Evidence map›Paper›PMID 29852978›Full record

ArticleJournal of the American College of Cardiology2018

Endogenous Sex Hormones and Incident Cardiovascular Disease in Post-Menopausal Women.

Di Zhao, Eliseo Guallar, Pamela Ouyang, Vinita Subramanya, Dhananjay Vaidya, Chiadi E Ndumele, Joao A Lima, Matthew A Allison, Sanjiv J Shah, Alain G Bertoni and 3 more

Open access · greenAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American College of Cardiology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 221 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
221citing papers in PubMed, 7 pooled it
23.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

221 citing papers in PubMed, 7 syntheses or guidelines pooled it, 412 citations in OpenAlex.

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161 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 5 institutions in 1 country.

Di ZhaoDepartment of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Eliseo GuallarDepartment of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Pamela OuyangDivision of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Vinita SubramanyaDivision of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Dhananjay VaidyaDepartment of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Chiadi E NdumeleDepartment of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Joao A LimaDivision of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Matthew A AllisonDivision of Preventive Medicine, University of California-San Diego, La Jolla, California.
Sanjiv J ShahDivision of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Alain G BertoniDepartment of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Matthew J BudoffLos Angeles Biomedical Research Center at Harbor-UCLA, Torrance, California.
Wendy S PostDepartment of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Erin D MichosDepartment of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: edonnell@jhmi.edu.
Johns Hopkins University · USNorthwestern University · USThe Lundquist Institute · USUniversity of California San Diego · USWake Forest University · US

Funding

Transition from Risk Factors to Early HF: Prevalence, Pathogenesis, and PhenomicsR01HL127028 · NHLBI · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI BERTONI, ALAIN GERALD, SHAH, SANJIV J · 2015 to 2018
$6.5M
Study of Cardiac Mechanics in Systemic HypertensionR01HL107577 · NHLBI · NORTHWESTERN UNIVERSITY AT CHICAGO · PI SHAH, SANJIV J · 2011 to 2019
$4.1M
Cigarette Smoke and Susceptibility to Influenza InfectionR01HL095163 · NHLBI · UNIV OF NORTH CAROLINA CHAPEL HILL · PI JASPERS, ILONA, NOAH, TERRY L · 2009 to 2013
$2.0M
Adjunctive Use of Apyrase to Fibrinolytic TherapyR44HL095169 · NHLBI · APT THERAPEUTICS, INC. · PI CHEN, RIDONG · 2012 to 2013
$1.3M
Serum Sex Hormone Levels and Subclinical AtherosclerosisR01HL074338 · NHLBI · NORTHWESTERN UNIVERSITY AT CHICAGO · PI GAPSTUR, SUSAN M · 2003 to 2006
$1.1M
Serum Sex Hormonoe Levels &Subclinical AtherosclerosisR01HL074406 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI OUYANG, PAMELA · 2003 to 2006
$1.0M
SUBCLINICAL CARDIOVASCULAR DISEASE STUDYN01HC095166 · HC · UNIVERSITY OF VERMONT &ST AGRIC COLLEGE · PI TRACY, RUSSELL P · 1999 to 2001
$758k
SUBCLINICAL CARDIOVASCULAR DISEASE STUDY-FIELD CENTERN01HC095162 · HC · JOHNS HOPKINS UNIVERSITY · PI SZKLO, MOYSES A · 1999 to 2000
$694k
SUBCLINICAL CARDIOVASCULAR DISEASE STUDY--FIELD CENTERN01HC095161 · HC · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI SHEA, STEVEN · 1999 to 2001
$642k
SUBCLINICAL CARDIOVASCULAR DISEASE STUDY--FIELD CENTERN01HC095165 · HC · WAKE FOREST UNIVERSITY · PI BURKE, GREGORY L · 1999 to 2001
$616k
SUBCLINICAL CARDIOVASCULAR DISEASE STUDY--FIELD CENTERN01HC095160 · HC · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI SAAD, MOHAMMED F · 1999 to 2001
$592k
SUBCLINICAL CARDIOVASCULAR DISEASE STUDY-FIELD CENTERN01HC095164 · HC · NORTHWESTERN UNIVERSITY · PI LIU, KIANG JOHN · 1999 to 2001
$511k
NHLBI NIH HHS N01 HC095159NHLBI NIH HHS N01 HC095160NHLBI NIH HHS N01 HC095161NHLBI NIH HHS N01 HC095162NHLBI NIH HHS N01 HC095163NHLBI NIH HHS N01 HC095164NHLBI NIH HHS N01 HC095165NHLBI NIH HHS N01 HC095166NHLBI NIH HHS N01 HC095167NHLBI NIH HHS N01 HC095168NHLBI NIH HHS N01 HC095169NHLBI NIH HHS R01 HL074338NHLBI NIH HHS R01 HL074406NHLBI NIH HHS R01 HL107577NHLBI NIH HHS R01 HL127028
6 · The paper itself

Abstract

backgroundHigher androgen and lower estrogen levels are associated with cardiovascular disease (CVD) risk factors in women. However, studies on sex hormones and incident CVD events in women have yielded conflicting results.

objectivesThe authors assessed the associations of sex hormone levels with incident CVD, coronary heart disease (CHD), and heart failure (HF) events among women without CVD at baseline.

methodsThe authors studied 2,834 post-menopausal women participating in the MESA (Multi-Ethnic Study of Atherosclerosis) with testosterone, estradiol, dehydroepiandrosterone, and sex hormone binding globulin (SHBG) levels measured at baseline (2000 to 2002). They used Cox hazard models to evaluate associations of sex hormones with each outcome, adjusting for demographics, CVD risk factors, and hormone therapy use.

resultsThe mean age was 64.9 ± 8.9 years. During 12.1 years of follow-up, 283 CVD, 171 CHD, and 103 HF incident events occurred. In multivariable-adjusted models, the hazard ratio (95% confidence interval [CI]) associated with 1 SD greater log-transformed sex hormone level for the respective outcomes of CVD, CHD, and HF were as follows: total testosterone: 1.14 (95% CI: 1.01 to 1.29), 1.20 (95% CI: 1.03 to 1.40), 1.09 (95% CI: 0.90 to 1.34); estradiol: 0.94 (95% CI: 0.80 to 1.11), 0.77 (95% CI: 0.63 to 0.95), 0.78 (95% CI: 0.60 to 1.02); and testosterone/estradiol ratio: 1.19 (95% CI: 1.02 to 1.40), 1.45 (95% CI: 1.19 to 1.78), 1.31 (95% CI: 1.01 to 1.70). Dehydroepiandrosterone and SHBG levels were not associated with these outcomes.

conclusionsAmong post-menopausal women, a higher testosterone/estradiol ratio was associated with an elevated risk for incident CVD, CHD, and HF events, higher levels of testosterone associated with increased CVD and CHD, whereas higher estradiol levels were associated with a lower CHD risk. Sex hormone levels after menopause are associated with women's increased CVD risk later in life.

Indexed as

AgedBiomarkersCardiovascular DiseasesCohort StudiesDehydroepiandrosteroneEstradiolFemaleFollow-Up StudiesGonadal Steroid HormonesHumansIncidenceMiddle AgedPostmenopauseProspective StudiesSex Hormone-Binding GlobulinTestosteroneBiomarkersDehydroepiandrosteroneEstradiolGonadal Steroid HormonesSex Hormone-Binding GlobulinSHBG protein, humanTestosteronecardiovascular diseasecoronary heart diseaseestradiolheart failuresex hormone binding globulinsex hormonestestosterone

Identifiers

PMID29852978
PMCPMC5986086
OpenAlexW2805138198

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.