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Sex hormone exposure and reproductive factors in pulmonary arterial hypertension: a case-control study

dc.contributor.authorBadlam, Jessica B.
dc.contributor.authorBadesch, David
dc.contributor.authorBrittain, Evan
dc.contributor.authorCordell, Shannon
dc.contributor.authorDing, Tan
dc.contributor.authorFox, Kelly
dc.contributor.authorHemnes, Anna
dc.contributor.authorLoyd, James
dc.contributor.authorPugh, Meredith
dc.contributor.authorRobbins, Ivan
dc.contributor.authorYu, Chang
dc.contributor.authorAustin, Eric D.
dc.identifier.citationBadlam, J. B., Badesch, D., Brittain, E., Cordell, S., Ding, T., Fox, K., Hemnes, A., Loyd, J., Pugh, M., Robbins, I., Yu, C., & Austin, E. D. (2020). Sex hormone exposure and reproductive factors in pulmonary arterial hypertension: a case-control study. Pulmonary circulation, 10(1), 2045894020908786.
dc.description.abstractPulmonary arterial hypertension (PAH) is a sexually dimorphic disease that for unknown reasons affects women more than men. The role of estrogens, both endogenous and exogenous, and reproductive factors in this female susceptibility is still poorly understood. It has been strongly suggested that sex hormones may influence the development and progression of the disease. We sought to determine whether sex hormone exposures and reproductive factors associate with PAH patients compared to control subjects, using a questionnaire and interview to obtain information regarding these potential risk factors. We conducted a single-center unmatched case-control study. Six hundred and thirty-four women and men with PAH, as well as 27 subjects with BMPR2 mutations but no PAH and 132 healthy population controls were enrolled from the Vanderbilt Pulmonary Hypertension Research Cohort and Questionnaires and nurse-led interviews were conducted to obtain information regarding sex hormone exposures and reproductive factors. Additional history was obtained on enrolled patients including disease severity variables and comorbidities. Responses to the questionnaires were analyzed to describe these exposures in this population as well as assess the association between disease severity variables and sex hormone exposures. Reproductive and endogenous factors that determine lifelong estrogen exposure were similar between PAH cases and controls. Patients with associated PAH were significantly more likely to be postmenopausal compared to controls. There were similar rates of "ever-use" and duration of use of oral contraceptive pills and hormone replacement therapy in patients when compared to controls. Disease severity variables were not significantly affected by any exposure after adjusting for PAH sub-group. In contrast to our hypothesis, that a greater exposure to exogenous sources of female sex hormones associates with PAH case status, we found similar rates of endogenous and exogenous sex hormone exposure between PAH patients and unmatched controls.en_US
dc.description.sponsorshipAH received funding from grant NIH P01 HL108800 and EDA received funding from NIH R01 HL134802.en_US
dc.publisherPulmonary Circulationen_US
dc.rightsCopyright © The Author(s) 2020 Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (
dc.subjectgender issuesen_US
dc.subjectpulmonary arterial hypertensionen_US
dc.titleSex hormone exposure and reproductive factors in pulmonary arterial hypertension: a case-control studyen_US

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