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Troisi R, Titus L, Hatch EE, Palmer JR, Huo D, Strohsnitter WC, Adam E, Ricker W, Hyer M, Hoover RN. A Prospective Cohort Study of Prenatal Diethylstilbestrol Exposure and Cardiovascular Disease Risk. J Clin Endocrinol Metab 2018; 103:206-212. [PMID: 29069384 PMCID: PMC5761490 DOI: 10.1210/jc.2017-01940] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 10/17/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE Prenatal exposure to diethylstilbestrol (DES), a prototype endocrine-disrupting chemical, is associated with risk for adverse reproductive outcomes and cancer in women. We investigated whether cardiovascular disease (CVD) risk might also be greater in women prenatally exposed to DES. METHODS DES-exposed (n = 3941) and -unexposed (n = 1705) women participating in the Combined DES Cohort Follow-up Study were followed prospectively from 1994 to 2013. Prenatal DES exposure (or lack of exposure) was documented in the birth record or physician's note. Participants reported by questionnaire any "serious medical conditions requiring hospitalization, surgery or long-term treatment," including coronary artery disease (CAD), myocardial infarction (MI), and stroke. We sought physician's verification of self-reports and identified CVD deaths from the National Death Index. Hazard ratios (HRs) with 95% confidence intervals (CIs) from Cox proportional hazard regression models estimated associations between DES exposure and CVD incidence, adjusted for birth year, original cohort, and potential confounders. RESULTS In comparison of the exposed to the unexposed women, the HRs for reported conditions were 1.74 (95% CI, 1.03 to 2.93) for CAD, 2.20 (95% CI, 1.15 to 4.21) for MI, 1.01 (95% CI, 0.54 to 1.90) for stroke, and 1.31 (95% CI, 0.93 to 1.86) for the combined conditions (i.e., total CVD). The HRs were similar for verified outcomes (CAD, 1.72; MI, 2.67; stroke, 0.92; and total CVD, 1.25) and with additional adjustment for hypertension, diabetes, and high cholesterol (HRs: CAD, 1.67; MI, 2.04; stroke, 0.96; and total CVD, 1.24). CONCLUSIONS These data demonstrate associations in women who have prenatal DES exposure with CAD and MI, but not with stroke, which appear to be independent of established CVD risk factors.
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Affiliation(s)
- Rebecca Troisi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20850
| | - Linda Titus
- Departments of Epidemiology and Pediatrics, Geisel School of Medicine at Dartmouth, the Norris Cotton Cancer Center, Lebanon, New Hampshire 03756
| | - Elizabeth E. Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts 02118
| | - Julie R. Palmer
- Slone Epidemiology Unit, Boston University, Boston, Massachusetts 02118
| | - Dezheng Huo
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois 60637
| | - William C. Strohsnitter
- Department of Molecular, Cell, and Cancer Biology, University of Massachusetts Medical School, Worcester, Massachusetts 01605
| | - Ervin Adam
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas 77030
| | - Winnie Ricker
- Information Management Services, Inc., Rockville, Maryland 20852
| | - Marianne Hyer
- Information Management Services, Inc., Rockville, Maryland 20852
| | - Robert N. Hoover
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20850
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Maric-Bilkan C, Arnold AP, Taylor DA, Dwinell M, Howlett SE, Wenger N, Reckelhoff JF, Sandberg K, Churchill G, Levin E, Lundberg MS. Report of the National Heart, Lung, and Blood Institute Working Group on Sex Differences Research in Cardiovascular Disease: Scientific Questions and Challenges. Hypertension 2016; 67:802-7. [PMID: 26975706 DOI: 10.1161/hypertensionaha.115.06967] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Christine Maric-Bilkan
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (C.M.-B., M.S.L.); Department of Integrative Biology and Physiology, University of California at Los Angeles (A.P.A.); Department of Regenerative Medicine, Texas Heart Institute, Houston (D.A.T.); Department of Physiology, Medical College of Wisconsin, Milwaukee (M.D.); Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada (S.E.H.); Cardiovascular Physiology, University of Manchester, Manchester, United Kingdom (S.E.H.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (N.W.); Department of Physiology, University of Mississippi Medical Center, Jackson (J.F.R.); Department of Medicine, Georgetown University Medical Center, Washington, DC (K.S.); The Jackson Laboratory, Bar Harbor, ME (G.C.); and Department of Endocrinology, Diabetes, and Metabolism, University of California, Irvine (E.L.).
