Hypogonadism as a risk factor for cardiovascular mortality in men: a meta-analytic study

Abstract

Objective: To verify whether hypogonadism represents a risk factor for cardiovascular (CV) morbidity and mortality and to verify whether testosterone replacement therapy (TRT) improves CV parameters in subjects with known CV diseases (CVDs). Design: Meta-analysis. Methods: An extensive Medline search was performed using the following words 'testosterone, CVD, and males'. The search was restricted to data from January 1, 1969, up to January 1, 2011. Results: Of the 1178 retrieved articles, 70 were included in the study. Among cross-sectional studies, patients with CVD have significantly lower testosterone and higher 17-b estradiol (E 2 ) levels. Conversely, no difference was observed for DHEAS. The association between low testosterone and high E 2 levels with CVD was confirmed in a logistic regression model, after adjusting for age and body mass index (hazard ratio (HR)Z0.763 (0.744-0.783) and HRZ1.015 (1.014-1.017), respectively, for each increment of total testosterone and E 2 levels; both P!0.0001). Longitudinal studies showed that baseline testosterone level was significantly lower among patients with incident overall-and CV-related mortality, in comparison with controls. Conversely, we did not observe any difference in the baseline testosterone and E 2 levels between case and controls for incident CVD. Finally, TRT was positively associated with a significant increase in treadmill test duration and time to 1 mm ST segment depression. Conclusions: Lower testosterone and higher E 2 levels correlate with increased risk of CVD and CV mortality. TRT in hypogonadism moderates metabolic components associated with CV risk. Whether low testosterone is just an association with CV risk, or an actual cause-effect relationship, awaits further studies.

Adaptation to acute coronary syndrome-induced stress with lowering of testosterone: a possible survival factor

“…There is an inverse relationship between endogenous serum testosterone levels and coronary heart disease in males (8,11,12) although all studies cannot confirm this finding (6,13,14,15,16), and the direction of causality of the phenomenon remains unclear. Moreover, a decreased serum testosterone concentration has been shown to be associated with acute ischemic strokes, infarct size and mortality (17).…”

“…In patients with a previous history of cardiovascular disease (CVD) events, hypogonadism has been reported to associate with a reduced risk of new CVD events (6). On the other hand, low serum testosterone concentration has also been proposed to predict increased cardiovascular risk (7,8).…”

Testosterone therapy and cardiovascular risk

“…The relative risk for an increase of one standard deviation of testosterone was 0.84 (95% CI 0.76 to 0.92). Another meta-analysis confirmed the association of low testosterone with mortality, but failed to demonstrate a significant association with incident CV disease (22). The point estimate suggested increased CV disease incidence with lower testosterone, but the 95% CI included no effect.…”

Testicular and thyroid function as survival predictors in the elderly patient candidate to surgery

“…Accordingly, the presence of hypogonadism in men with cardiovascular disease (CVD) is about two times higher than observed in the general population and is associated with increase of the most known cardiovascular risk factors, and cardiovascular morbidity and mortality [1]. The most recent studies have also identified that men with CVD show significantly lower serum levels of bioavailable T than those men with negative coronary angiography (see Box 1 for CV safety issues and T-replacement).…”