AimsSerum sex hormones have been linked to cardiovascular disease risk. However, their roles in the pathogenesis of heart failure (HF) in both men and women are unclear. We investigated the associations between free androgen, testosterone, and estradiol, and future risk of HF.Methods and resultsThis prospective cohort study evaluated UK Biobank participants free of prevalent cardiovascular disease and HF at baseline. Unitless free androgen, testosterone, and estradiol indices were generated using serum concentrations of total testosterone (nmol/L), estradiol (pmol/L), sex hormone binding globulin (SHBG, nmol/L), and albumin (g/L) in blood collected at enrolment. Multivariable Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident HF in relation to quartiles (Q) of free androgen (FAI), testosterone (FTI), estradiol (FEI) indices, and potential confounders. There were 180 712 men (including 5585 HF cases with FAI and 571 HF cases with FEI), and 177 324 women (including 2858 HF cases with FAI and 314 HF cases with FEI) with complete data. Increased FAI was associated with decreased HF risk in both men (HRQ4 vs. Q1: 0.86, 95% CI 0.79–0.94, p‐trendcontinuous < 0.0001) and post‐menopausal women (HRQ4 vs. Q1: 0.83, 95% CI 0.73–0.95). Similar inverse associations were observed for FTI only in men (HRQ4 vs. Q1: 0.91, 95% CI 0.83–0.98). Higher FEI was significantly associated with decreased HF risk among men (HRQ4 vs. Q1: 0.76, 95% CI 0.59–0.98), but was positively associated among pre‐menopausal women (HRQ4 vs. Q1: 2.16, 95% CI 1.11–4.18).ConclusionsSex hormones potentially influence HF pathogenesis and may offer pathways for interventions.

中文翻译：

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诊断前游离雄激素和雌二醇水平影响女性和男性的心力衰竭风险：英国生物银行的一项前瞻性队列研究

目的血清性激素与心血管疾病风险有关。然而，它们在男性和女性心力衰竭（HF）发病机制中的作用尚不清楚。我们调查了游离雄激素、睾酮和雌二醇与未来心力衰竭风险之间的关联。方法和结果这项前瞻性队列研究评估了英国生物银行参与者在基线时没有流行的心血管疾病和心力衰竭的情况。使用总睾酮 (nmol/L)、雌二醇 (pmol/L)、性激素结合球蛋白 (SHBG, nmol/L) 和白蛋白 (g/L) 的血清浓度生成无单位游离雄激素、睾酮和雌二醇指数。登记时采集的血液。使用多变量 Cox 回归来估计与游离雄激素 (FAI)、睾酮 (FTI)、雌二醇 (FEI) 指数和潜力四分位数 (Q) 相关的 HF 事件的风险比 (HR) 和 95% 置信区间 (CI)混杂因素。数据完整的男性180 712例（其中FAI合并HF病例5585例，FEI合并HF病例571例），女性177 324例（其中FAI合并HF病例2858例，FEI合并HF病例314例）。 FAI 增加与男性心力衰竭风险降低相关（HRQ4 与 Q1：0.86，95% CI 0.79–0.94，p-趋势连续的< 0.0001）和绝经后妇女（HRQ4 与 Q1：0.83，95% CI 0.73–0.95）。仅在男性中观察到类似的 FTI 负相关（HRQ4 与 Q1：0.91，95% CI 0.83–0.98）。较高的 FEI 与男性心力衰竭风险降低显着相关（HRQ4 与 Q1：0.76，95% CI 0.59-0.98），但与绝经前女性呈正相关（HRQ4 与 Q1：2.16，95% CI 1.11–4.18）。结论性激素可能影响心力衰竭的发病机制，并可能提供干预途径。