Predictive value of low testosterone concentrations regarding coronary heart disease and mortality in men and women – evidence from the FINRISK97 study

Abstract

Introduction The relevance of low testosterone concentrations for incident coronary heart disease (CHD) and mortality has been discussed in various studies. Here, we evaluate the predictive value of low baseline testosterone levels in a large population‐based cohort. Methods We measured the serum levels of testosterone in 7671 subjects (3710 male, 3961 female) of the population‐based FINRISK97 study. Results The median follow‐up (FU) was 13.8 years. During the FU, a total of 779 deaths from any cause, and 395 incident CHD events were recorded. The age‐adjusted baseline testosterone levels were similar in subjects suffering incident events during FU and those without incident events during FU (men: 15.80 vs. 17.01 nmol L−1; P = 0.69, women: 1.14 vs. 1.15 nmol L−1; P = 0.92). Weak correlations of testosterone levels were found with smoking (R = 0.09; P < 0.001), HDL cholesterol levels (R = 0.22, P < 0.001), systolic blood pressure (R = −0.05; P = 0.011), BMI (R = −0.23; P < 0.001) and waist‐hip‐ratio (R = −0.21; P < 0.001) in men, and with eGFR (R = −0.05; P = 0.009) in women. Kaplan–Meier analyses did not reveal a positive association of testosterone levels with incident CHD or mortality. Accordingly, also in Cox regression analyses, testosterone levels were not predictive for incident CHD or mortality – neither in men (HR 1.02 [95%CI: 0.70–1.51]; P = 0.79 for lowest versus highest quarter regarding CHD and HR 1.06 [95%CI: 0.80–1.39]; P = 0.67 regarding mortality), nor in women (HR 1.13 [95%CI: 0.69–1.85]; P = 0.56 for lowest versus highest quarter regarding CHD and HR 0.99 [95%CI: 0.71–1.39]; P = 0.80 regarding mortality). Conclusions Low levels of testosterone are not predictive regarding future CHD or mortality – neither in men, nor in women.

Testosterone, sex hormone-binding globulin and risk of cardiovascular events: A report from the Outcome Reduction with an Initial Glargine Intervention trial

“…In Study IV, neither total nor free testosterone were associated with any of the outcomes. The results are in line with some observational studies in which there was no association between testosterone and prognosis (127,128). But, as described in the introduction, there are contradictory findings i.e.…”

“…This association is less well-studied in women than in men. While some studies suggest a U-shaped relationship similar to that for testosterone (92,133) other investigations did not show any prognostic relationship at all (127,128,134,135). In a subgroup analysis of the Multi-Ethnic Study of Atherosclerosis (n=2 834 postmenopausal women) comprising women not on hormonal therapy (n=1 934), high levels of SHBG and low levels of free testosterone and estradiol were related to an increased risk of coronary heart disease.…”

Prevalence of Low Testosterone According to Health Behavior in Older Adults Men

“…Testosterone gradually decreases with age, with a more rapid decrease beginning around age 60 [ 3 , 4 ]. In men, a decrease in testosterone is reported to be associated with sexual problems such as impotence, as well as increased mortality due to insulin resistance, diabetes, hypertension, hyperlipidemia, and cardiovascular disease [ 5 , 6 , 7 , 8 ]. Eventually, this decrease in testosterone can reduce quality of life and increase medical burden [ 9 , 10 ].…”

Testosterone and sex hormone-binding globulin in dysglycemic women at high cardiovascular risk: A report from the Outcome Reduction with an Initial Glargine Intervention trial

“…The current literature on the prognostic capacity of testosterone and SHBG in women is inconclusive, with some studies suggesting a U-shaped relationship with the implication that those with the lowest or the highest levels have an impaired survival 15,16 while other investigations are devoid of any prognostic association. [17][18][19][20] The main results from a recent report from the Multi-Ethnic Study of Atherosclerosis (MESA; n = 2834 postmenopausal women) showed that higher total testosterone was associated with increased risk of cardiovascular disease. A similar trend, however with nominal significance, was seen in the present study.…”