Open AccessHigh Level of Plasma Estradiol as a New Predictor of Ischemic Arterial Disease in Older Postmenopausal Women: The Three‐City Cohort Study
Author(s) -
ScarabinCarré Valérie,
Caico Marianne,
BraillyTabard Sylvie,
Trabado Séverine,
Ducimetière Pierre,
Giroud Maurice,
Ryan Joanne,
Helmer Catherine,
PluBureau Geneviève,
GuiochonMantel Anne,
Scarabin PierreYves
Publication year - 2012
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.112.001388
Subject(s) - medicine , cohort , postmenopausal women , disease , cohort study , coronary artery disease , cardiology
Background Despite evidence that estrogens may be involved in atherothrombosis, the role of endogenous sex steroid hormones in ischemic arterial disease among postmenopausal women remains uncertain. Methods and Results In the Three‐City prospective cohort study of subjects (n=9294) >65 years of age, we investigated the association of total 17β‐estradiol, bioavailable 17β‐estradiol, and total testosterone with the 4‐year incidence of ischemic arterial disease among postmenopausal women who did not use any hormone therapy. We designed a case–cohort study including a random sample of 537 subjects and 106 incident cases of first cardiovascular events. Weighted Cox proportional‐hazards models with age as the time scale were used to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) for ischemic arterial disease by a 1–standard deviation increase in sex steroid hormones. In univariate analysis, HR of ischemic arterial disease was positively and significantly associated with both total and bioavailable estradiol levels. These associations remained significant after adjustment for traditional cardiovascular risk factors, including body mass index, diabetes, hypercholesterolemia, hypertension, and smoking status (HR: 1.42, 95% CI: 1.12–1.79, P <0.01; and HR: 1.42, 95% CI: 1.12–1.78, P <0.01, respectively). Separate analysis for coronary heart disease yielded similar results (adjusted HR: 1.49, 95% CI: 1.10–2.02, P =0.01; and adjusted HR: 1.50, 95% CI: 1.11–2.04, P <0.01, respectively), and a borderline significant trend was observed for ischemic stroke (HR: 1.34, 95% CI: 0.95–1.89, P =0.08; and HR: 1.32, 95% CI: 0.94–1.84, P =0.11, respectively). By contrast, no significant association was found between total testosterone and ischemic arterial disease in both univariate and adjusted analyses. Conclusions High plasma level of endogenous estradiol emerges as a new predictor of ischemic arterial disease in older postmenopausal women. ( J Am Heart Assoc . 2012;1:e001388 doi : 10.1161/JAHA.112.001388 .)