Table 2.
Hazard Ratios (95% CI) for all CVD, CHD and HF associated with sex hormone levels in post-menopausal women: MESA 2000–2013*,†
| All CVD | |||
|---|---|---|---|
| (N events/N total= 283/2,834; IR = 9.3 per 1000 person-years) | |||
|
| |||
| Model 1‡ | Model 2§ | Model 3ǁ | |
| Total T (nmol/L) | 1.17 (1.04, 1.32) | 1.15 (1.02, 1.29) | 1.14 (1.01, 1.29) |
| Bioavailable T (nmol/L) | 1.17 (1.03, 1.33) | 1.10 (0.97, 1.25) | 1.07 (0.94, 1.22) |
| Free T (Percent) | 1.11 (0.96, 1.28) | 0.99 (0.85, 1.16) | 0.92 (0.78, 1.09) |
| Estradiol (nmol/L) | 1.03 (0.88, 1.21) | 0.99 (0.84, 1.16) | 0.94 (0.80, 1.11) |
| Total T/estradiol ratio | 1.13 (0.97, 1.31) | 1.15 (0.99, 1.34) | 1.19 (1.02, 1.40) |
| DHEA (nmol/L) | 0.96 (0.85, 1.09) | 0.93 (0.82, 1.04) | 0.91 (0.81, 1.03) |
| SHBG (nmol/L) | 0.89 (0.77, 1.03) | 0.99 (0.85, 1.15) | 1.07 (0.91, 1.25) |
|
| |||
| All CHD | |||
| (N events/N total= 171/2,834; IR = 5.5 per 1000 person-years) | |||
| Model 1‡ | Model 2§ | Model 3ǁ | |
| Total T (nmol/L) | 1.21 (1.04, 1.41) | 1.19 (1.02, 1.38) | 1.20 (1.03, 1.40) |
| Bioavailable T (nmol/L) | 1.18 (1.01, 1.39) | 1.10 (0.93, 1.30) | 1.08 (0.92, 1.28) |
| Free T (Percent) | 1.07 (0.89, 1.29) | 0.94 (0.77, 1.14) | 0.85 (0.69, 1.05) |
| Estradiol (nmol/L) | 0.90 (0.74, 1.10) | 0.84 (0.69, 1.03) | 0.77 (0.63, 0.95) |
| Total T/estradiol ratio | 1.28 (1.06, 1.55) | 1.33 (1.09, 1.61) | 1.45 (1.19, 1.78) |
| DHEA (nmol/L) | 0.95 (0.81, 1.11) | 0.91 (0.78, 1.06) | 0.92 (0.78, 1.07) |
| SHBG (nmol/L) | 0.93 (0.77, 1.11) | 1.06 (0.87, 1.28) | 1.17 (0.95, 1.44) |
|
| |||
| All HF | |||
| (N events/N total= 103/2,834; IR = 3.3 per 1000 person-years) | |||
| Model 1‡ | Model 2§ | Model 3ǁ | |
| Total T (nmol/L) | 1.12 (0.92, 1.36) | 1.09 (0.90, 1.33) | 1.09 (0.90, 1.34) |
| Bioavailable T (nmol/L) | 1.22 (0.99, 1.50) | 1.14 (0.92, 1.41) | 1.13 (0.90, 1.41) |
| Free T (Percent) | 1.10 (0.86, 1.40) | 0.98 (0.76, 1.27) | 0.91 (0.69, 1.20) |
| Estradiol (nmol/L) | 0.90 (0.70, 1.17) | 0.87 (0.67, 1.13) | 0.78 (0.60, 1.02) |
| Total T/estradiol ratio | 1.20 (0.93, 1.54) | 1.21 (0.93, 1.55) | 1.31 (1.01, 1.70) |
| DHEA (nmol/L) | 0.86 (0.71, 1.05) | 0.84 (0.69, 1.02) | 0.85 (0.70, 1.04) |
| SHBG (nmol/L) | 0.91 (0.71, 1.15) | 1.00 (0.78, 1.29) | 1.09 (0.83, 1.43) |
|
| |||
| HFpEF | |||
| (N events/N total= 55/2,821; IR = 1.8 per 1000 person-years) | |||
| Model 1‡ | Model 2§ | Model 3ǁ | |
