Association of Testosterone-to-estradiol Ratio with Inflammation and Clinical Outcomes among Postmenopausal HFpEF.

Authors

Miaomiao Qi, Qiongying Wang, Runmin Sun, Mingze Li, Lulu Zhu, Wenting Wang, Xin Fan, Jing Yu

Published in

Endocrine connections. Jul 24, 2026. Epub Jul 24, 2026.

Abstract

Sex hormones is linked to the inflammatory and diastolic dysfunction. The testosterone-to-estradiol ratio (T/E2) may better capture the relative androgenic-to-estrogenic balance more comprehensively. We investigated whether T/E2 is associated with systemic inflammation, diastolic dysfunction, and short-term outcomes in postmenopausal women with HFpEF.
This single-center prospective cohort included 184 postmenopausal women with HFpEF and followed up for 12 months. Sex hormones were measured by chemiluminescent immunoassays. Associations of T/E2 with inflammatory biomarkers, echocardiographic indices, 12-month NT-proBNP and clinical outcomes were evaluated using correlation, multivariable linear regression, and logistic regression analyses.
Median testosterone and estradiol concentrations were 14.61 ng/dL and 18.60 pg/mL, respectively. Higher T/E2 was independently associated with lower hs-CRP (β = -0.353, P < 0.001), NLR (β = -0.162, P = 0.015), IL-6 (β = -0.166, P = 0.005), and E/e' (β = -0.073, P = 0.032), but not with D-dimer, LAD or 12-month NT-proBNP (β = 0.065, 95% CI -0.115 to 0.245; P = 0.481). The 12-month composite clinical endpoint occurred in 54 participants (29.3%). Higher T/E2 was associated with lower odds of the composite endpoint (OR = 0.653, 95% CI 0.450-0.949; P = 0.025), mainly reflecting heart failure hospitalization (OR = 0.618, 95% CI 0.417-0.915; P = 0.016).
In postmenopausal women with HFpEF, lower T/E2 is associated with greater systemic inflammation, worse diastolic hemodynamics, and higher odds of short-term clinical event. These findings suggest that T/E2 may serve as a candidate endocrine-inflammatory marker for HFpEF phenotyping in postmenopausal women.

PMID:
42496870
Bibliographic data and abstract were imported from PubMed on 24 Jul 2026.

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