| | - Arthur P Arnold
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (C.M.-B., M.S.L.); Department of Integrative Biology and Physiology, University of California at Los Angeles (A.P.A.); Department of Regenerative Medicine, Texas Heart Institute, Houston (D.A.T.); Department of Physiology, Medical College of Wisconsin, Milwaukee (M.D.); Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada (S.E.H.); Cardiovascular Physiology, University of Manchester, Manchester, United Kingdom (S.E.H.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (N.W.); Department of Physiology, University of Mississippi Medical Center, Jackson (J.F.R.); Department of Medicine, Georgetown University Medical Center, Washington, DC (K.S.); The Jackson Laboratory, Bar Harbor, ME (G.C.); and Department of Endocrinology, Diabetes, and Metabolism, University of California, Irvine (E.L.)
| | - Doris A Taylor
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (C.M.-B., M.S.L.); Department of Integrative Biology and Physiology, University of California at Los Angeles (A.P.A.); Department of Regenerative Medicine, Texas Heart Institute, Houston (D.A.T.); Department of Physiology, Medical College of Wisconsin, Milwaukee (M.D.); Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada (S.E.H.); Cardiovascular Physiology, University of Manchester, Manchester, United Kingdom (S.E.H.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (N.W.); Department of Physiology, University of Mississippi Medical Center, Jackson (J.F.R.); Department of Medicine, Georgetown University Medical Center, Washington, DC (K.S.); The Jackson Laboratory, Bar Harbor, ME (G.C.); and Department of Endocrinology, Diabetes, and Metabolism, University of California, Irvine (E.L.)
| | - Melinda Dwinell
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (C.M.-B., M.S.L.); Department of Integrative Biology and Physiology, University of California at Los Angeles (A.P.A.); Department of Regenerative Medicine, Texas Heart Institute, Houston (D.A.T.); Department of Physiology, Medical College of Wisconsin, Milwaukee (M.D.); Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada (S.E.H.); Cardiovascular Physiology, University of Manchester, Manchester, United Kingdom (S.E.H.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (N.W.); Department of Physiology, University of Mississippi Medical Center, Jackson (J.F.R.); Department of Medicine, Georgetown University Medical Center, Washington, DC (K.S.); The Jackson Laboratory, Bar Harbor, ME (G.C.); and Department of Endocrinology, Diabetes, and Metabolism, University of California, Irvine (E.L.)
| | - Susan E Howlett
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (C.M.-B., M.S.L.); Department of Integrative Biology and Physiology, University of California at Los Angeles (A.P.A.); Department of Regenerative Medicine, Texas Heart Institute, Houston (D.A.T.); Department of Physiology, Medical College of Wisconsin, Milwaukee (M.D.); Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada (S.E.H.); Cardiovascular Physiology, University of Manchester, Manchester, United Kingdom (S.E.H.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (N.W.); Department of Physiology, University of Mississippi Medical Center, Jackson (J.F.R.); Department of Medicine, Georgetown University Medical Center, Washington, DC (K.S.); The Jackson Laboratory, Bar Harbor, ME (G.C.); and Department of Endocrinology, Diabetes, and Metabolism, University of California, Irvine (E.L.)
| | - Nanette Wenger
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (C.M.-B., M.S.L.); Department of Integrative Biology and Physiology, University of California at Los Angeles (A.P.A.); Department of Regenerative Medicine, Texas Heart Institute, Houston (D.A.T.); Department of Physiology, Medical College of Wisconsin, Milwaukee (M.D.); Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada (S.E.H.); Cardiovascular Physiology, University of Manchester, Manchester, United Kingdom (S.E.H.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (N.W.); Department of Physiology, University of Mississippi Medical Center, Jackson (J.F.R.); Department of Medicine, Georgetown University Medical Center, Washington, DC (K.S.); The Jackson Laboratory, Bar Harbor, ME (G.C.); and Department of Endocrinology, Diabetes, and Metabolism, University of California, Irvine (E.L.)
