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Extremes of an aromatase index predict increased 25‐year risk of cardiovascular mortality in older women
Author(s) -
Laughlin Gail A.,
Ix Joachim H.,
Cummins Kevin,
Allison Matthew A.,
Daniels Lori B.
Publication year - 2012
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.2011.04287.x
Subject(s) - medicine , body mass index , endocrinology , prospective cohort study , waist , waist–hip ratio , risk factor
Summary Background Peripheral conversion of androgens to oestrogens via aromatase is the primary source of oestrogen in postmenopausal women and may play a role in cardiovascular health. Design Prospective. Participants, Measurements The association of an index of aromatase activity (AROM), the serum oestrone‐to‐androstenedione ratio, with 25‐year cardiovascular disease (CVD) mortality was examined in 819 postmenopausal non‐oestrogen using women (mean age at baseline = 72). Results Overall, 247 deaths were attributed to CVD. The median AROM value was 60 (95% range 17–129). AROM was positively correlated with age ( r = 0·28) and body mass index (BMI) ( r = 0·22) ( P < 0·001). The age‐adjusted risk for CVD mortality was significantly elevated for women in the lowest (HR = 2·01, 95% CI 1·31–3·12) and highest (HR = 1·51, 95%CI 1·02–2·22) quintiles of AROM, compared with the middle quintile. This U‐shaped association persisted after additional adjustment for BMI, waist‐to‐hip ratio, exercise, smoking, alcohol use and traditional CVD risk factor covariates. There was a significant interaction of AROM and BMI ( P = 0·001), such that high AROM was associated with a 63% reduction in risk of CVD death for women with low BMI (<22 kg/m 2 ), but with 2·1‐ to 2·5‐fold increased risk in women with mid‐range (22–<25 kg/m 2 ) and high (≥25 kg/m 2 ) BMI. Oestradiol did not influence AROM associations and was not independently related to CVD death. Conclusions These results suggest that aromatase is a novel endocrine factor predictive of CVD mortality among postmenopausal women. If confirmed, additional studies are needed to determine whether extremes of aromatase reflect genetic influences or underlying disease processes.