Endogenous Testosterone and its Relationship to Preclinical and Clinical Measures of Cardiovascular Disease in the Atherosclerosis Risk in Communities Study

Abstract

Low male plasma T is cross-sectionally associated with key CVD risk factors, but after adjustment there was no association with mean cIMT, incident cardiac events, or mortality. Our results are reassuring that neither high nor low T levels directly predict atherosclerosis, but are a marker for other cardiovascular risk factors.

ACTH and gonadotropin deficiencies predict mortality in patients treated for nonfunctioning pituitary adenoma: long‐term follow‐up of 519 patients in two large European centres

“…Subgroup analysis in our Gn‐deficient cohort found that this association was only significant in men; hypogonadal males had a greater than fivefold increased risk of mortality compared to the eugonadal reference cohort. Male hypogonadism is associated with dyslipidaemia, hypertension, insulin resistance and atherosclerosis,30, 31 but it remains divisive whether is an independent risk factor or simply a surrogate marker for underlying metabolic disease 32. Low testosterone is also associated with increased mortality in unselected cohorts without evidence of pituitary disease 33, 34.…”

Neutral associations of testosterone, dihydrotestosterone and estradiol with fatal and non‐fatal cardiovascular events, and mortality in men aged 17–97 years

“…Studies of DHT in middle‐aged men are lacking. DHT was not studied in either the ARIC or the EMAS populations . One study including middle‐aged men using DHT measured by immunoassay showed no relationship between DHT and ischaemic heart disease mortality .…”

“…Studies using LC‐MS measured T have generally reported inverse associations between T and CVD events, however these studies have consisted of older populations . Results from middle‐aged populations using LC‐MS measured T are conflicting . Earlier studies of middle‐aged men using T measured by immunoassay have reported no association between T and acute myocardial infarction and an inverse association of free and bioavailable T with CVD deaths at 9 but not 18 years, however these studies consisted of a smaller number of outcome events.…”

Sex Steroids, Sex Hormone-Binding Globulin and Cardiovascular Health in Men and Postmenopausal Women: The Rotterdam Study

“…However, after adjusting for confounders these findings did not remain statistically significant. Low endogenous T has been linked to a less favorable cardiovascular risk profile (eg, dyslipidemia, BP, thrombosis, endothelial dysfunction), whereas its role in CVD and CVD mortality is modest (16,17). The therapeutic effects of exogenous T have not been proven to be beneficial or have even been harmful with regard to the risk of CVD (16,26).…”

“…Sex steroids, such as estradiol (E 2 ) and testosterone (T), and sex hormone-binding globulin (SHBG), influence individual cardiovascular risk factors and cardiovascular morbidity and mortality (15)(16)(17)(18), and differences between men and women have been reported (19). The pivotal role of sex steroids and SHBG in bodily systems, among which the cardiovascular system, makes them a promising interventional target.…”