| | - Jane F Reckelhoff
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (C.M.-B., M.S.L.); Department of Integrative Biology and Physiology, University of California at Los Angeles (A.P.A.); Department of Regenerative Medicine, Texas Heart Institute, Houston (D.A.T.); Department of Physiology, Medical College of Wisconsin, Milwaukee (M.D.); Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada (S.E.H.); Cardiovascular Physiology, University of Manchester, Manchester, United Kingdom (S.E.H.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (N.W.); Department of Physiology, University of Mississippi Medical Center, Jackson (J.F.R.); Department of Medicine, Georgetown University Medical Center, Washington, DC (K.S.); The Jackson Laboratory, Bar Harbor, ME (G.C.); and Department of Endocrinology, Diabetes, and Metabolism, University of California, Irvine (E.L.)
| | - Kathryn Sandberg
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (C.M.-B., M.S.L.); Department of Integrative Biology and Physiology, University of California at Los Angeles (A.P.A.); Department of Regenerative Medicine, Texas Heart Institute, Houston (D.A.T.); Department of Physiology, Medical College of Wisconsin, Milwaukee (M.D.); Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada (S.E.H.); Cardiovascular Physiology, University of Manchester, Manchester, United Kingdom (S.E.H.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (N.W.); Department of Physiology, University of Mississippi Medical Center, Jackson (J.F.R.); Department of Medicine, Georgetown University Medical Center, Washington, DC (K.S.); The Jackson Laboratory, Bar Harbor, ME (G.C.); and Department of Endocrinology, Diabetes, and Metabolism, University of California, Irvine (E.L.)
| | - Gary Churchill
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (C.M.-B., M.S.L.); Department of Integrative Biology and Physiology, University of California at Los Angeles (A.P.A.); Department of Regenerative Medicine, Texas Heart Institute, Houston (D.A.T.); Department of Physiology, Medical College of Wisconsin, Milwaukee (M.D.); Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada (S.E.H.); Cardiovascular Physiology, University of Manchester, Manchester, United Kingdom (S.E.H.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (N.W.); Department of Physiology, University of Mississippi Medical Center, Jackson (J.F.R.); Department of Medicine, Georgetown University Medical Center, Washington, DC (K.S.); The Jackson Laboratory, Bar Harbor, ME (G.C.); and Department of Endocrinology, Diabetes, and Metabolism, University of California, Irvine (E.L.)
| | - Ellis Levin
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (C.M.-B., M.S.L.); Department of Integrative Biology and Physiology, University of California at Los Angeles (A.P.A.); Department of Regenerative Medicine, Texas Heart Institute, Houston (D.A.T.); Department of Physiology, Medical College of Wisconsin, Milwaukee (M.D.); Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada (S.E.H.); Cardiovascular Physiology, University of Manchester, Manchester, United Kingdom (S.E.H.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (N.W.); Department of Physiology, University of Mississippi Medical Center, Jackson (J.F.R.); Department of Medicine, Georgetown University Medical Center, Washington, DC (K.S.); The Jackson Laboratory, Bar Harbor, ME (G.C.); and Department of Endocrinology, Diabetes, and Metabolism, University of California, Irvine (E.L.)
| | - Martha S Lundberg
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (C.M.-B., M.S.L.); Department of Integrative Biology and Physiology, University of California at Los Angeles (A.P.A.); Department of Regenerative Medicine, Texas Heart Institute, Houston (D.A.T.); Department of Physiology, Medical College of Wisconsin, Milwaukee (M.D.); Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada (S.E.H.); Cardiovascular Physiology, University of Manchester, Manchester, United Kingdom (S.E.H.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (N.W.); Department of Physiology, University of Mississippi Medical Center, Jackson (J.F.R.); Department of Medicine, Georgetown University Medical Center, Washington, DC (K.S.); The Jackson Laboratory, Bar Harbor, ME (G.C.); and Department of Endocrinology, Diabetes, and Metabolism, University of California, Irvine (E.L.).
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