Testosterone Deficiency Increases Hospital Readmission and Mortality Rates in Male Patients with Heart Failure

Abstract

BackgroundTestosterone deficiency in patients with heart failure (HF) is associated with decreased exercise capacity and mortality; however, its impact on hospital readmission rate is uncertain. Furthermore, the relationship between testosterone deficiency and sympathetic activation is unknown.ObjectiveWe investigated the role of testosterone level on hospital readmission and mortality rates as well as sympathetic nerve activity in patients with HF.MethodsTotal testosterone (TT) and free testosterone (FT) were measured in 110 hospitalized male patients with a left ventricular ejection fraction < 45% and New York Heart Association classification IV. The patients were placed into low testosterone (LT; n = 66) and normal testosterone (NT; n = 44) groups. Hypogonadism was defined as TT < 300 ng/dL and FT < 131 pmol/L. Muscle sympathetic nerve activity (MSNA) was recorded by microneurography in a subpopulation of 27 patients.ResultsLength of hospital stay was longer in the LT group compared to in the NT group (37 ± 4 vs. 25 ± 4 days; p = 0.008). Similarly, the cumulative hazard of readmission within 1 year was greater in the LT group compared to in the NT group (44% vs. 22%, p = 0.001). In the single-predictor analysis, TT (hazard ratio [HR], 2.77; 95% confidence interval [CI], 1.58–4.85; p = 0.02) predicted hospital readmission within 90 days. In addition, TT (HR, 4.65; 95% CI, 2.67–8.10; p = 0.009) and readmission within 90 days (HR, 3.27; 95% CI, 1.23–8.69; p = 0.02) predicted increased mortality. Neurohumoral activation, as estimated by MSNA, was significantly higher in the LT group compared to in the NT group (65 ± 3 vs. 51 ± 4 bursts/100 heart beats; p < 0.001).ConclusionThese results support the concept that LT is an independent risk factor for hospital readmission within 90 days and increased mortality in patients with HF. Furthermore, increased MSNA was observed in patients with LT.

Analysis of cardiovascular risk factors associated with serum testosterone levels according to the US 2011–2012 National Health and Nutrition Examination Survey

“…Hence, the elevated testosterone level has no apparent biological effects, and is likely due to liver toxicity of some components present in inhaled smoke, thus elevating SHBG. The role of testosterone in the development of coronary artery disease in men is controversial and previous studies suggested that though low testosterone is related to ischemic stroke in men [47] as well as an independent risk factor for 90-day hospital readmission and mortality in heart failure patients [48], testosterone replacement therapies have been reported to increase the risks of cardiovascular events, strokes and non-calcified carotid plaque [27,28,49]. Thus, there may be different physiological effects between endogenous vs. exogenously substituted testosterone.…”

An update on the role of testosterone replacement therapy in the management of hypogonadism

“…Recent long-term studies, however, suggest no increased risk of prostate cancer [Dohle et al 2015], possible improvement in lower urinary tract symptoms, no adverse effect on OSA after the first few weeks [Dohle et al 2015], low testosterone is associated with increased mortality and hospital admission from heart failure, and that TRT improves heart failure [Santos et al 2015].…”

Androgen Therapy and Rehospitalization in Older Men With Testosterone Deficiency

“…Because testosterone deficiency is independently associated with sarcopenia and overall functional health decline, 13–15 older men with low testosterone may be particularly susceptible to such adverse effects of hospitalization. Androgen therapy—which increases muscle mass and strength by stimulation of protein anabolism 3334 —is reported to have broad therapeutic effects on muscle mass, strength and function in older hypogonadal men.…”

“…11,12 Older men with low testosterone are particularly susceptible to these adverse events, given that testosterone deficiency is independently associated with sarcopenia and overall functional health decline. 13–15 Because testosterone deficiency occurs in a high percentage of older men with chronic disease—including heart failure (HF), chronic obstructive pulmonary disease (COPD), diabetes, and chronic kidney disease 16,17 — examining the outcomes of hospitalization in this population is important. It is possible that androgen therapy—which is reported to improve physical strength, exercise capacity and functional health—will help reduce such adverse hospital outcomes.…”