandrosterone\u2010sulfate) and SHBG in the association between sex (women versus men) and risk of stroke\/MI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">During a median follow\u2010up of 8.6\u2009years, 71 stroke and 63 MI events occurred. An inconsistent mediatory role was observed for total testosterone and dihydrotestosterone on the association between sex and risk of stroke. The direct effects were 0.42 (95% CI, 0.18\u20130.86) and 0.40 (95% CI, 0.17\u20130.82) and indirect effects were 2.48 (95% CI, 1.27\u20136.17) and 2.90 (95% CI, 1.67\u20136.35) for total testosterone and dihydrotestosterone, respectively. No mediating role was observed for other androgens or SHBG in relation to stroke, and neither androgens nor SHBG mediated the risk of MI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Our findings suggest that both total testosterone and dihydrotestosterone may have dimorphic mediating role with stroke risk, and that these associations may vary between men and women.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.047531","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T13:29:57Z","timestamp":1789738197000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Do Androgens and Sex Hormone\u2013Binding Globulin Mediate Sex Differences in the Risk of Stroke and Myocardial Infarction? The KORA Study"],"prefix":"10.1161","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5538-6073","authenticated-orcid":false,"given":"Hamidreza","family":"Raeisi\u2010Dehkordi","sequence":"first","affiliation":[{"name":"Utrecht University","place":["Utrecht, the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mojgan","family":"Amiri","sequence":"additional","affiliation":[{"name":"Erasmus MC University Medical Center","place":["Rotterdam, the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8416-6440","authenticated-orcid":false,"given":"Barbara","family":"Thorand","sequence":"additional","affiliation":[{"name":"Helmholtz Zentrum M\u00fcnchen\u2013German Research Center for Environmental Health","place":["Neuherberg, Germany"]},{"name":"Partner Site Munich\u2010Neuherberg","place":["Neuherberg, Germany"]},{"name":"LMU Munich, Pettenkofer School of Public Health","place":["Munich, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6645-0985","authenticated-orcid":false,"given":"Annette","family":"Peters","sequence":"additional","affiliation":[{"name":"Helmholtz Zentrum M\u00fcnchen\u2013German Research Center for Environmental Health","place":["Neuherberg, Germany"]},{"name":"Partner Site Munich\u2010Neuherberg","place":["Neuherberg, Germany"]},{"name":"LMU Munich, Pettenkofer School of Public Health","place":["Munich, Germany"]},{"name":"Partner Site Munich Heart Alliance","place":["Munich, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7804-1740","authenticated-orcid":false,"given":"Wolfgang","family":"Rathmann","sequence":"additional","affiliation":[{"name":"Leibniz Centre for Diabetes Research at Heinrich Heine University of D\u00fcsseldorf","place":["D\u00fcsseldorf, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanja","family":"Zeller","sequence":"additional","affiliation":[{"name":"University of L\u00fcbeck, University Medical Center Schleswig Holstein","place":["L\u00fcbeck, Germany"]},{"name":"Partner Site Hamburg\/Kiel\/L\u00fcbeck","place":["L\u00fcbeck, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9259-0199","authenticated-orcid":false,"given":"Jerzy","family":"Adamski","sequence":"additional","affiliation":[{"name":"German Research Center for Environmental Health","place":["Neuherberg, Germany"]},{"name":"National University of Singapore","place":["Singapore"]},{"name":"University of Ljubljana","place":["Ljubljana, Slovenia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4606-4929","authenticated-orcid":false,"given":"Oscar H.","family":"Franco","sequence":"additional","affiliation":[{"name":"Utrecht University","place":["Utrecht, the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4605-435X","authenticated-orcid":false,"given":"Yvonne T.","family":"van der Schouw","sequence":"additional","affiliation":[{"name":"Utrecht University","place":["Utrecht, the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3235-3073","authenticated-orcid":false,"given":"Taulant","family":"Muka","sequence":"additional","affiliation":[{"name":"Epistudia","place":["Bern, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4731-5491","authenticated-orcid":false,"given":"Jana","family":"Nano","sequence":"additional","affiliation":[{"name":"Helmholtz Zentrum M\u00fcnchen\u2013German Research Center for Environmental Health","place":["Neuherberg, Germany"]},{"name":"LMU Munich, Pettenkofer School of Public Health","place":["Munich, Germany"]},{"name":"Technical University of Munich","place":["Munich, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.11.010"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.yfrne.2017.04.001"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1210\/er.2015-1137"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.116.307301"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/circresaha.117.311681"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsxm.2018.06.012"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.12.005"},{"key":"e_1_3_2_9_2","first-page":"139","volume-title":"Testosterone and Cardiovascular Health","author":"Elagizi A","year":"2024","unstructured":"Elagizi A, Gersh FL, Lavie CJ, Laukkanen JA, O'Keefe JH. Testosterone and Cardiovascular Health. Oxford University Press; 2024:139\u2013141."