4.6 Review

Circulating sex hormones and risk of atrial fibrillation: A systematic review and meta-analysis

Journal

FRONTIERS IN CARDIOVASCULAR MEDICINE
Volume 9, Issue -, Pages -

Publisher

FRONTIERS MEDIA SA
DOI: 10.3389/fcvm.2022.952430

Keywords

sex hormones; atrial fibrillation; total testosterone; estradiol; dehydroepiandrosterone sulfate

Funding

  1. National Key R&D Program of China
  2. Guangdong Provincial Key RD Program [2018YFE0208000]
  3. Medical Science and Technology Research Fund of Guangdong Province [2019B020230004]
  4. Science and Technology Program of Guangzhou City [A2021129]
  5. Guangdong Basic and Applied Basic Research Foundation [202102080404]
  6. [2022A1515010686]

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This study aimed to evaluate the association between circulating sex hormones and the risk of atrial fibrillation (AF). Through a meta-analysis of multiple cohort studies, it was found that higher endogenous dehydroepiandrosterone sulfate (DHEAS) levels in men were associated with a lower risk of AF, while total testosterone and estradiol were not associated with AF risk. Further longitudinal studies are needed to explore the relationship between various circulating sex hormones and AF risk.
Background: Sex hormones are associated with many cardiovascular risk factors, but their effects on atrial fibrillation (AF) incidence remain unclear. This systematic review and meta-analysis aimed to evaluate the association of circulating sex hormones with AF risk by pooling available data from observational studies. Methods: A systematic literature search for pertinent articles with case-control and cohort designs was conducted via five databases up to 7 July 2021. A meta-analysis with six cohort studies was conducted separately on men and women. Adjusted relative risk (RR) with a 95% confidence interval (CI) was derived by comparing the highest with the lowest levels of a specific sex hormone and by using a random-effect or fixed-effect model. Heterogeneity was tested using the I-2 statistic and the Q-test. Results: A total of six cohort studies and four case-control studies were included. In a meta-analysis of cohort studies, dehydroepiandrosterone sulfate (DHEAS) was associated with a decreased risk of AF in men (RR: 0.729, 95% CI: 0.559-0.952, I-2 = 50.0%, P-heterogeneity = 0.157) after combining results from two cohort studies; total testosterone was not associated with any risk of AF in men and postmenopausal women, and AF risk was not associated with estradiol in men after synthesizing available studies. Conclusion: This study indicates that a higher endogenous DHEAS level was associated with a lower AF risk in men, whereas total testosterone and estradiol were not associated with AF risk. Longitudinal studies with multiple monitoring are needed to further promulgate the relationship between various circulating sex hormones and AF risk.

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