title: Sex hormone levels in patients with sudden cardiac arrest.
abstract: BACKGROUND
  Sex hormones are known to have significant effects on the pathophysiology of cardiovascular disease.
  
  
  OBJECTIVE
  The purpose of this study was to study the association between sex hormone levels and sudden cardiac arrest (SCA).
  
  
  METHODS
  In the ongoing Oregon Sudden Unexpected Death Study (catchment population approximately 1 million), cases of SCA were compared with matched controls. Testosterone and estradiol levels were measured from blood samples drawn at the time of the SCA event in cases and during a routine visit in controls.
  
  
  RESULTS
  Among cases (n = 149, age 64.1 ± 11.7 years, 73.2% male), compared to controls (n = 149, 64.2 ± 11.6 years, 72.5% male), median testosterone levels were significantly lower in males (4.4 vs 5.4 ng/mL, P = .01). Median estradiol levels were higher in male (68 vs 52 pg/mL, P <.001) and female cases (54 vs 36 pg/mL, P <.001). In multivariate analysis, higher testosterone levels were associated with lower SCA odds only in males (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.58-0.96, P = .02). Higher estradiol levels were associated with higher SCA odds in both males (OR 2.0, 95% CI 1.5-2.6, P <.001) and females (OR 3.5, 95% CI 1.9-6.4, P <.001). A higher testosterone/estrogen ratio was associated with lower SCA odds in males only (OR 0.5, 95% CI 0.4-0.7, P <.001). In a canine model of SCA, plasma testosterone levels were not significantly altered by the cardiac arrest event.
  
  
  CONCLUSIONS
  We observed significant differences in sex hormone levels in patients who suffered SCA, with potential mechanistic implications. The role of sex hormones in the genesis of fatal ventricular arrhythmias warrants further exploration.
authors.affiliation: Cedars Sinai Medical Center, Los Angeles, California.
authors.forename: Kumar
authors.initials: K
authors.lastname: Narayanan
authors.affiliation: Cedars Sinai Medical Center, Los Angeles, California; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Havmoeller
authors.affiliation: Cedars Sinai Medical Center, Los Angeles, California.
authors.forename: Kyndaron
authors.initials: K
authors.lastname: Reinier
authors.affiliation: Cedars Sinai Medical Center, Los Angeles, California.
authors.forename: Katherine
authors.initials: K
authors.lastname: Jerger
authors.affiliation: Cedars Sinai Medical Center, Los Angeles, California.
authors.forename: Carmen
authors.initials: C
authors.lastname: Teodorescu
authors.affiliation: Cedars Sinai Medical Center, Los Angeles, California.
authors.forename: Audrey
authors.initials: A
authors.lastname: Uy-Evanado
authors.affiliation: Cedars Sinai Medical Center, Los Angeles, California.
authors.forename: Jo
authors.initials: J
authors.lastname: Navarro
authors.affiliation: Cedars Sinai Medical Center, Los Angeles, California.
authors.forename: Adriana
authors.initials: A
authors.lastname: Huertas-Vazquez
authors.affiliation: Oregon Health and Science University, Portland, Oregon.
authors.forename: Karen
authors.initials: K
authors.lastname: Gunson
authors.affiliation: Oregon Health and Science University, Portland, Oregon.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Jui
authors.affiliation: Cedars Sinai Medical Center, Los Angeles, California. Electronic address: sumeet.chugh@cshs.org.
authors.forename: Sumeet S
authors.initials: SS
authors.lastname: Chugh
mesh_terms: D017677:Age Distribution; D000368:Aged; D000818:Animals; D001145:Arrhythmias, Cardiac / Q000097:blood* / Q000401:mortality* / Q000503:physiopathology; D053840:Brugada Syndrome; D000075224:Cardiac Conduction System Disease; D016022:Case-Control Studies; D016001:Confidence Intervals; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D004195:Disease Models, Animal; D004285:Dogs; D004958:Estradiol / Q000097:blood; D005260:Female; D012739:Gonadal Steroid Hormones / Q000097:blood*; D006329:Heart Conduction System / Q000002:abnormalities* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009922:Oregon / Q000453:epidemiology; D011379:Prognosis; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D013739:Testosterone / Q000097:blood
chemical_list: D012739:Gonadal Steroid Hormones; D013739:Testosterone; D004958:Estradiol
keywords: Estradiol; Sudden cardiac arrest; Testosterone