Low serum testosterone and increased mortality in men with coronary heart disease (original) (raw)
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Prognostic value of total testosterone levels in patients with acute coronary syndromes
European Journal of Preventive Cardiology, 2019
Background Endogenous testosterone levels decrease in men with aging. Controversies persist regarding the screening and treatment of low testosterone levels in patients with acute coronary syndromes (ACS). Methods and results Total serum testosterone levels were measured in 1054 men hospitalized for ACS that were part of a Swiss prospective cohort. Total testosterone levels were classified first in tertiles and using the cut-off of 300 ng/dL. Primary endpoint was all-cause mortality at one year. Cox regression models adjusting for the GRACE score (composite of age, heart rate systolic blood pressure, creatinine, cardiac arrest at admission, ST segment deviation, abnormal troponin enzyme and Killip classification), preexisting diabetes and inflammation (high-sensitivity C-reactive protein). A total of 430 men (40.8%) had total testosterone levels ≤300 ng/dL. Low total testosterone levels were correlated with lower high-density lipoprotein cholesterol and higher triglycerides, high-se...
The Effect of Low Testosterone and Estrogen Levels on Progressive Coronary Artery Disease in Men
Reports of biochemistry & molecular biology, 2019
Background Age-related morbidity and mortality rates from coronary heart disease (CHD) are higher in men than in women. Abnormal androgen levels cause a variety of abnormal symptoms in men. Testosterone and estrogen are the main sex hormone in men and women, respectively, and studies have shown that they have important roles in cardiovascular health and disease. Methods We measured testosterone and estrogen in 102 men with coronary heart disease and 45 controls. Blood samples were collected from subjects and plasma testosterone and estrogen were measured by ELISA. Results Men with coronary heart disease had less testosterone (OD Ratio: 0.782) and estrogen (OD Ratio: 0.955) than controls. Conclusion Low testosterone and estrogen levels correlate with coronary artery disease.
The American journal of cardiology, 2015
The aim of this study was to assess the effect of testosterone replacement therapy (TRT) on cardiovascular outcomes. Men (January 1, 1996, to December 31, 2011) with a low initial total testosterone concentration, a subsequent testosterone level, and >3 years of follow-up were studied. Levels were correlated with testosterone supplement use. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of death, nonfatal myocardial infarction, and stroke at 3 years. Multivariate adjusted hazard ratios (HRs) comparing groups of persistent low (<212 ng/dl, n = 801), normal (212 to 742 ng/dl, n = 2,241), and high (>742 ng/dl, n = 1,694) achieved testosterone were calculated by Cox hazard regression. A total of 4,736 men were studied. Three-year rates of MACE and death were 6.6% and 4.3%, respectively. Subjects supplemented to normal testosterone had reduced 3-year MACE (HR 0.74; 95% confidence interval [CI] 0.56 to 0.98, p = 0.04) compared to persi...
In Males there is high coincidence between low testosterone and acute coronary syndrome (ACS).In this study we will demonstrate the effect of myocardial ischemia on serum testosterone level by measurement of total and free testosterone hormone in patients with acute coronary syndrome for assessment of testosterone level changes during and after acute ischemia and evaluation of left ventricular systolic and diastolic function among these patients at time of their admission by Doppler echocardiography. Material and methods : 80 patients (30 STEMI(ST elevated MI),30 non-STEMI(non ST elevated MI),20 unstable angina),20 control mean age (55±10) not supposed to those risks .This study include male patients from :1-maadi military hospital, 2-Azhar university :cardiology department in El Hussein hospital,3-Cairo university hospital, mean age of patients (55±10)admitted to CCU unit with ACS from feb.2015 to Dec. 2016. Former labs was done including HDL , LDL ,cholesterol .Blood sample taken on day(0,5 th ,one month) duration from admission. And measuring free and total testosterone level in patient serum. Echocardiongraphy was done for each patient at the day of admission including data about systolic function by eyeballing and M-mode ,diastolic function by mitral inflow pattern and tissue doppler , regional wall motion abnormalities through short axis view (SAX).
