This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Men's Health  • Men's Health, Other  • Cardiovascular System  • Endocrine Diseases  • Endocrine Diseases, Other  • Congestive Heart Failure/ Cardiomyopathy  • Alert me on articles by topic  Social Bookmarking   What's this?

Ewa A. Jankowska, MD, PhD; Piotr Rozentryt, MD, PhD; Beata Ponikowska, MD, PhD; Oliver Hartmann; Dorota Kustrzycka-Kratochwil, PhD; Krzysztof Reczuch, MD, PhD; Jolanta Nowak, MD, PhD; Ludmila Borodulin-Nadzieja, PhD; Lech Polonski, MD, PhD; Waldemar Banasiak, MD, PhD; Philip A. Poole-Wilson, MD, FMedSci; Stefan D. Anker, MD, PhD; Piotr Ponikowski, MD, PhD

JAMA. 2009;301(18):1892-1901.

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, 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.

Author Affiliations: Center for Heart Disease, Cardiology Department, Military Hospital, Wroclaw, Poland (Drs Jankowska, Kustrzycka-Kratochwil, Reczuch, Banasiak, and Ponikowski); Institute of Anthropology, Polish Academy of Sciences, Wroclaw, Poland (Dr Jankowska); Departments of Heart Diseases (Drs Jankowska, Reczuch, and Ponikowski) and Physiology (Drs Ponikowska and Borodulin-Nadzieja), Wroclaw Medical University, Wroclaw, Poland; Third Department of Cardiology, Silesian Center for Heart Disease, Zabrze, Poland (Drs Rozentryt, Nowak, and Polonski); Division of Applied Cachexia Research, Department of Cardiology, Charite, Berlin, Germany (Dr Anker and Mr Hartmann); Center for Clinical and Basic Research, Istituto Di Ricovero e Cura a Carattere Scientifico, San Raffaele, Rome, Italy (Dr Anker); and Cardiac Medicine, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College London, London, England (Dr Poole-Wilson).
Deceased.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Heart Failure
Janet M. Torpy, Cassio Lynm, and Richard M. Glass
JAMA. 2009;301(18):1950.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Estradiol and Mortality in Men with Heart Failure
Journal Watch Cardiology 2009;2009:4-4.
FULL TEXT