},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaf262"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.7326\/M23-2781"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.3275\/8881"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000091114.36254.f3"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000157697.54255.CE"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2024.107686"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1080\/13697137.2023.2250252"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-2664"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013-3576"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2009.04.016"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1530\/JOE-12-0455"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgad590"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1210\/er.2003-0005"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l476"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2021.06.037"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaa518"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0164704"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsbmb.2017.08.004"},{"key":"e_1_3_2_28_2","unstructured":"Biocrates . AbsoluteIDQ Stero17 Kit. Increased Confidence in Steroid Hormone Analysis. 2019. https:\/\/www.biocrates.com\/products\/research\u2010products\/absoluteidq\u2010stero17\u2010kit."},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaf414"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(91)90036-9"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/30.9.1121"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0735-1097(00)00804-4"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-024-02179-1"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1289\/EHP5478"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1037\/a0031034"},{"key":"e_1_3_2_36_2","volume-title":"Explanation in Causal Inference: Methods for Mediation and Interaction","author":"VanderWeele T","year":"2015","unstructured":"VanderWeele T. Explanation in Causal Inference: Methods for Mediation and Interaction. Oxford University Press; 2015."},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-019-00494-6"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0000000000001378"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-024-01136-2"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-024-02494-7"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2008-2416"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13293-023-00546-3"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1111\/joim.12943"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1111\/cen.12452"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2022.106669"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2015-2687"},{"key":"e_1_3_2_47_2","first-page":"509","article-title":"Neuroprotective role of testosterone in the nervous system","volume":"56","author":"Bia\u0142ek M","year":"2004","unstructured":"Bia\u0142ek M, Zaremba P, Borowicz KK, Czuczwar SJ. Neuroprotective role of testosterone in the nervous system. Pol J Pharmacol. 2004;56:509\u2013518.","journal-title":"Pol J Pharmacol"},{"key":"e_1_3_2_48_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2010-0266"},{"key":"e_1_3_2_49_2","doi-asserted-by":"publisher","DOI":"10.1080\/13685538.2018.1482487"},{"key":"e_1_3_2_50_2","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgab715"},{"key":"e_1_3_2_51_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.brainres.2014.02.028"},{"key":"e_1_3_2_52_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(15)00284-3"},{"key":"e_1_3_2_53_2","doi-asserted-by":"publisher","DOI":"10.1177\/2047487318778346"},{"key":"e_1_3_2_54_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2018.05.051"},{"key":"e_1_3_2_55_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.028905"},{"key":"e_1_3_2_56_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.000485"},{"key":"e_1_3_2_57_2","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2007.099291"},{"key":"e_1_3_2_58_2","doi-asserted-by":"publisher","DOI":"10.1111\/1440-1681.13146"},{"key":"e_1_3_2_59_2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1223162"},{"key":"e_1_3_2_60_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2215025"},{"key":"e_1_3_2_61_2","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyac036"},{"key":"e_1_3_2_62_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-020-0751-5"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.125.047531","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T07:16:54Z","timestamp":1790320614000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.125.047531"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,18]]},"references-count":61,"alternative-id":["10.1161\/JAHA.125.047531"],"URL":"https:\/\/doi.org\/10.1161\/jaha.125.047531","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,18]]},"assertion":[{"value":"2026-04-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-31","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e047531"}}