Gonadal and adrenal androgen deficiencies as independent predictors of increased cardiovascular mortality in men with type II diabetes mellitus and stable coronary artery disease

Ponikowska, Beata; Jankowska, Ewa A.; Maj, Jolanta; Węgrzynowska‐Teodorczyk, Kinga; Biel, Bartosz; Reczuch, Krzysztof; Borodulin-Nadzieja, Ludmiła; Banasiak, Waldemar; Ponikowski, Piotr

doi:10.1016/j.ijcard.2009.03.072

Cited by 42 publications

(40 citation statements)

References 26 publications

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“…1,3,4,[6][7][8][9] This may be because of patients' advanced medical complications, co-morbid diseases and numerous drug therapies. 34,35 There was also an exceptionally high number of current or ex-smokers (44%) in our patient population. The higher prevalence in this study could also be explained by the exclusion of younger patients with diabetes mellitus, compared to other studies.…”

Section: Discussionmentioning

confidence: 69%

The prevalence and associations of erectile dysfunction in a South African male diabetic urban population

Kemp

Rheeder

2015

Journal of Endocrinology, Metabolism and Diabetes of South Afri

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Background: Erectile dysfunction (ED) is a common condition in patients with type 1 or type 2 diabetes mellitus. The prevalence and predictors in our patient population are unknown since minimal data exist for this condition in South Africa. Method: An observational, cross-sectional study was performed on 150 consecutive male patients aged ≥ 50 years, with either type 1 or type 2 diabetes mellitus, attending the Steve Biko Academic Hospital Diabetes Clinic. These patients were evaluated for diabetes mellitus control and medical complications, and for the presence of ED. Morning serum testosterone levels were determined. Results: Some degree of ED was reported in 95% of the patients, with 51% reporting serious dysfunction. Using multivariate logistic regression, it was determined that the significant factors associated with ED were age, body mass index, the peripheral neuropathy score and diuretic therapy. Differences in quality-of-life scores were seen in some ED subgroups. Conclusion: This study confirms the high prevalence of ED in diabetic male patients in a tertiary setting. It is suggested that universal screening should be performed for this population group. Multiple predictors of ED were identified in this study. ED negatively affected quality of life, but not in a statistically significant way.

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Section: Discussionmentioning

confidence: 69%

The prevalence and associations of erectile dysfunction in a South African male diabetic urban population

Kemp

Rheeder

2015

Journal of Endocrinology, Metabolism and Diabetes of South Afri

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“…The decision to treat older men, especially with low testosterone levels, or men with chronic diseases associated with low testosterone levels, remains controversial. 9,23,24 Multiple studies have shown that low testosterone levels are associated with an increase in all-cause mortality that is independent of the metabolic syndrome and diabetes, even after adjusting for confounders. 3,6,25 Cardiovascular events and death can be 2-3 times elevated.…”

Section: Discussionmentioning

confidence: 99%

“…3,6,25 Cardiovascular events and death can be 2-3 times elevated. 11,23 In contrast, a high endogenous serum testosterone level predicted a reduced five-year risk of cardiovascular events in elderly males in the Osteoporotic Fractures in Men (MrOS) study. 24 It is uncertain whether or not testosterone replacement reverses the detrimental effects of a low testosterone level.…”

Section: Discussionmentioning

confidence: 99%

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The prevalence and association of low testosterone levels in a South African male, diabetic, urban population

Kemp

Rheeder

2015

Journal of Endocrinology, Metabolism and Diabetes of South Afri

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Background: According to the literature, low serum testosterone levels are associated with diabetes mellitus. No or minimal data exist for its prevalence or predictors in South Africa. Design: This was a cross-sectional study. Setting: The setting was an academic centre, i.e. the University of Pretoria and Steve Biko Academic Hospital Diabetes Clinic. Subjects: A total of 150 consecutive male patients aged 50 years and older with diabetes mellitus were selected using convenience sampling. Outcome measures: The patients were evaluated for diabetes control and complications, and for hypogonadism symptoms. Early-morning serum testosterone levels were determined. Results: The prevalence of androgen deficiency symptoms was 94.7%. Some 50% of the men had low total testosterone levels. Using multivariate logistic regression, the significant factors associated with low total testosterone were waist circumference and known cardiovascular disease. The prevalence of symptoms of androgen deficiency was very high; 94.7% of the patients reported a significant number of symptoms listed on the Androgen Deficiency in the Aging Male questionnaire. Conclusion: This study confirms the high prevalence of low testosterone levels in diabetic male patients in a tertiary setting. Universal screening remains controversial owing to uncertainty regarding the risks and benefits of testosterone therapy in this population group. Predictors of low testosterone levels were identified.

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“…While total testosterone was mostly negatively related to mortality [13,14,16,20,42] with one study reporting a non-significant relationship [22], free testosterone was positively [22] or negatively [5] related to mortality andlimited evidence suggests that SHBG may not be related [22] to mortality.…”

Section: Discussionmentioning

confidence: 99%

Vitamin D and biomarkers of sex steroid hormones are non-linearly and inversely related to all-cause mortality: results from NHANES III

Beydoun¹,

Eid²,

Jeng³

et al. 2015

Horm Stud

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Background: In men, hypovitaminosis D as well as high and low testosterone levels have been linked to adverse events, including death. A biological interaction has been previously suggested between vitamin D and androgens. In a cohort study using Third National Health and Nutrition Examination Survey data, we simultaneously investigated circulating vitamin D and biomarkers of sex steroid hormones as predictors of all-cause mortality. Methods: Age-adjusted and fully-adjusted Cox regression models were constructed to estimate hazard ratios (HR) and their 95% confidence intervals (CI). Whereas the vitamin D sufficient group (25(OH)D 3 ≥30 ng/ml) was selected as a referent, biomarkers of sex steroid hormones (testosterone, estradiol, SHBG) were defined as Loge-transformed continuous variables. Results: Of 1,472 men with a mean age of 42.1 years at baseline, 382 died over a median of 192 months of follow-up. Estradiol levels were significantly higher among vitamin D deficient compared to vitamin D sufficient men and sex hormone binding globulin level was significantly higher in vitamin D sufficient compared to vitamin D insufficient or deficient groups. An inverse non-linear relationship was observed between all-cause mortality rate and levels of testosterone, estradiol and vitamin D, in fully-adjusted models. There were no significant interaction effects between vitamin D and sex steroid hormones in relation to all-cause mortality rate. Conclusions: Vitamin D and sex steroid hormones, but not sex hormone binding globulin, may be inversely and non-linearly related to all-cause mortality among adult men, after adjustment for baseline demographic, socioeconomic, lifestyle and clinical characteristics.

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Gonadal and adrenal androgen deficiencies as independent predictors of increased cardiovascular mortality in men with type II diabetes mellitus and stable coronary artery disease

Cited by 42 publications

References 26 publications

The prevalence and associations of erectile dysfunction in a South African male diabetic urban population

The prevalence and associations of erectile dysfunction in a South African male diabetic urban population

The prevalence and association of low testosterone levels in a South African male, diabetic, urban population

Vitamin D and biomarkers of sex steroid hormones are non-linearly and inversely related to all-cause mortality: results from NHANES III

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