Low testosterone levels predict all-cause mortality and cardiovascular events in women: a prospective cohort study in German primary care patients

Abstract

Objective: Although associations between testosterone and cardiovascular (CV) morbidity in women have been proposed, no large prospective study has evaluated potential associations between testosterone and mortality in women. The objective was to determine whether baseline testosterone levels in women are associated with future overall or CV morbidity and mortality. Design: Prospective cohort study with a 4.5-year follow-up period. Methods: From a representative sample of German primary care practices, 2914 female patients between 18 and 75 years were analyzed for the main outcome measures: CV risk factors, CV diseases, and all-cause mortality. Results: At baseline, the study population was aged 57.96G14.37 years with a mean body mass index of 26.71G5.17 kg/m 2 . No predictive value of total testosterone for incident CV risk factors or CV diseases was observed in logistic regressions. Patients with total testosterone levels in the lowest quintile Q1, however, had a higher risk to die of any cause or to develop a CV event within the follow-up period compared to patients in the collapsed quintiles Q2-Q5 in crude and adjusted Cox regression models (all-cause mortality: Q2-Q5 versus Q1: crude hazard ratios (HR) 0.49, 95% confidence interval (CI) 0.33-0.74; adjusted HR 0.62, 95% CI 0.42-0.939; CV events: Q2-Q5 versus Q1: crude HR 0.54, 95% CI 0.38-0.77; adjusted HR 0.68, 95% CI 0.48-0.97). Kaplan-Meier curves revealed similar data. Conclusions: Low baseline testosterone in women is associated with increased all-cause mortality and incident CV events independent of traditional risk factors.

Testosterone enhances estradiol's cardioprotection in ovariectomized rats

“…Sievers et al (2010) reported that low baseline testosterone in relatively older women is associated with increased all-cause mortality and cardiovascular events, which is largely independent of traditional risk factors. Low-dose testosterone supplementation improved functional capacity, insulin sensitivity and muscle strength in elderly female patients with chronic heart failure, and no androgenic side effects were detected (Iellamo et al 2010).…”

A Review of the Relationships between Endogenous Sex Steroids and Incident Ischemic Stroke and Coronary Heart Disease Events

“…It is therefore possible that more recent studies may have greater power to detect an association between sex steroid levels and ischemic CVD risk. In support of this possibility, more recent prospective cohort studies [5,6,17,19,21,24,28] have tended to report the presence of significant relationships between endogenous sex steroids and ischemic CVD risk.…”

Coronary Artery Disease in Elderly Women: A Disturbed Relation of Estrogen with Testosterone

“…Elevated testosterone levels and low levels of sex hormone-binding globulin have been found to be positively associated with CV risk factors and the metabolic syndrome in postmenopausal women [3,4]. However, others have reported an increased CV morbidity and mortality in postmenopausal women with low testosterone levels [5,6]. …”

“…In premenopausal women, hyperandrogenism, such as is present in polycystic ovary syndrome, is associated with adverse metabolic effects. In postmenopausal women, however, various studies have reported conflicting results in CV outcomes in association with high- as well as low-circulating testosterone levels [3,4,5,6]. …”