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Sex-steroid hormones and electrocardiographic QT-interval duration: findings from the third National Health and Nutrition Examination Survey and the Multi-Ethnic Study of Atherosclerosis.

ABSTRACT: The association between physiologic levels of sex hormones and QT-interval duration in humans was evaluated using data from 727 men enrolled in the Third National Health and Nutrition Examination Survey and 2,942 men and 1,885 postmenopausal women enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA). Testosterone, estradiol, and sex hormone-binding globulin levels were measured in serum and free testosterone was calculated from those values. QT interval was measured using a standard 12-lead electrocardiogram. In men from the Third National Health and Nutrition Survey, the multivariate adjusted differences in average QT-interval duration comparing the highest quartiles with the lowest quartiles of total testosterone and free testosterone were -8.5 ms (95% confidence interval (CI): -15.5, -1.4) and -8.0 ms (95% CI: -13.2, -2.8), respectively. The corresponding differences were -1.8 ms (95% CI: -3.8, -0.2), and -4.7 ms (95% CI: -6.7, -2.6), respectively, in men from MESA and -0.6 ms (95% CI: -3.0, 1.8) and 0.8 ms (95% CI: -1.6, 3.3), respectively, in postmenopausal women from MESA. Estradiol levels were not associated with QT-interval duration in men, but there was a marginally significant positive association in postmenopausal women. The findings suggest that testosterone levels may explain differences in QT-interval duration between men and women and could be a contributor to population variability in QT-interval duration among men.

SUBMITTER: Zhang Y

PROVIDER: S-EPMC3202165 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ContextDisturbances in 25-hydroxyvitamin D, calcium, and phosphorus concentrations have been associated with increased risks of total and cardiovascular mortality. It is possible that changes in electrocardiographic QT interval duration may mediate these effects, but the association of 25-hydroxyvitamin D, phosphorus, and calcium concentrations with QT interval duration has not been evaluated in general population samples.ObjectiveThe objective of the study was to evaluate the association of 25-hydroxyvitamin D, phosphorus, and calcium concentrations with QT interval duration in two large samples of the U.S. general population.DesignThis study included cross-sectional analyses the Third National Health and Nutrition Survey (NHANES III) and the Atherosclerosis Risk in Communities (ARIC) study.SettingThe study was conducted in the general community.Patients or other participantsPatients included 7,312 men and women from NHANES III and 14,825 men and women from the ARIC study.InterventionsSerum 25-hydroxyvitamin D, total and ionized calcium, and inorganic phosphorus were measured in NHANES III, and serum total calcium and inorganic phosphorus were measured in ARIC.Main outcome measureQT interval duration was obtained from standard 12-lead electrocardiograms.ResultsIn NHANES III, the multivariate adjusted differences in average QT interval duration comparing the highest vs. the lowest quartiles of serum total calcium, ionized calcium, and phosphorus were -3.6 msec (-5.8 to -1.3; P for trend = 0.005), -5.4 msec (-7.4 to -3.5; P for trend <0.001), and 3.9 msec (2.0-5.9; P for trend <0.001), respectively. The corresponding differences in ARIC were -3.1 msec (-4.3 to -2.0; P for trend <0.001), -2.9 msec (-3.8 to -1.9; P for trend <0.001), and 2.3 msec (1.3-3.3; P for trend <0.001). No association was found between 25-hydroxyvitamin D concentrations and QT interval duration.ConclusionsIn two large samples of the general population, QT interval duration was inversely associated with the serum total and ionized calcium and positively associated with serum phosphorus.

Project description:BackgroundCardiac Infarction/Injury Score (CIIS), an electrocardiographic based scoring system, is a surrogate marker of subclinical myocardial injury (SC-MI) and has shown excellent prognostic value in predicting future cardiovascular mortality. As an association of mild to moderate alcohol consumption with cardiovascular disease (CVD) is conflicting, using an electrocardiographic based scoring system such as CIIS is a simple and cost-effective way to investigate this controversial relationship.MethodsThis analysis included 6090 participants (58.42±13.12 years, 54.2% women) free of CVD from the Third National Health and Nutrition Examination Survey (NHANES III). We used multivariable linear regression analysis to examine the cross-sectional association between each alcohol category (non-drinker (reference), 1-6 drinks/week, 7-13 drinks/week, ≥14 drinks/week, and CIIS. SC-MI was defined as CIIS ≥10 units.ResultsThe prevalence of SC-MI was high among heavy drinkers (≥14 drinks/week) and was lower in participants who were moderate drinkers (7-13 drinks/week). There was a statistically significant and inverse association between moderate alcohol consumption and CIIS (β (95% CI): -0.64 (-1.27, -0.007), P = 0.04) using multivariable linear regression analysis. This inverse association between moderate alcohol consumption and CIIS was more striking among whites compared to non-whites (β (95% CI): -1.06 (-1.93, -0.19) vs. 0.05 (-0.91, 1.00) respectively; interaction p-value = 0.08). Also, the association was stronger among women and older participants, however interaction p-value did not reach statistical significance.ConclusionThere is an inverse association between moderate alcohol consumption and CIIS in participants without manifestations of CVD. As lower CIIS has been associated with low risk of poor outcomes including CVD mortality, these findings further support the existing evidence of the potential benefits of moderate alcohol consumption on cardiovascular health.

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Sex-steroid hormones and electrocardiographic QT-interval duration: findings from the third National Health and Nutrition Examination Survey and the Multi-Ethnic Study of Atherosclerosis.

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