Endogenous Sex Hormones and Incident Cardiovascular Disease in Post-Menopausal Women

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:71

Article

Zhao, Di¹  Guallar, Eliseo¹  Ouyang, Pamela²  Subramanya, Vinita²  Vaidya, Dhananjay^1,3  Ndumele, Chiadi E.^1,2  Lima, Joao A.²  Allison, Matthew A.⁴  Shah, Sanjiv J.⁵  Bertoni, Alain G.⁶  Budoff, Matthew J.⁷  Post, Wendy S.^1,2  Michos, Erin D.^1,2 

[1] Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA

[2] Johns Hopkins Univ, Sch Med, Dept Med, Div Cardiol, Baltimore, MD 21205 USA

[3] Johns Hopkins Univ, Sch Med, Dept Med, Div Gen Internal Med, Baltimore, MD 21205 USA

[4] Univ Calif San Diego, Div Prevent Med, La Jolla, CA 92093 USA

[5] Northwestern Univ, Dept Med, Feinberg Sch Med, Div Cardiol, Chicago, IL 60611 USA

[6] Wake Forest Sch Med, Dept Epidemiol & Prevent, Winston Salem, NC USA

[7] Univ Calif Los Angeles, Los Angeles Biomed Res Ctr Harbor, Torrance, CA USA

关键词: cardiovascular disease;    coronary heart disease;    estradiol;    heart failure;    sex hormone binding globulin;    sex hormones;    testosterone;   

DOI  :  10.1016/j.jacc.2018.01.083

来源: Elsevier

【 摘 要 】

BACKGROUND Higher androgen and lower estrogen levels are associated with cardiovascular disease (CVD) risk factors in women. However, studies on sex hormones and incident CVD events in women have yielded conflicting results. OBJECTIVES The authors assessed the associations of sex hormone levels with incident CVD, coronary heart disease (CHD), and heart failure (HF) events among women without CVD at baseline. METHODS The authors studied 2,834 post-menopausal women participating in the MESA (Multi-Ethnic Study of Atherosclerosis) with testosterone, estradiol, dehydroepiandrosterone, and sex hormone binding globulin (SHBG) levels measured at baseline (2000 to 2002). They used Cox hazard models to evaluate associations of sex hormones with each outcome, adjusting for demographics, CVD risk factors, and hormone therapy use. RESULTS The mean age was 64.9 +/- 8.9 years. During 12.1 years of follow-up, 283 CVD, 171 CHD, and 103 HF incident events occurred. In multivariable-adjusted models, the hazard ratio (95% confidence interval [CI]) associated with 1 SD greater log-transformed sex hormone level for the respective outcomes of CVD, CHD, and HF were as follows: total testosterone: 1.14 (95% CI: 1.01 to 1.29), 1.20 (95% CI: 1.03 to 1.40), 1.09 (95% CI: 0.90 to 1.34); estradiol: 0.94 (95% CI: 0.80 to 1.11), 0.77 (95% CI: 0.63 to 0.95), 0.78 (95% CI: 0.60 to 1.02); and testosterone/estradiol ratio: 1.19 (95% CI: 1.02 to 1.40), 1.45 (95% CI: 1.19 to 1.78), 1.31 (95% CI: 1.01 to 1.70). Dehydroepiandrosterone and SHBG levels were not associated with these outcomes. CONCLUSIONS Among post-menopausal women, a higher testosterone/estradiol ratio was associated with an elevated risk for incident CVD, CHD, and HF events, higher levels of testosterone associated with increased CVD and CHD, whereas higher estradiol levels were associated with a lower CHD risk. Sex hormone levels after menopause are associated with women's increased CVD risk later in life. (c) 2018 by the American College of Cardiology Foundation.

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