PMID- 19436016
OWN - NLM
STAT- MEDLINE
DCOM- 20090518
LR  - 20161017
IS  - 1538-3598 (Electronic)
IS  - 0098-7484 (Linking)
VI  - 301
IP  - 18
DP  - 2009 May 13
TI  - Circulating estradiol and mortality in men with systolic chronic heart failure.
PG  - 1892-901
LID - 10.1001/jama.2009.639 [doi]
AB  - CONTEXT: Androgen deficiency is common in men with chronic heart failure (HF) and 
      is associated with increased morbidity and mortality. Estrogens are formed by the 
      aromatization of androgens; therefore, abnormal estrogen metabolism would be 
      anticipated in HF. OBJECTIVE: To examine the relationship between serum 
      concentration of estradiol and mortality in men with chronic HF and reduced left 
      ventricular ejection fraction (LVEF). DESIGN, SETTING, AND PARTICIPANTS: A 
      prospective observational study at 2 tertiary cardiology centers (Wroclaw and 
      Zabrze, Poland) of 501 men (mean [SD] age, 58 [12] years) with chronic HF, LVEF 
      of 28% (SD, 8%), and New York Heart Association [NYHA] classes 1, 2, 3, and 4 of 
      52, 231, 181, and 37, respectively, who were recruited between January 1, 2002, 
      and May 31, 2006. Cohort was divided into quintiles of serum estradiol (quintile 
      1, < 12.90 pg/mL; quintile 2, 12.90-21.79 pg/mL; quintile 3, 21.80-30.11 pg/mL; 
      quintile 4, 30.12-37.39 pg/mL; and quintile 5, > or = 37.40 pg/mL). Quintile 3 
      was considered prospectively as the reference group. MAIN OUTCOME MEASURES: Serum 
      concentrations of estradiol and androgens (total testosterone and 
      dehydroepiandrosterone sulfate [DHEA-S]) were measured using immunoassays. 
      RESULTS: Among 501 men with chronic HF, 171 deaths (34%) occurred during the 
      3-year follow-up. Compared with quintile 3, men in the lowest and highest 
      estradiol quintiles had increased mortality (adjusted hazard ratio [HR], 4.17; 
      95% confidence interval [CI], 2.33-7.45 and HR, 2.33; 95% CI, 1.30-4.18; 
      respectively; P < .001). These 2 quintiles had different clinical characteristics 
      (quintile 1: increased serum total testosterone, decreased serum DHEA-S, advanced 
      NYHA class, impaired renal function, and decreased total fat tissue mass; and 
      quintile 5: increased serum bilirubin and liver enzymes, and decreased serum 
      sodium; all P < .05 vs quintile 3). For increasing estradiol quintiles, 3-year 
      survival rates adjusted for clinical variables and androgens were 44.6% (95% CI, 
      24.4%-63.0%), 65.8% (95% CI, 47.3%-79.2%), 82.4% (95% CI, 69.4%-90.2%), 79.0% 
      (95% CI, 65.5%-87.6%), and 63.6% (95% CI, 46.6%-76.5%); respectively (P < .001). 
      CONCLUSION: Among men with chronic HF and reduced LVEF, high and low 
      concentrations of estradiol compared with the middle quintile of estradiol are 
      related to an increased mortality.
FAU - Jankowska, Ewa A
AU  - Jankowska EA
AD  - Center for Heart Disease, Cardiology Department, Military Hospital, ul Weigla 5, 
      50-981 Wroclaw, Poland. ewa.jankowska@antro.pan.wroc.pl
FAU - Rozentryt, Piotr
AU  - Rozentryt P
FAU - Ponikowska, Beata
AU  - Ponikowska B
FAU - Hartmann, Oliver
AU  - Hartmann O
FAU - Kustrzycka-Kratochwil, Dorota
AU  - Kustrzycka-Kratochwil D
FAU - Reczuch, Krzysztof
AU  - Reczuch K
FAU - Nowak, Jolanta
AU  - Nowak J
FAU - Borodulin-Nadzieja, Ludmila
AU  - Borodulin-Nadzieja L
FAU - Polonski, Lech
AU  - Polonski L
FAU - Banasiak, Waldemar
AU  - Banasiak W
FAU - Poole-Wilson, Philip A
AU  - Poole-Wilson PA
FAU - Anker, Stefan D
AU  - Anker SD
FAU - Ponikowski, Piotr
AU  - Ponikowski P
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - JAMA
JT  - JAMA
JID - 7501160
RN  - 3XMK78S47O (Testosterone)
RN  - 4TI98Z838E (Estradiol)
RN  - 57B09Q7FJR (Dehydroepiandrosterone Sulfate)
SB  - IM
MH  - Aged
MH  - Chronic Disease
MH  - Dehydroepiandrosterone Sulfate/blood
MH  - Estradiol/*blood
MH  - Heart Failure, Systolic/*blood/*mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Prospective Studies
MH  - Stroke Volume
MH  - Survival Rate
MH  - Testosterone/blood
EDAT- 2009/05/14 09:00
MHDA- 2009/05/19 09:00
CRDT- 2009/05/14 09:00
PHST- 2009/05/14 09:00 [entrez]
PHST- 2009/05/14 09:00 [pubmed]
PHST- 2009/05/19 09:00 [medline]
AID - 301/18/1892 [pii]
AID - 10.1001/jama.2009.639 [doi]
PST - ppublish
SO  - JAMA. 2009 May 13;301(18):1892-901. doi: 10.1001/jama.2009.639.