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Relationship Between Higher Estradiol Levels and 9‐Year Mortality in Older Women: The Invecchiare in Chianti Study
Author(s) -
Maggio Marcello,
Ceda Gian Paolo,
Lauretani Fulvio,
Bandinelli Stefania,
Ruggiero Carmelinda,
Guralnik Jack M.,
Jeffrey Metter E.,
Ling Shari M.,
Paolisso Giuseppe,
Valenti Giorgio,
Cappola Anne R.,
Ferrucci Luigi
Publication year - 2009
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2009.02464.x
Subject(s) - medicine , hazard ratio , confidence interval , menopause , diabetes mellitus , population , hormone replacement therapy (female to male) , stroke (engine) , testosterone (patch) , endocrinology , mechanical engineering , environmental health , engineering
OBJECTIVES: To investigate the relationship between total estradiol (E2) levels and 9‐year mortality in older postmenopausal women not taking hormone replacement therapy (HRT). DESIGN: Population‐based study of persons living in the Chianti geographic area (Tuscany, Italy). SETTING: Community. PARTICIPANTS: A representative sample of 509 women aged 65 and older with measures of total E2. MEASUREMENTS: Serum total E2 was measured at the University of Parma using ultrasensitive radioimmunoassay (RIA). RESULTS: Women who died (n=135) during 9 years of follow up were older; had higher total E2 levels; and were more likely to have evidence of stroke, hypertension, diabetes mellitus, and congestive heart failure at baseline than survivors. Higher E2 levels were associated with a greater likelihood of death (hazard ratio (HR)=1.03, 95% confidence interval (CI)=1.01–1.06), and the relationship was independent of age, waist:hip ratio, C‐reactive protein, education, cognitive function, physical activity, caloric intake, smoking, and chronic disease (HR=1.08 pg/mL, 95% CI=1.03–1.13, P =.003). The excessive risk of death associated with higher total E2 was not attenuated after adjustment for total testosterone (HR=1.12, 95% CI=1.02–1.18, P <.001) and after further adjustment for insulin resistance evaluated using the homeostasis model assessment (HR=1.07, 95% CI=1.03–1.17, P <.001). Total E2 was highly predictive of death after more than 5 years (HR=1.42: CI 1.01–1.91, P =.04) and not predictive of death for less than 5 years ( P =.78). CONCLUSION: Higher total E2 concentration predicts mortality in older women not taking HRT.