Prospective study of endogenous sex hormones and fatal cardiovascular disease in postmenopausal women

Abstract

Objectives: To examine the association between androstenedione, total and bioavailable testosterone, oestrone, and total and bioavailable oestradiol concentrations and the risk of death from cardiovascular and ischaemic heart disease. Design: 19 year old population based prospective study with 99.9% follow up. Setting: Rancho Bernardo, california. Subjects: 651 postmenopausal women, none taking oestrogen. Main outcome measures: Concentrations of plasma sex hormones measured by radioimmunoassay in an endocrinology research laboratory. Cardiovascular and ischaemic heart disease deaths assessed by death certificate; 85% of 30% sample validated by record review. Results: Age adjusted concentrations of sex hormones did not differ significantly in women with and without a history of heart disease at baseline and did not predict cardiovascular death or death from ischaemic heart disease. Most 95% confidence intervals for the age adjusted relative risk of cardiovascular death or death from ischaemic heart disease were narrow, and all included one. Endogenous oestrogen concentrations were not associated with significantly more favourable risk factors for heart disease, and testosterone was not associated with less favourable risk factors. Conclusion: These prospective data do not support a causal or preventive role for endogenous oestrogens or androgens and cardiovascular mortality in older women.