Epidemiology and Community Health Branch, National Heart Lung and Blood Institute, Bethesda, MD, USA.
Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
Eur J Heart Fail. 2024 Mar;26(3):540-550. doi: 10.1002/ejhf.3189. Epub 2024 Mar 25.
Serum sex hormones have been linked to cardiovascular disease risk. However, their roles in the pathogenesis of heart failure (HF) in both men and women are unclear. We investigated the associations between free androgen, testosterone, and estradiol, and future risk of HF.
This prospective cohort study evaluated UK Biobank participants free of prevalent cardiovascular disease and HF at baseline. Unitless free androgen, testosterone, and estradiol indices were generated using serum concentrations of total testosterone (nmol/L), estradiol (pmol/L), sex hormone binding globulin (SHBG, nmol/L), and albumin (g/L) in blood collected at enrolment. Multivariable Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident HF in relation to quartiles (Q) of free androgen (FAI), testosterone (FTI), estradiol (FEI) indices, and potential confounders. There were 180 712 men (including 5585 HF cases with FAI and 571 HF cases with FEI), and 177 324 women (including 2858 HF cases with FAI and 314 HF cases with FEI) with complete data. Increased FAI was associated with decreased HF risk in both men (HR: 0.86, 95% CI 0.79-0.94, p-trend < 0.0001) and post-menopausal women (HR: 0.83, 95% CI 0.73-0.95). Similar inverse associations were observed for FTI only in men (HR: 0.91, 95% CI 0.83-0.98). Higher FEI was significantly associated with decreased HF risk among men (HR: 0.76, 95% CI 0.59-0.98), but was positively associated among pre-menopausal women (HR: 2.16, 95% CI 1.11-4.18).
Sex hormones potentially influence HF pathogenesis and may offer pathways for interventions.
血清性激素与心血管疾病风险相关。然而，它们在男性和女性心力衰竭（HF）发病机制中的作用尚不清楚。我们研究了游离雄激素、睾酮和雌二醇与未来 HF 风险之间的关系。
这项前瞻性队列研究评估了英国生物库中基线时无心血管疾病和 HF 的参与者。使用在入组时采集的血液中总睾酮（nmol/L）、雌二醇（pmol/L）、性激素结合球蛋白（SHBG，nmol/L）和白蛋白（g/L）的浓度，生成无单位游离雄激素（FAI）、睾酮（FTI）、雌二醇（FEI）指数，并使用多变量 Cox 回归来估计与游离雄激素（FAI）、睾酮（FTI）、雌二醇（FEI）指数四分位数（Q）相关的 HF 发生率的风险比（HR）和 95%置信区间（CI），以及潜在的混杂因素。共有 180712 名男性（包括 5585 例 FAI 心衰病例和 571 例 FEI 心衰病例）和 177324 名女性（包括 2858 例 FAI 心衰病例和 314 例 FEI 心衰病例）有完整的数据。在男性（HR：0.86，95%CI 0.79-0.94，p-trend<0.0001）和绝经后女性（HR：0.83，95%CI 0.73-0.95）中，FAI 升高与 HF 风险降低相关。仅在男性中观察到 FTI 的类似反向关联（HR：0.91，95%CI 0.83-0.98）。FEI 较高与男性 HF 风险降低显著相关（HR：0.76，95%CI 0.59-0.98），但在绝经前女性中呈正相关（HR：2.16，95%CI 1.11-4.18）。
性激素可能影响 HF 的发病机制，并可能为干预提供途径。
