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Relationship Between Higher Estradiol Levels and 9-Year Mortality in Older Women: The Invecchiare in Chianti Study |
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| Authors: | Marcello Maggio MD PhD Gian Paolo Ceda MD Fulvio Lauretani MD Stefania Bandinelli MD Carmelinda Ruggiero MD PhD Jack M Guralnik MD PhD E Jeffrey Metter MD Shari M Ling MD Giuseppe Paolisso MD Giorgio Valenti MD Anne R Cappola MD ScM Luigi Ferrucci MD PhD |
| Affiliation: | From the Department of Internal Medicine and Biomedical Sciences, Section of Geriatrics, University of Parma, Parma, Italy;;Geriatric Rehabilitation Department, Azienda Ospedaliero-Universitaria, Parma, Italy;;Geriatric Rehabilitation, Azienda Sanitaria Firenze, Florence, Italy;;Department of Clinical and Experimental Medicine, Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy;;Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda, Maryland;;Longitudinal Studies Section;, Clinical Research Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland;;Department of Geriatric Medicine and Metabolic Diseases, VI Unit of Internal Medicine, Second University of Naples, Naples, Italy;;and Division of Endocrinology, Diabetes, and Metabolism, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. |
| Abstract: | OBJECTIVES: To investigate the relationship between total estradiol (E2) levels and 9-year mortality in older postmenopausal women not taking hormone replacement therapy (HRT). DESIGN: Population-based study of persons living in the Chianti geographic area (Tuscany, Italy). SETTING: Community. PARTICIPANTS: A representative sample of 509 women aged 65 and older with measures of total E2. MEASUREMENTS: Serum total E2 was measured at the University of Parma using ultrasensitive radioimmunoassay (RIA). RESULTS: Women who died (n=135) during 9 years of follow up were older; had higher total E2 levels; and were more likely to have evidence of stroke, hypertension, diabetes mellitus, and congestive heart failure at baseline than survivors. Higher E2 levels were associated with a greater likelihood of death (hazard ratio (HR)=1.03, 95% confidence interval (CI)=1.01–1.06), and the relationship was independent of age, waist:hip ratio, C-reactive protein, education, cognitive function, physical activity, caloric intake, smoking, and chronic disease (HR=1.08 pg/mL, 95% CI=1.03–1.13, P =.003). The excessive risk of death associated with higher total E2 was not attenuated after adjustment for total testosterone (HR=1.12, 95% CI=1.02–1.18, P <.001) and after further adjustment for insulin resistance evaluated using the homeostasis model assessment (HR=1.07, 95% CI=1.03–1.17, P <.001). Total E2 was highly predictive of death after more than 5 years (HR=1.42: CI 1.01–1.91, P =.04) and not predictive of death for less than 5 years ( P =.78). CONCLUSION: Higher total E2 concentration predicts mortality in older women not taking HRT. |
| Keywords: | estradiol older postmenopausal women mortality |
