Higher estrone sulfate levels show a strong and consistent association with lower risk of major cardiovascular events. The analysis, published in Circulation, evaluated serum estrone, estrone sulfate, and estradiol in relation to HF, CAD, and MI in a nationally representative cohort.

The study assessed 5,527 adults from the National Health and Nutrition Examination Survey (NHANES), including 2,495 males and 3,032 females. Participants were stratified into quartiles by circulating hormone concentrations. After adjustment for age, sex, race, body mass index (BMI), smoking, diabetes, dyslipidemia, and hypertension, estrone sulfate demonstrated a robust inverse association with cardiovascular outcomes.

Individuals in quartiles three and four had lower odds of events with odds ratios (ORs) of 0.67 and 0.53, respectively. Women in the highest quartile showed an even stronger reduction with an OR of 0.38.

Estrone and estradiol did not show consistent or reproducible associations with HF, CAD, or MI. These findings position estrone sulfate as a potentially more relevant biomarker for cardiovascular risk assessment and support further mechanistic studies to clarify its role in cardiometabolic health.