Sex hormones and the risk of atrial fibrillation: The Multi-Ethnic Study of Atherosclerosis (MESA)

• Type of Material: Article
• Authors: Wesley T. O'Neal, Emory University; Saman Nazarian, University of Pennsylvania; Alvaro Alonso, Emory University; Susan R. Heckbert, University of Washington; Laura Vaccarino, Emory University; Elsayed Z. Soliman, Wake Forest School of Medicine
• Language: English
• Date: 2017-10-01
• Publisher: Springer (part of Springer Nature): Springer Open Choice Hybrid Journals
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017, Springer Science+Business Media, LLC.
• Final Published Version (URL): http://dx.doi.org/10.1007/s12020-017-1385-3
• Title of Journal or Parent Work: Endocrine
• ISSN: 1355-008X
• Volume: 58
• Issue: 1
• Start Page: 91
• End Page: 96
• Grant/Funding Information: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.; This research was supported by grants UL1-TR-000040 and UL1-TR-001079 from the National Center for Research Resources, 16EIA26410001 from the American Heart Association, and R01-HL-127659 from the National Heart, Lung, and Blood Institute.; This research was supported by contracts N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 from the National Heart, Lung, and Blood Institute.; WTO is supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number F32-HL-134290.
• Keywords: DEATH; Risk; Science & Technology; POSTMENOPAUSAL WOMEN; Life Sciences & Biomedicine; EPIDEMIOLOGY; Sex hormones; IMPACT; Epidemiology; COHORT; Endocrinology & Metabolism; Atrial fibrillation; STROKE; MEN; CARDIOVASCULAR-DISEASE; PREVALENCE; ASSOCIATION
• Research Categories: Health Sciences, Epidemiology

Abstract

Purpose: Atrial fibrillation is more prevalent in men than women. Due to these sex differences in atrial fibrillation susceptibility, we examined whether sex hormones have differing associations with atrial fibrillation risk in men and women. Methods: This analysis included 4883 (mean age = 63 ± 10 years; 39% women; 64% non-white) participants from the Multi-Ethnic Study of Atherosclerosis. Sex hormones (total testosterone, bioavailable testosterone, estradiol, and sex hormone binding globulin) were measured at baseline (2000-2002) for all male and all postmenopausal female participants. Atrial fibrillation was ascertained by hospital discharge records, Medicare claims data, and study electrocardiograms through December 31, 2012. Results: Over a median follow-up of 10.9 years, a total of 613 (13%) atrial fibrillation cases were detected. A higher incidence rate of atrial fibrillation was observed for males (n = 385, age-standardized incidence rate per 1000 person-years = 12.3, 95%CI = 11.1, 13.6) than females (n = 228, age-standardized incidence rate per 1000 person-years = 9.0, 95%CI = 7.9, 10.3). In men, higher bioavailable testosterone levels were associated with increased atrial fibrillation risk (HR = 1.32, 95%CI = 1.01, 1.74; p = 0.044; comparing 3rd to 1st tertile), while an association in the opposite direction was observed for women (HR = 0.81, 95%CI = 0.58, 1.13; p = 0.22; comparing 3rd to 1st tertile). Other hormones were not associated with atrial fibrillation in men or women. Conclusion: Higher levels of endogenous bioavailable testosterone contribute to atrial fibrillation development in men. The combination of endogenous bioavailable testosterone and other risk factors potentially are important for atrial fibrillation development in men.