title: Relationship between higher estradiol levels and 9-year mortality in older women: the Invecchiare in Chianti study.
abstract: OBJECTIVE
  To investigate the relationship between total estradiol (E2) levels and 9-year mortality in older postmenopausal women not taking hormone replacement therapy (HRT).
  
  
  METHODS
  Population-based study of persons living in the Chianti geographic area (Tuscany, Italy).
  
  
  METHODS
  Community.
  
  
  METHODS
  A representative sample of 509 women aged 65 and older with measures of total E2.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  Higher total E2 concentration predicts mortality in older women not taking HRT.
authors.affiliation: Department of Internal Medicine and Biomedical Sciences, Section of Geriatrics, University of Parma, Parma, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Maggio
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Ceda
authors.forename: Fulvio
authors.initials: F
authors.lastname: Lauretani
authors.forename: Stefania
authors.initials: S
authors.lastname: Bandinelli
authors.forename: Carmelinda
authors.initials: C
authors.lastname: Ruggiero
authors.forename: Jack M
authors.initials: JM
authors.lastname: Guralnik
authors.forename: E Jeffrey
authors.initials: EJ
authors.lastname: Metter
authors.forename: Shari M
authors.initials: SM
authors.lastname: Ling
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Paolisso
authors.forename: Giorgio
authors.initials: G
authors.lastname: Valenti
authors.forename: Anne R
authors.initials: AR
authors.lastname: Cappola
authors.forename: Luigi
authors.initials: L
authors.lastname: Ferrucci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004958:Estradiol / Q000097:blood*; D005260:Female; D006801:Humans; D009026:Mortality / Q000639:trends; D013997:Time Factors
chemical_list: D004958:Estradiol