| Total T (nmol/L) | 1.25 (0.96, 1.64) | 1.21 (0.92, 1.58) | 1.22 (0.91, 1.62) |
| Bioavailable T (nmol/L) | 1.21 (0.91, 1.61) | 1.08 (0.80, 1.46) | 1.10 (0.80, 1.51) |
| Free T (Percent) | 1.07 (0.76, 1.49) | 0.88 (0.62, 1.26) | 0.91 (0.62, 1.33) |
| Estradiol (nmol/L) | 1.14 (0.79, 1.66) | 1.10 (0.75, 1.62) | 0.98 (0.67, 1.43) |
| Total T/estradiol ratio | 1.13 (0.80, 1.60) | 1.13 (0.79, 1.61) | 1.22 (0.85, 1.75) |
| DHEA (nmol/L) | 1.18 (0.89, 1.58) | 1.15 (0.86, 1.52) | 1.21 (0.90, 1.63) |
| SHBG (nmol/L) | 0.94 (0.67, 1.30) | 1.12 (0.79, 1.60) | 1.10 (0.75, 1.60) |
|
| |||
| HFrEF | |||
| (N events/N total= 35/2,821; IR = 1.1 per 1000 person-years) | |||
| Model 1‡ | Model 2§ | Model 3ǁ | |
| Total T (nmol/L) | 1.10 (0.79, 1.55) | 1.09 (0.78, 1.53) | 1.11 (0.80, 1.56) |
| Bioavailable T (nmol/L) | 1.24 (0.86, 1.77) | 1.20 (0.83, 1.73) | 1.19 (0.82, 1.73) |
| Free T (Percent) | 1.11 (0.75, 1.67) | 1.07 (0.70, 1.64) | 1.01 (0.64, 1.59) |
| Estradiol (nmol/L) | 0.65 (0.44, 0.97) | 0.64 (0.43, 0.97) | 0.60 (0.39, 0.93) |
| Total T/estradiol ratio | 1.54 (1.02, 2.32) | 1.52 (1.00, 2.31) | 1.65 (1.07, 2.54) |
| DHEA (nmol/L) | 0.63 (0.48, 0.81) | 0.59 (0.45, 0.77) | 0.59 (0.44, 0.78) |
| SHBG (nmol/L) | 0.90 (0.61, 1.35) | 0.94 (0.62, 1.44) | 1.00 (0.64, 1.58) |
Abbreviations: CVD, cardiovascular disease; CHD, coronary heart disease; HF, heart failure; IR, Incidence Rates; T, Testosterone; DHEA, Dehydroepiandrosterone; SHBG, Sex Hormone Binding Globulin
All sex-hormones are log-transformed and standardized. Hazard Ratios are associated with 1 SD increase in log sex hormones. Bolded results are statistically significant.
Model 1: adjusts for age (year, continuous), race/ethnicity (white, black, Hispanic, and Chinese), study site (CA, MN, NY, IL, NC, and MD), and use of hormone therapy (yes, no).
Model 2: model 1 + education (<high school, high school, >high school), waist to hip ratio (continuous), physical activity, and smoking (never, former, current).
Model 3: model 2 + systolic blood pressure (mmHg, continuous), use of antihypertensive medications (yes, no), total cholesterol (mg/dl, continuous), HDL-cholesterol (mg/dl, continuous), use of lipid lowering medications (yes, no), diabetes (yes, no), eGFR (mL/min/1.73 m2), CRP (mg/l, log-transformed continuous), IL6 (pg/ml, log-transformed, continuous), fibrinogen (mg/dl, log-transformed continuous), D-dimer (ug/ml, log-transformed continuous).