George Institute for Global Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Int J Epidemiol. 2021 Aug 30;50(4):1241-1249. doi: 10.1093/ije/dyaa284.
It is commonly assumed that high oestradiol levels in women are cardioprotective. We assessed the association between oestradiol and the risk of incident myocardial infarction (MI) in women.
We used data from 263 295 female UK Biobank participants [mean age 56.2; standard deviation (SD) 8.0 years] without previous cardiovascular disease (CVD). Associations of oestradiol with age and other cardiovascular risk factors were assessed. Cox proportional hazards models estimated crude, ag- and multiple-adjusted hazard ratios (HR) for MI associated with oestradiol levels.
After a mean follow-up of 9 years, 2206 incident cases of MI had been recorded, including 230 events among the 57 204 women (mean age 48) with detectable oestradiol levels. In the unadjusted analyses, a unit higher in log-transformed oestradiol was associated with an HR [95% confidence interval (CI) for MI of 0.73 (0.58; 0.92)]. After adjusting for age, this HR became 0.94 (0.75; 1.17), and after further adjusting for classical CVD risk factors, it was 1.05 (0.83; 1.31. Results were similar in subgroup analyses defined by age, menopausal status, socioeconomic status, contraceptive pill use and the use of hormone replacement therapy. The multivariable-adjusted HR for the 171 431 women (mean age 59) with undetectable levels of oestradiol, compared with those with detectable levels, was 0.97 (0.92; 1.02).
Higher levels of oestradiol were not associated with a decreased risk of MI. The presumed cardioprotective effects of oestradiol seem to be largely confounded by age and further confounded by other cardiovascular risk factors.
人们普遍认为女性体内的高雌激素水平具有心脏保护作用。我们评估了女性体内雌激素与心肌梗死（MI）发病风险之间的关系。
我们使用了 263295 名英国生物库女性参与者的数据（平均年龄 56.2 岁；标准差 [SD] 8.0 岁），这些参与者均无心血管疾病（CVD）病史。我们评估了雌激素与年龄和其他心血管危险因素的相关性。Cox 比例风险模型估计了 MI 与雌激素水平相关的未经调整、按年龄调整和多因素调整的风险比（HR）。
平均随访 9 年后，记录了 2206 例 MI 发病事件，其中在可检测到雌激素水平的 57204 名女性（平均年龄 48 岁）中，有 230 例发生了事件。在未调整的分析中，log 转换后的雌激素每增加一个单位，与 MI 的 HR[95%置信区间（CI）为 0.73（0.58；0.92）]相关。在调整年龄后，该 HR 变为 0.94（0.75；1.17），在进一步调整经典 CVD 危险因素后，该 HR 变为 1.05（0.83；1.31）。亚组分析结果相似，这些亚组按年龄、绝经状态、社会经济地位、避孕药使用和激素替代疗法进行了定义。与可检测到雌激素水平的女性相比，171431 名（平均年龄 59 岁）雌激素水平不可检测的女性的多变量调整 HR 为 0.97（0.92；1.02）。
较高水平的雌激素与 MI 发病风险降低无关。雌激素的预期心脏保护作用似乎在很大程度上受到年龄的影响，并且进一步受到其他心血管危险因素的影响。
