title: Takotsubo syndrome and estrogen receptor genes: partners in crime?
abstract: OBJECTIVE
  We aimed to analyze genetic polymorphism of estrogen receptor (ESR) 1 and ESR2 in a series of postmenopausal women with Takotsubo syndrome (TS).
  
  
  METHODS
  In total, 81 consecutive white women were prospectively enrolled: 22 with TS (TS group; mean age 71.2 ± 9.8 years), 22 with acute myocardial infarction (MI group; mean age 73.2 ± 8 years), and 37 asymptomatic healthy controls (CTRL group; mean age 69 ± 4.2 years). Genotyping of ESR1 -397C>T (rs2234693) and -351A>G (rs9340799) and ESR2 -1839G>T (rs 1271572) and 1082G>A (rs1256049) genetic variants was performed. We estimated the odds ratio (OR) between the genotype of each examined locus with the occurrence of TS or MI.
  
  
  RESULTS
  The risk of experiencing TS was higher for those study participants carrying the T allele at the rs2234693 locus of the ESR1 gene [OR: 2.0, 95% confidence interval (CI): 0.973-4.11, P = 0.04, TS vs. MI + CTRL; OR: 2.79, 95% CI: 1.17-6.64, P = 0.016, TS vs. MI alone]. Women carrying a T allele at the rs1271572 locus of the ESR2 gene demonstrated an even higher risk (OR: 3.23, 95% CI: 1.55-6.73, P = 0.0019, TS vs. MI + CTRL; OR: 9.13, 95% CI: 2.78-29.9, P = 0.0001, TS vs. MI alone).
  
  
  CONCLUSIONS
  The study reports preliminary findings suggesting a possible link between ESR polymorphisms and the occurrence of TS. Larger studies are needed to confirm our results.
authors.affiliation: aSection of Pharmacology bSection of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy cAurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin, USA dDepartment of Emergency and Cardiology, San Antonio Hospital, San Daniele del Friuli, Udine eDepartment of Translational Medicine, Università del Piemonte Orientale Amedeo Avogadro, Novara fHeart Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona,' Salerno gDepartment of Paediatric, Gynaecological, Microbiological and Biomedical Sciences, University of Messina, Messina, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Pizzino
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bitto
authors.forename: Pasquale
authors.initials: P
authors.lastname: Crea
authors.forename: Bijoy
authors.initials: B
authors.lastname: Khandheria
authors.forename: Olga
authors.initials: O
authors.lastname: Vriz
authors.forename: Scipione
authors.initials: S
authors.lastname: Carerj
authors.forename: Francesco
authors.initials: F
authors.lastname: Squadrito
authors.forename: Rosalba
authors.initials: R
authors.lastname: Minisini
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Citro
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cusmà-Piccione
authors.forename: Antonio
authors.initials: A
authors.lastname: Madaffari
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Andò
authors.forename: Domenica
authors.initials: D
authors.lastname: Altavilla
authors.forename: Concetta
authors.initials: C
authors.lastname: Zito
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D004452:Echocardiography; D004562:Electrocardiography; D047628:Estrogen Receptor alpha / Q000235:genetics*; D047629:Estrogen Receptor beta / Q000235:genetics*; D005260:Female; D056726:Genetic Association Studies; D020022:Genetic Predisposition to Disease; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D010641:Phenotype; D020641:Polymorphism, Single Nucleotide; D017698:Postmenopause; D012307:Risk Factors; D013318:Stroke Volume; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis / Q000235:genetics* / Q000503:physiopathology; D016277:Ventricular Function, Left
chemical_list: C506487:ESR1 protein, human; C000600034:ESR2 protein, human; D047628:Estrogen Receptor alpha; D047629:Estrogen Receptor beta