title: Endogenous sex hormones and cardiovascular disease incidence in men.
abstract: BACKGROUND
  Data suggest that endogenous sex hormones (testosterone, dehydroepiandrosterone sulfate [DHEA-S], and estradiol) influence cardiovascular disease (CVD) risk factors and vascular function. Yet, prospective studies relating sex hormones to CVD incidence in men have yielded inconsistent results.
  
  
  OBJECTIVE
  To examine the association of circulating sex hormone levels and CVD risk in men.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Community-based study in Framingham, Massachusetts.
  
  
  METHODS
  2084 middle-aged white men without CVD at baseline.
  
  
  METHODS
  The authors used multivariable Cox regression to relate baseline levels of testosterone, DHEA-S, and estradiol to the incidence of CVD (coronary, cerebrovascular, or peripheral vascular disease or heart failure) during 10 years of follow-up.
  
  
  RESULTS
  During follow-up, 386 men (18.5%) experienced a first CVD event. After adjustment for baseline standard CVD risk factors, higher estradiol level was associated with lower risk for CVD (hazard ratio per SD increment in log estradiol, 0.90 [95% CI, 0.82 to 0.99]; P = 0.035). The authors observed effect modification by age: Higher estradiol levels were associated with lower CVD risk in older (median age >56 years) men (hazard ratio per SD increment, 0.86 [CI, 0.78 to 0.96]; P = 0.005) but not in younger (median age < or =56 years) men (hazard ratio per SD increment, 1.11 [CI, 0.89 to 1.38]; P = 0.36). The association of higher estradiol level with lower CVD incidence remained robust in time-dependent Cox models (updating standard CVD risk factors during follow-up). Serum testosterone and DHEA-S levels were not statistically significantly associated with incident CVD.
  
  
  CONCLUSIONS
  Sex hormone levels were measured only at baseline, and the findings may not be generalizable to women and nonwhite people.
  
  
  CONCLUSIONS
  In the community-based sample, a higher serum estradiol level was associated with lower risk for CVD events in older men. The findings are consistent with the hypothesis that endogenous estrogen has vasculoprotective influences in men.
authors.affiliation: National Heart, Lung, and Blood Institute's Framingham Heart Study, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Johan
authors.initials: J
authors.lastname: Arnlöv
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pencina
authors.forename: Shreyasee
authors.initials: S
authors.lastname: Amin
authors.forename: Byung-Ho
authors.initials: BH
authors.lastname: Nam
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Murabito
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Wang
authors.forename: Philip E
authors.initials: PE
authors.lastname: Knapp
authors.forename: Ralph B
authors.initials: RB
authors.lastname: D'Agostino
authors.forename: Shalendar
authors.initials: S
authors.lastname: Bhasin
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
mesh_terms: D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology*; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D004958:Estradiol / Q000097:blood; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013739:Testosterone / Q000097:blood
chemical_list: D013739:Testosterone; D004958:Estradiol; D019314:Dehydroepiandrosterone Sulfate