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From the Division of Biostatistics and Epidemiology (R.D.A.), University of Virginia School of Medicine, Charlottesville; Department of Health Science (R.D.A.), Shiga University of Medical Science, Otsu, Japan; Laboratory of Epidemiology, Demography, and Biometry (L.J.L., D.S.), National Institute on Aging, Bethesda, MD; Pacific Health Research Institute (R.D.A., B.L.R., G.W.R., K.H.M., J.D.C., K.Y., H.P.), Honolulu, HI; Department of Medicine (P.W.F.W.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (D.S.), Albert Einstein College of Medicine, Bronx, NY; Veteran's Affairs Pacific Islands Health Care System (G.W.R., H.P.), Honolulu, HI; Honolulu Heart Program and Honolulu-Asia Aging Study (R.D.A., B.L.R., G.W.R., K.H.M., J.D.C., K.Y., J.S.P., H.P.), Kuakini Medical Center, HI; and Departments of Geriatric Medicine (R.D.A., B.L.R., G.W.R., K.H.M., J.D.C., H.P.) and Medicine (G.W.R., K.H.M., J.D.C., H.P.), John A. Burns School of Medicine, University of Hawaii, Honolulu.
Address correspondence and reprint requests to Dr. Robert D. Abbott, University of Virginia Health System, Department of Public Health Sciences, P.O. Box 800717, Charlottesville, VA 22908-0717; e-mail: rda3e{at}virginia.edu
Objective: To determine if levels of serum estradiol and testosterone can predict stroke in a population-based sample of elderly men.
Methods: Serum 17ß estradiol and testosterone were measured in 2,197 men aged 71 to 93 years who participated in the Honolulu-Asia Aging Study from 1991 to 1993. All were free of prevalent stroke, coronary heart disease, and cancer. Participants were followed to the end of 1998 for thromboembolic and hemorrhagic events.
Results: During the course of follow-up, 124 men developed a stroke (9.1/1,000 person-years). After age adjustment, men in the top quintile of serum estradiol (
125 pmol/L [34.1 pg/mL]) experienced a twofold excess risk of stroke vs men whose estradiol levels were lower (14.8 vs 7.3/1,000 person-years, p < 0.001). Among the lower quintiles, there were little differences in the risk of stroke. Findings were also significant and comparable for bioavailable estradiol and for thromboembolic and hemorrhagic events. After additional adjustment for hypertension, diabetes, adiposity, cholesterol concentrations, atrial fibrillation, and other characteristics, men in the top quintile of serum estradiol continued to have a higher risk of stroke vs those whose estradiol levels were lower (relative hazards = 2.2; 95% CI = 1.5 to 3.4, p < 0.001). Testosterone was not related to the risk of stroke.
Conclusions: High levels of serum estradiol may be associated with an elevated risk of stroke in elderly men.
Supported by a contract (N01-AG-4-2149) and grant (1-R01-AG17155-01A1) from the National Institute on Aging, a contract (N01-HC-05102) from the National Heart, Lung, and Blood Institute, a grant (1-R01-NS41265-01) from the National Institute of Neurologic Disorders and Stroke, a grant from the United States Department of the Army (DAMD17-98-1-8621), the Office of Research and Development, Medical Research Service, Department of Veterans Affairs, and the Japan Society for the Promotion of Science.
Disclosure: The authors report no conflicts of interest.
The information contained in this article does not necessarily reflect the position or the policy of the United States Government, and no official endorsement should be inferred.
Received August 17, 2006. Accepted in final form November 1, 2006.
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  Estradiol Levels and Stroke Risk in Men Journal Watch Neurology, July 24, 2007; 2007(724): 2 - 2. [Full Text]
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