Relationship between higher estradiol levels and 9-year mortality in older women: the Invecchiare in Chianti study

J Am Geriatr Soc. 2009 Oct;57(10):1810-5. doi: 10.1111/j.1532-5415.2009.02464.x. Epub 2009 Sep 8.


Objectives: To investigate the relationship between total estradiol (E2) levels and 9-year mortality in older postmenopausal women not taking hormone replacement therapy (HRT).

Design: Population-based study of persons living in the Chianti geographic area (Tuscany, Italy).

Setting: Community.

Participants: A representative sample of 509 women aged 65 and older with measures of total E2.

Measurements: Serum total E2 was measured at the University of Parma using ultrasensitive radioimmunoassay (RIA).

Results: Women who died (n=135) during 9 years of follow up were older; had higher total E2 levels; and were more likely to have evidence of stroke, hypertension, diabetes mellitus, and congestive heart failure at baseline than survivors. Higher E2 levels were associated with a greater likelihood of death (hazard ratio (HR)=1.03, 95% confidence interval (CI)=1.01-1.06), and the relationship was independent of age, waist:hip ratio, C-reactive protein, education, cognitive function, physical activity, caloric intake, smoking, and chronic disease (HR=1.08 pg/mL, 95% CI=1.03-1.13, P=.003). The excessive risk of death associated with higher total E2 was not attenuated after adjustment for total testosterone (HR=1.12, 95% CI=1.02-1.18, P<.001) and after further adjustment for insulin resistance evaluated using the homeostasis model assessment (HR=1.07, 95% CI=1.03-1.17, P<.001). Total E2 was highly predictive of death after more than 5 years (HR=1.42: CI 1.01-1.91, P=.04) and not predictive of death for less than 5 years (P=.78).

Conclusion: Higher total E2 concentration predicts mortality in older women not taking HRT.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, N.I.H., Intramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Estradiol / blood*
  • Female
  • Humans
  • Mortality / trends
  • Time Factors


  • Estradiol