Prevention of ischemic heart disease, a condition affecting the coronary arteries that carry blood to the heart, has made great strides in recent decades, allowing a significant reduction in the rates of acute events, ranging from heart attacks to death. However, the worldwide incidence of ischaemic heart disease is still very high.

The disease affects both sexes, but often with very different pathophysiology, symptomatology and response to treatment, so biological attributes have been claimed as the main factors in these differences, channelling attention to the possible role of sex hormones.

The Italian EVA (Endocrine Vascular Disease Approach) study, coordinated by a team of researchers from Sapienza University of Rome and conducted on 434 subjects with ischaemic heart disease who were hospitalised and underwent coronarography and/or angioplasty, assessed the impact of male (testosterone) and female (estradiol) sex hormones on the pathophysiology and severity of coronary artery disease and in particular on the activation of blood platelets, which are directly associated with the risk of acute coronary events.

The study, started in 2015 with funding from the Italian Ministry of University and Research - MUR within the SIR (Scientific Independence of young Researchers) framework, won by Valeria Raparelli from Sapienza's Department of Experimental Medicine (now a researcher at the University of Ferrara), also involved other universities such as Ferrara and Milan (Italy), Liverpool (UK), Alberta and McGill (Canada).

The results of the EVA study, published in the Journal of Endocrinological Investigation, showed that a low testosterone-to-estradiol ratio is associated in both sexes with an increased risk of mortality in the two years following the diagnosis. Moreover, this relationship was shown to be associated with increased platelet activity. 

Considering the crucial role of platelet activation on the risk of acute coronary events, the correlation with the testosterone-to-estradiol ratio opens up new research paths. These results suggest the benefit of assessing sex hormones in both sexes for planning new therapeutic strategies that also take into account the hormonal balance of each individual with ischaemic heart disease.

References:

Testosterone-to-estradiol ratio and platelet thromboxane release in ischemic heart disease: the EVA project - V. Raparelli, C. Nocella, M. Proietti, G. F. Romiti, B. Corica, S. Bartimoccia, L. Stefanini, A. Lenzi, N. Viceconte, G. Tanzilli, V. Cammisotto, L. Pilote, R. Cangemi, S. Basili, R. Carnevale, EVA Collaborators. J Endocrinol Invest. 2022  doi: 10.1007/s40618-022-01771-0

Further Information

Roberto Cangemi
Department of Translational and Precision Medicine
roberto.cangemi@uniroma1.it