Male sex hormone, preeclampsia link found.

Doctors have long been baffled by what seemed to be a strange repercussion of preeclampsia, a complication of pregnancy. Women who have had this condition face double or triple the normal risk of developing heart disease in later years. Although the symptoms of preeclampsia -- high blood pressure, protein in the urine, and swelling -- largely disappear after pregnancy, the cardiovascular risk lingers for decades.

Finnish researchers now suggest that this risk may not be a consequence of preeclampsia at all. Rather, preeclampsia may simply be a harbinger of cardiovascular problems.

Their conclusion stems from the finding that women who have had preeclampsia also have higher-than-average concentrations of testosterone, a male sex hormone that is also present in women. While the female hormone estrogen seems to protect against cardiovascular disease, researchers suspect that testosterone may increase the risk. That difference -would explain, in part, why young and middle-aged men have more heart problems than women of the same age. As women's estrogen production drops with age, heart disease risks even out between the sexes.

The researchers compared blood taken from 22 women who had had preeclampsia during pregnancy an average of 17 years earlier with samples from 22 women who had had normal pregnancies. Although the preeclamptic women had elevated testosterone, they did not have unusual concentrations of several other metabolic hormones, the team of Finnish researchers reports in the February Journal of Clinical Endocrinology and Metabolism. Had preeciampsia engendered a fundamental metabolic change, concentrations of the other hormones would also have been abnormal, argues study coauthor Olavi R. Ylikorkala, an obstetric gynecologist at Helsinki University Central Hospital.

The tests also indicated that the preeclampsia group had slightly higher blood pressure, although not high enough to warrant medication. In fact, all 44 women in the study were healthy, Ylikorkala says.

In an earlier study, the researchers had found that women with a history of preeciampsia also tend to have high concentrations of insulin in their blood. Such women may be insulin-resistant, a condition in which the islet cells in the pancreas produce insulin but other cells in the body fail to use it efficiently. The body produces more and more insulin as the cells resist the hormone's effects.

It remains unclear which characteristic of these women -- insulin resistance or excess testosterone -- is primarily responsible for the heightened risk of cardiovascular problems later in life, the researchers say. Complicating the matter, laboratory studies have shown that insulin can stimulate ovarian tissue to produce testosterone.

"This finding is really interesting," says James M. Roberts, an obstetric gynecologist at the Magee-Women's Research Institute in Pittsburgh and the University of Pittsburgh. Scientists suspect that obesity may also be a common factor in women who have preeclamptic pregnancies and later heart disease, he says. Insulin resistance and high testosterone concentrations might be signs of an abnormality in metabolizing fat, which would boost the risk of heart disease, he says, and might predispose some women to preeclampsia. The precise cause of the condition remains unknown.

In any case, the finding bolsters the theory that the pregnancy complication "is a signal, not a cause" of heart problems, Roberts says.

Preeclampsia strikes about 1 in 20 pregnant women. Untreated, about 2 percent of preeclwupsia cases develop into eclampsia, a condition marked by potentially lethal seizures or coma.