The Journal of Clinical Endocrinology and Metabolism Journal Article

Sex Hormones and Incident Heart Failure (ARIC)

October 26, 2020
 

Di Zhao, Eliseo Guallar, Christie M Ballantyne, Wendy S Post, Pamela Ouyang, Dhananjay Vaidya, Xiaoming Jia, Wendy Ying, Vinita Subramanya, Chiadi E Ndumele, Ron C Hoogeveen, Erin D Michos
The Journal of Clinical Endocrinology & Metabolism, Volume 105, Issue 10, 1 October 2020, dgaa500
https://doi.org/10.1210/clinem/dgaa500

Abstract

Context

Sex differences exist in heart failure (HF) phenotypes, but there is limited research on the role of sex hormones in HF and its subtypes.

Objective

To examine the associations of total testosterone, dehydroepiandrosterone sulfate (DHEA-S), and sex hormone-binding globulin (SHBG) with incident HF, HF with preserved ejection fraction (HFpEF), and HF with reduced ejection fraction (HFrEF).

Design

Atherosclerosis Risk in Communities (ARIC) study (prospective cohort study). Median follow-up is 19.2 years.

Setting

General community.

Participants

4107 men and 4839 postmenopausal women, with mean age of 63.2 (standard deviation [SD] 5.7) and 62.8 (5.5) years, respectively.

Exposure

Plasma sex hormone levels were measured at visit 4 (1996–1998).

Main Outcome Measures

Incident HF events were identified through hospital discharge codes and death certificates.

Results

The Hazard Ratios for HF associated with 1 SD decrease in log-transformed total testosterone, DHEA-S, and SHBG were 1.10 (95% confidence interval 1.03, 1.17), 1.07 (1.00, 1.15), and 1.04 (0.96, 1.11) in men, and 1.05 (0.99, 1.13), 1.17 (1.09, 1.24), and 0.93 (0.85, 1.01) in women, respectively. The associations between sex hormones with subtypes of HF had similar patterns but were attenuated and became statistically insignificant.

Conclusion

In this prospective cohort, lower levels of endogenous testosterone and DHEA-S in men and DHEA-S in postmenopausal women were associated with the development of HF. Similar directions of association in both sexes and both HF subtypes suggest that sex hormones play a role in the development of HF through common pathways regardless of sex.

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