Relation of Testosterone Levels to Mortality in Men With Heart Failure

Abstract

We aimed to investigate the impact of testosterone on the prognosis of heart failure (HF), as well as the underlying cardiac function, cardiac damage, and exercise capacity. We analyzed consecutive 618 men with HF (age 65.9 years). These patients were divided into quartiles based on their serum levels of total testosterone (TT): first (TT > 631 ng/dl, n = 154), second (462 < TT ≤ 631 ng/dl, n = 155), third (300 < TT ≤ 462 ng/dl, n = 156), and fourth (TT ≤ 300 ng/dl, n = 153) quartiles. In the Kaplan-Meier analysis (mean 1,281 days), all-cause mortality progressively increased throughout from the first to the fourth groups. In the multivariable Cox proportional hazard analysis, TT was found to be an independent predictor of all-cause mortality (hazard ratio 0.929, p = 0.042). In addition, we compared the parameters of echocardiography and cardiopulmonary exercise testing, as well as levels of B-type natriuretic peptide and cardiac troponin I, among the 4 groups. Left ventricular ejection fraction and B-type natriuretic peptide did not differ among the groups. In contrast, the fourth quartile, compared with the first, second, and third groups, had higher levels of troponin I and lower peak VO (p <0.05, respectively). Decreased serum testosterone is associated with myocardial damage, lower exercise capacity, and higher mortality in men with HF.

Prior History and Incidence of Cancer Impacts on Cardiac Prognosis in Hospitalized Patients With Heart Failure

“…As described previously, 18,19 we diagnosed several comorbidities, which often coexist and are associated with adverse prognosis in patients with HF. CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 cm 2 according to the Modification of Diet based on Renal Disease formula.…”

Skeletal muscle wasting in chronic heart failure

“…34 Another contributing factor to sarcopenia is a variable degree of malnutrition 56 that may be caused by inflammatory cytokines, 57-59 which have been known to contribute to anorexia in chronic disease. 68 However, testosterone deprivation therapy due to prostate cancer selectively impairs lower-limb muscle function, primarily affecting muscles that support body weight, mediate the forward movement the body during walking, and mediate balance. 64 Malnutrition and sarcopenia have also been shown to be associated with early post-liver transplant morbidity/mortality, yet allocation indices do not include nutritional status.…”

“…67 A recent study has identified low testosterone in men as an independent risk factor in CHF. 68 However, testosterone deprivation therapy due to prostate cancer selectively impairs lower-limb muscle function, primarily affecting muscles that support body weight, mediate the forward movement the body during walking, and mediate balance. 69 On the other hand, supplementation of androgens such as dihydrotestosterone in mice reversed the reduction in protein synthesis and amino acid transporter expression observed in ageing animals.…”

Prognostic significance of premature ventricular complex burden on hospitalized patients with heart failure

“…The definition of target comorbidities (ie, hypertension, diabetes, dyslipidemia, chronic kidney disease, and anemia) was mentioned in a previous work . The definition of hypertension was the recent use of antihypertensive medications, a systolic blood pressure of ≥140 mm Hg, and/or a diastolic blood pressure of >90 mm Hg.…”