Estradiol Level as a Risk Factor for Cardiovascular Endpoints in Men: A Systematic Review

Abstract

Cardiovascular disease is a major cause of higher mortality of middle-aged and elderly males in comparison to women. Sex hormones action on cardiovascular system is the most likely explanation of this differences. Nevertheless, estradiol and cardiovascular disease relationship is still unclear. The authors conducted a systematic review to identify the association of endogenous estradiol with cardiovascular endpoints in men. Articles were identified by a MedLine search (1961 — July 2023) and citation tracking. No evidence synthesis was conducted. 24 eligible articles were found. In 10 studies no association of sex hormones and endpoints was found. In 7 studies there was an association of testosterone and endpoints, but no significant results for estradiol. 7 studies have reported significant association of estradiol and cardiovascular endpoints. Inconsistency in evidence is significantly influenced by differences between studies in patient age, follow-up, researched endpoints and quality of estradiol essay. Over 40% of published studies, that researched the association of estradiol and death, found such a link. However, existing body of literature is largely heterogenous and doesn’t provide definite evidence for a pronounced net effect of estradiol on cardiovascular health in general men population. The present systematic review hints, that endogenous estradiol could be linked with cardiovascular risks in white men of young and middle age.