Reviews in Endocrine and Metabolic Disorders, 2021
The cardiovascular (CV) benefit and safety of treating low testosterone conditions is a matter of debate. Although testosterone deficiency has been linked to a rise in major adverse CV events, most of the studies on testosterone replacement therapy were not designed to assess CV risk and thus excluded men with advanced heart failure or recent history of myocardial infarction or stroke. Besides considering observational, interventional and prospective studies, this review article evaluates the impact of testosterone on atherosclerosis process, including lipoprotein functionality, progression of carotid intima media thickness, inflammation, coagulation and thromboembolism, quantification of plaque volume and vascular calcification. Until adequately powered studies evaluating testosterone effects in hypogonadal men at increased CV risk are available (TRAVERSE trial), clinicians should ponder the use of testosterone in men with atherosclerotic cardiovascular disease and discuss benefit ...
The Effect of Testosterone on Cardiovacular Biomarkers in the Testosterone Trials
The Journal of clinical endocrinology and metabolism, 2017
Studies of the possible cardiovascular risk of testosterone treatment are inconclusive. To determine the effect of testosterone treatment on cardiovascular (CV) biomarkers in older men with low testosterone. Double-blind, placebo-controlled trial. Twelve academic medical centers in the United States. 788 men ≥65 years old with an average of two serum testosterone levels <275 ng/dL who were enrolled in The Testosterone Trials. Testosterone gel, the dose adjusted to maintain the testosterone level in the normal range for young men, or placebo gel for 12 months. Serum markers of cardiovascular risk, including lipids and markers of glucose metabolism, fibrinolysis, inflammation, and myocardial damage. Testosterone treatment, compared to placebo, significantly decreased total cholesterol (adjusted mean difference -6.1 mg/dL, p<0.001), high density lipoprotein (HDL) cholesterol (adjusted mean difference -2.0 mg/dL, p<0.001) cholesterol and low density lipoprotein (LDL) cholestero...
OBJECTIVE: Low testosterone levels in men have been associated with an increased risk of cardiovascular disease. We aimed to identify the association between serum testosterone level and premature coronary artery disease (CAD) and its predictors in young adult males. METHODS: In this cross sectional study, consecutive male candidates for coronary angiography with unstable angina, no previous CAD and age ≤ 45 years were included. Serum levels of free (FT) and total testosterone (TT) as well as demographic and cardiovascular characteristics were compared between the CAD-positive and normal coronary subjects. The cutoff point for low TT was 2.5 ng/L. Additionally, the relationships between all the variables and the number of affected vessels and FT and TT and predictors of CAD were assessed. RESULTS: In this study, 191 patients with premature CAD were compared with 94 normal coronary subjects. Patients in the CAD group were significantly older (41.59 ± 3.79 versus 39.27 ± 4.97 years; P-value < 0.01), and had higher rates of diabetes mellitus (P-value = 0.04) and dyslipidemia (P-value = 0.01). Serum levels of FT and TT were significantly lower in the CAD group than the normal coronary subjects (P-value < 0.01 for both). The rate of subjects with low TT increased by the number of the affected vessels (p-value for trend <0.01) and there was a significant correlation between the Gensini score and FT and TT (r = -0.37, P-value < 0.01 and r = -0.34, P-value < 0.01, respectively). After adjustment for confounders, the association between low TT and CAD remained significant (Odds ratio = 4.30, 95% confidence interval: 1.99-9.32; P-value ≤ 0.001) CONCLUSION: Low levels of testosterone were associated with premature CAD and its severity in young adults.
