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. 2014 Apr;7(2):307-12.
doi: 10.1161/CIRCEP.113.001322. Epub 2014 Mar 8.

Association of sex hormones, aging, and atrial fibrillation in men: the Framingham Heart Study

Jared W Magnani  1 , Carlee B Moser, Joanne M Murabito, Lisa M Sullivan, Na Wang, Patrick T Ellinor, Ramachandran S Vasan, Emelia J Benjamin, Andrea D Coviello
Affiliations

Association of sex hormones, aging, and atrial fibrillation in men: the Framingham Heart Study

Jared W Magnani et al. Circ Arrhythm Electrophysiol. 2014 Apr.

Abstract

Background: Endogenous sex hormones have been related to cardiovascular outcomes and mortality. We hypothesized that sex hormones are related to atrial fibrillation (AF) in a community-based cohort of middle-aged to older men.

Methods and results: We examined testosterone, estradiol, and dehydroepiandrosterone sulfate in relation to incident AF in men participating in the Framingham Heart Study. We assessed the 10-year risk of AF in multivariable-adjusted hazard models. The cohort consisted of 1251 men (age, 68.0±8.2 years), of whom 275 developed incident AF. We identified a significant interaction between age and testosterone and, therefore, stratified men into age 55 to 69 years (n=786), 70 to 79 years (n=351), and ≥80 years (n=114). In men aged 55 to 69 years, each 1 SD decrease in testosterone was associated with hazard ratio (HR) 1.30 (95% confidence interval [CI], 1.07-1.59) for incident AF. The association between testosterone and 10-year incident AF in men 70 to 79 years did not reach statistical significance. In men≥80 years, a 1 SD decrease in testosterone was associated with HR 3.53 (95% CI, 1.96-6.37) for AF risk. Estradiol was associated with incident AF (HR, 1.12; 95% CI, 1.01-1.26). Dehydroepiandrosterone sulfate had a borderline association with risk of AF that was not statistically significant (HR, 1.12; 95% CI, 0.99-1.28).

Conclusions: Testosterone and estradiol are associated with incident AF in a cohort of older men. Testosterone deficiency in men≥80 years is strongly associated with AF risk. The clinical and electrophysiological mechanisms underlying the associations between sex hormones and AF in older men merit continued investigation.

Keywords: aging; atrial fibrillation; epidemiology; men.

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Conflict of interest statement

Conflict of Interest Disclosures: None

Figures

Figure 1
Figure 1
The three solid lines illustrate hazard ratios for incident atrial fibrillation estimated as a function of penalized regression splines of testosterone. Hazard ratios exceeding 1.0 are consistent with elevated risk beyond the baseline risk. The median level of testosterone in the cohort (450 ng/dl) is used as the referent value. The splines demonstrate significant effect modification by age with regard to decreased testosterone levels and increased risk of atrial fibrillation.
Figure 2
Figure 2
The figure demonstrates potential mechanisms implicated in the association of decreased sex hormones in older men and the increased risk of atrial fibrillation identified in our analysis, as developed by the text.
See this image and copyright information in PMC

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