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Estradiol and Metabolic Syndrome in Older Italian Men: The InCHIANTI Study

MARCELLO MAGGIO^*,

FULVIO LAURETANI

STEFANIA BANDINELLI

SHEHZAD BASARIA^,||

E. JEFFREY METTER

From the ^* Department of Internal Medicine and Biomedical Sciences, Section of Geriatrics, University of Parma, Italy; the Clinical Research Branch and ^# Laboratory of Cardiovascular Science, National Institute on Aging, Baltimore, Maryland; the Tuscany Regional Health Agency, Florence, Italy; the Geriatric Rehabilitation Unit, Azienda Sanitaria di Firenze (ASF)–Florence, Italy; the ^|| Department of Medicine, Division of Endocrinology, Johns Hopkins University School of Medicine, Bayview Medical Center, Baltimore, Maryland; the ^¶ Department of Geriatric Medicine and Metabolic Diseases II, University of Naples, Italy; and the ^** Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, National Institutes of Health, Bethesda, Maryland.

Correspondence to: Marcello Maggio, Department of Internal Medicine and Biomedical Sciences, Section of Geriatrics, University of Parma, via Gramsci 14 43100 Parma, Italy; or Marcello Maggio or Luigi Ferrucci, National Institute on Aging (NIA), National Institutes of Health (NIH) NIA-ASTRA unit at Harbor Hospital, 3001 S Hanover Street, Baltimore, MD 21225 (e-mail: marcellomaggio2001{at}yahoo.it; ferruccilu{at}grc.nia.nih.gov).

The increasing prevalence of metabolic syndrome (MS) with age in older men has been linked with decreasing testosterone levels. Interestingly, while testosterone levels decline with age, estradiol (E2) levels remain relatively stable, resulting in a decreased testosterone:E2 ratio. Because E2 levels tend to be elevated in morbid obesity, insulin resistance, and diabetes, it is reasonable to hypothesize that high E2 levels are associated with MS in older men. We studied the relationship of total and free E2 with MS after adjustment for multiple confounders, including age, BMI, smoking, alcohol consumption, physical activity, interleukin-6 (IL-6), fasting insulin, and testosterone. Men 65 years or older (age range, 65–96; n = 452) had complete data on E2, testosterone, fasting insulin, sex hormone–binding globulin, IL-6, and albumin. Concentrations of free E2 and free testosterone were calculated using the mass action equations. MS was defined according to Adult Treatment Panel III (ATP-III). Participants with MS had significantly higher serum free and total E2 (P < .001) (P = .003). After adjusting for confounders, including age, smoking, alcohol consumption, physical activity, log(IL-6), and log(insulin), participants with higher log(total E2) (odds ratio [OR], 2.31; 95% confidence interval [95% CI], 1.39–4.70; P = .02) and higher log(free E2) (OR, 2.69; 1.38–5.24; P < .001) had an increased risk of having MS. Log(free E2) (P = .04) maintained significant correlation with MS, even after further adjustment for BMI. In older men, high E2 is independently associated with MS. Whether confirmed in other studies, assessment of E2 should be also considered in older men. Whether changes in this hormonal pattern play a role in the development of MS should be further tested in longitudinal studies.

     Key words: Androgen, andropause

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