Article Text

Download PDFPDF
Endogenous oestradiol and cardiovascular disease in healthy men: a systematic review and meta-analysis of prospective studies
  1. Guy Vandenplas1,
  2. Dirk De Bacquer2,
  3. Patrick Calders3,
  4. Tom Fiers4,
  5. Jean-Marc Kaufman5,
  6. D Margriet Ouwens6,
  7. Johannes B Ruige5
  1. 1Heart Center, Ghent University Hospital, Ghent, Belgium
  2. 2Department of Public Health; Ghent University, Ghent, Belgium
  3. 3Revalidation Sciences and Physiotherapy; Ghent University, Ghent, Belgium
  4. 4Laboratory of Hormonology, Department of Clinical Chemistry, Ghent University Hospital, Ghent, Belgium
  5. 5Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
  6. 6German Diabetes Center, Institute for Clinical Biochemistry and Pathobiochemistry, Düsseldorf, Germany
  1. Correspondence to Dr Johannes B Ruige, Head of Clinic, Department of Endocrinology, Ghent University Hospital, De Pintelaan 185, Building 9K12, B-9000 Ghent, Belgium; johannes.ruige{at}


Context The literature provides no clear answer as to whether total oestradiol (E2) concentrations increase the risk of incident cardiovascular disease (CVD) in healthy men.

Objective The authors conducted a systematic review and meta-analysis to estimate the predictive value of E2 for CVD, and to identify study features explaining conflicting results.

Data sources Articles were identified by a Medline and Embase search and citation tracking.

Study selection Eligible articles were prospective population-based cohorts and nested case-control studies on E2 and incident cardiovascular disease (CVD), including myocardial infarction, stroke or death from coronary heart disease.

Data-extraction Independent researchers re-expressed associations of E2 and incident CVD in a uniform manner to be used in meta-regression analyses for identification of study features explaining conflicting results, and to estimate the predictive value of E2 for CVD.

Results and conclusions 14 studies out of 128 electronically identified articles were eligible. Data to be used for meta-analysis could be calculated in seven cases, and in the remaining seven cases, data of three more became available by contacting those authors. Overall, a non-significant association was found with an estimated summary RR of 0.98 for a change of >75th versus <25th percentile in E2 (95% CI 0.74 to 1.31). Mean body mass index (BMI) of the study population (βs −0.8, p<0.004), and quality of E2 assay (βs −0.6, p<0.08) may have modified the relationship between E2 and incident CVD. The present systematic review does not provide evidence for a pronounced harmful or beneficial effect of E2 on risk for incident CVD in healthy men. If present, an effect of E2 on risk for CVD might be modulated by BMI.

  • Oestradiol
  • testosterone
  • cardiovascular diseases
  • prospective studies
  • meta-analysis
  • allied specialties
  • endocrinology

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding This work was partly supported by the Flemish Fund for Scientific Research (FWO-Vlaanderen Grant G.0662.07). The study sponsor had no role in study design, analysis or conclusions of the report.

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.