title: Cortisol, estrogens and risk of ischaemic heart disease, cancer and all-cause mortality in postmenopausal women: a prospective cohort study.
abstract: BACKGROUND
  Chronic stress may affect morbidity and mortality through neuroendocrine changes, and the ratio of cortisol to sex steroid hormones has been suggested as a biomarker of stress. We aim to address a relation between the ratio of cortisol to estrogens (C/E) and risk of ischaemic heart disease (IHD), hormone-dependent cancers and all-cause mortality among postmenopausal women.
  
  
  METHODS
  Estradiol and cortisol were measured in a subset of 838 women randomly drawn from the second wave of the Copenhagen City Heart Study (n = 5297 examined in 1981-83) as well as among all women who developed hormone-dependent cancers after baseline. The participants were followed in nationwide registers until 2007, with < 0.1% loss to follow-up.
  
  
  RESULTS
  The C/E ratio was not associated with self-reported stress, and there were no clear associations with IHD (highest vs lowest quartile: HR = 1.23; 95% confidence interval 0.83-1.81), hormone-dependent cancers (0.69; 0.45-1.08) or all-cause mortality (1.10; 0.86-1.41).
  
  
  CONCLUSIONS
  The C/E ratio was not associated with morbidity and mortality in women, and we cannot replicate the robust findings of a relation between the cortisol to testosterone ratio and IHD previously reported in men. Whether the C/E ratio is a reasonable biomarker of stress is debatable.
authors.affiliation: Department of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark, Task-Consult, Copenhagen, Denmark. n.rod@pubhealth.ku.dk
authors.forename: Naja Hulvej
authors.initials: NH
authors.lastname: Rod
authors.forename: Tage S
authors.initials: TS
authors.lastname: Kristensen
authors.forename: Finn
authors.initials: F
authors.lastname: Diderichsen
authors.forename: Eva
authors.initials: E
authors.lastname: Prescott
authors.forename: Gorm B
authors.initials: GB
authors.lastname: Jensen
authors.forename: Ase Marie
authors.initials: AM
authors.lastname: Hansen
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D003718:Denmark / Q000453:epidemiology; D004958:Estradiol / Q000097:blood*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality*; D009376:Neoplasms, Hormone-Dependent / Q000401:mortality*; D017698:Postmenopause / Q000097:blood*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D013315:Stress, Psychological / Q000097:blood*
chemical_list: D015415:Biomarkers; D004958:Estradiol; D006854:Hydrocortisone