The American Journal of Cardiology, 2008
Intracoronary testosterone infusions induce coronary vasodilatation and increase coronary blood flow. Longer term testosterone supplementation favorably affected signs of myocardial ischemia in men with low plasma testosterone and coronary heart disease. However, the effects on myocardial perfusion are unknown. Effects of longer term testosterone treatment on myocardial perfusion and vascular function were investigated in men with CHD and low plasma testosterone. Twenty-two men (mean age 57 ± 9 [SD] years) were randomly assigned to oral testosterone undecanoate (TU; 80 mg twice daily) or placebo in a crossover study design. After each 8-week period, subjects underwent at rest and adenosine-stress first-pass myocardial perfusion cardiovascular magnetic resonance, pulse-wave analysis, and endothelial function measurements using radial artery tonometry, blood sampling, anthropomorphic measurements, and quality-of-life assessment. Although no difference was found in global myocardial perfusion after TU compared with placebo, myocardium supplied by unobstructed coronary arteries showed increased perfusion (1.83 ± 0.9 vs 1.52 ± 0.65; p = 0.037). TU decreased basal radial and aortic augmentation indexes (p = 0.03 and p = 0.02, respectively), indicating decreased arterial stiffness, but there was no effect on endothelial function. TU significantly decreased high-density lipoprotein cholesterol and increased hip circumference, but had no effect on hemostatic factors, quality of life, and angina symptoms. In conclusion, oral TU had selective and modest enhancing effects on perfusion in myocardium supplied by unobstructed coronary arteries, in line with previous intracoronary findings. The TU-related decrease in basal arterial stiffness may partly explain previously shown effects of exogenous testosterone on signs of exercise-induced myocardial ischemia.
Vascular health and risk management, 2016
Long-term testosterone therapy (TTh) in men with hypogonadism has been shown to improve all components of the metabolic syndrome. In this study, we investigated the effects of long-term TTh up to 8 years in hypogonadal men with a history of cardiovascular disease (CVD). In two urological clinics observational registries, we identified 77 hypogonadal men receiving TTh who also had a history of CVD. The effects of TTh on anthropometric and metabolic parameters were investigated for a maximum duration of 8 years. Any occurrence of major adverse cardiovascular events was reported. All men received long-acting injections of testosterone undecanoate at 3-monthly intervals. In 77 hypogonadal men with a history of CVD who received TTh, we observed a significant weight loss and a decrease in waist circumference and body mass index. Mean weight decreased from 114±13 kg to 91±9 kg, change from baseline: -24±1 kg and -20.2%±0.5%. Waist circumference decreased from 112±8 cm to 99±6 cm, change fr...
Premature coronary artery disease and testosterone in Sri Lankan men
Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2014
Objective: Recent studies have shown that low endogenous testosterone in men is associated with coronary artery disease (CAD) and its risk factors such as obesity, hypertension, dyslipidaemia, and diabetes mellitus. This study was planned to investigate the association of low total testosterone levels with premature coronary artery disease. Methods: Thirty one men, 45 years of age or below with documented coronary artery disease (mean age 41 ± 3) constituted the cases. Control group consisted of 31 men below the same age, without having clinically evident coronary artery disease (mean age 37 ± 4). Total testosterone, fasting plasma glucose and serum lipid levels were measured. Results: Mean ages of the two groups were significantly different (p = 0.001). Body mass index (p = 0.843) and hip circumferences (p = 0.097) were not significantly different between the two groups, but waist circumference (p = 0.007) and waist to hip ratio (p = 0.002) were significantly higher among cases. Prevalence of hypertension, diabetes mellitus, and smoking among cases was higher compared to controls. Total testosterone levels of cases were significantly lower than those of controls (11.1 ± 3.2 nmol/L vs. 27.1 ± 4.3 nmol/L, p = 0.001), which remained significant, following adjustment for the clinical covariates (age, BMI, smoking, diabetes mellitus). Plasma glucose (p = 0.016) and HDL-cholesterol (p = 0.001) were significantly different between the groups. Conclusion: Serum total testosterone was significantly lower in patients with premature CAD compared to controls. Low level of total testosterone may be related to the development of premature coronary artery disease.