Background: Data on the interplay between sexual hormones balance, platelet function and clinical outcomes of adults with ischemic heart disease (IHD) are still lacking. Objective: To assess the association between the Testosterone (T)-to-Estradiol (E2) Ratio (T/E2) and platelet activation biomarkers in IHD and its predictive value on adverse outcomes. Methods: The EVA study is a prospective observational study of consecutive hospitalized adults with IHD undergoing coronary angiography and/or percutaneous coronary interventions. Serum T/E2 ratios E2, levels of thromboxane B2 (TxB2) and nitrates (NO), were measured at admission and major adverse events, including all-cause mortality, were collected during a long-term follow-up. Results: Among 509 adults with IHD (mean age 67 ± 11 years, 30% females), males were older with a more adverse cluster of cardiovascular risk factors than females. Acute coronary syndrome and non-obstructive coronary artery disease were more prevalent in females versus males. The lower sex-specific T/E2 ratios identified adults with the highest level of serum TxB2 and the lowest NO levels. During a median follow-up of 23.7 months, the lower sex-specific T/E2 was associated with higher all-cause mortality (HR 3.49; 95% CI 1.24-9.80; p = 0.018). In in vitro, platelets incubated with T/E2 ratios comparable to those measured in vivo in the lowest quartile showed increased platelet activation as indicated by higher levels of aggregation and TxB2 production. Conclusion: Among adults with IHD, higher T/E2 ratio was associated with a lower long-term risk of fatal events. The effect of sex hormones on the platelet thromboxane release may partially explain such finding.

Testosterone-to-estradiol ratio and platelet thromboxane release in ischemic heart disease: the EVA project

Raparelli, V
Primo
;
Bellini T
Membro del Collaboration Group
;
Zuliani, G
Membro del Collaboration Group
;
Passaro, A
Membro del Collaboration Group
;
Brombo, G
Membro del Collaboration Group
;
Cutini, A
Membro del Collaboration Group
;
Capatti, E
Membro del Collaboration Group
;
Dalla Nora, E
Membro del Collaboration Group
;
Di Vece, F
Membro del Collaboration Group
;
D'Amuri, A
Membro del Collaboration Group
;
Romagnoli, T
Membro del Collaboration Group
;
Luciani, F
Membro del Collaboration Group
;
Polastri, M
Membro del Collaboration Group
;
Violi, A
Membro del Collaboration Group
;
Fortunato, V
Membro del Collaboration Group
;
Bella, A
Membro del Collaboration Group
;
Manfredini, R
Membro del Collaboration Group
;
De Giorgi, A
Membro del Collaboration Group
;
Fabbian, F
Membro del Collaboration Group
2022

Abstract

Background: Data on the interplay between sexual hormones balance, platelet function and clinical outcomes of adults with ischemic heart disease (IHD) are still lacking. Objective: To assess the association between the Testosterone (T)-to-Estradiol (E2) Ratio (T/E2) and platelet activation biomarkers in IHD and its predictive value on adverse outcomes. Methods: The EVA study is a prospective observational study of consecutive hospitalized adults with IHD undergoing coronary angiography and/or percutaneous coronary interventions. Serum T/E2 ratios E2, levels of thromboxane B2 (TxB2) and nitrates (NO), were measured at admission and major adverse events, including all-cause mortality, were collected during a long-term follow-up. Results: Among 509 adults with IHD (mean age 67 ± 11 years, 30% females), males were older with a more adverse cluster of cardiovascular risk factors than females. Acute coronary syndrome and non-obstructive coronary artery disease were more prevalent in females versus males. The lower sex-specific T/E2 ratios identified adults with the highest level of serum TxB2 and the lowest NO levels. During a median follow-up of 23.7 months, the lower sex-specific T/E2 was associated with higher all-cause mortality (HR 3.49; 95% CI 1.24-9.80; p = 0.018). In in vitro, platelets incubated with T/E2 ratios comparable to those measured in vivo in the lowest quartile showed increased platelet activation as indicated by higher levels of aggregation and TxB2 production. Conclusion: Among adults with IHD, higher T/E2 ratio was associated with a lower long-term risk of fatal events. The effect of sex hormones on the platelet thromboxane release may partially explain such finding.
2022
Raparelli, V; Nocella, C; Proietti, M; Romiti, G F; Corica, B; Bartimoccia, S; Stefanini, L; Lenzi, A; Viceconte, N; Tanzilli, G; Cammisotto, V; Pilote, L; Cangemi, R; Basili, S; Carnevale, R; Bellini, T; Zuliani, G; Passaro, A; Brombo, G; Cutini, A; Capatti, E; Dalla Nora, E; Di Vece, F; D'Amuri, A; Romagnoli, T; Luciani, F; Polastri, M; Violi, A; Fortunato, V; Bella, A; Manfredini, R; De Giorgi, A; Fabbian, F
File in questo prodotto:
File Dimensione Formato  
2022_RaparelliTE2 EVA.pdf

accesso aperto

Descrizione: Full text ahead of print
Tipologia: Full text (versione editoriale)
Licenza: Creative commons
Dimensione 1.74 MB
Formato Adobe PDF
1.74 MB Adobe PDF Visualizza/Apri
s40618-022-01771-0.pdf

accesso aperto

Descrizione: Full text editoriale
Tipologia: Full text (versione editoriale)
Licenza: Creative commons
Dimensione 1.72 MB
Formato Adobe PDF
1.72 MB Adobe PDF Visualizza/Apri

I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11392/2480557
Citazioni
  • ???jsp.display-item.citation.pmc??? 5
  • Scopus 9
  • ???jsp.display-item.citation.isi??? 9
social impact