Testosterone and cardiac mass and function in men with type 1 diabetes in the Epidemiology of Diabetes Interventions and Complications Study (EDIC)

Abstract

Structured Summary Objective Low testosterone concentrations have been reported to be associated with increased risk of congestive heart failure, but the mechanisms are unclear. Our objectives was to examine the relationship between endogenous testosterone and measures of cardiac mass and function among men with type 1 diabetes. Design Secondary analysis of a prospective observational study. Participants Men (n=508) in the Epidemiology of Diabetes Interventions and Complications (EDIC) study, the observational follow-up of the Diabetes Control and Complications Trial. Measurements Testosterone assessed by liquid chromatography mass spectrometry at EDIC year 10 and cardiac magnetic resonance imaging (CMR) measures at EDIC years 14/15. Linear regression models were used to assess the relationship between testosterone, sex hormone binding globulin (SHBG) and left ventricular (LV) mass, volume, ejection fraction, and cardiac index before and after adjustment for age, randomization arm, alcohol and cigarette use, macroalbuminuria, hemoglobin A1c, insulin dose, body mass index, lipids, blood pressure, use of anti-hypertensive medications, and microvascular complications. Results In fully-adjusted models, total testosterone concentrations were significantly associated with LV mass (p=0.014), end-diastolic volume (p=0.002), end-systolic volume (p=0.012), and stroke volume (p=0.022) but not measures of LV function after adjustment for cardiac risk factors. Bioavailable testosterone was associated with LV mass but not volume or function, while SHBG was associated with volume but not mass or function. Conclusions Among men with type 1 diabetes, higher total testosterone was associated with higher LV mass and volume but not with function. The clinical significance of this association remains to be established.

Effects of adjunct testosterone on cardiac morphology and function in advanced cancers: an ancillary analysis of a randomized controlled trial

“…Previous findings from non-oncology settings indicate that exogenous testosterone may also directly induce physiological cardiac myocyte hypertrophy [23]. For instance, among men with type 1 diabetes, higher total testosterone was associated with higher LV mass and volume [24], and Subramanya and colleagues [25] recently reported that after a median of 9.1 years, higher free testosterone levels were independently associated with an increase in LV mass in women and men in the Multiethnic Study of Atherosclerosis. In RCTs, testosterone treatment improved cardiac biomarkers in patients with type II diabetes [26], and reduced systemic vascular resistance and increased both cardiac output and overall exercise capacity in heart failure patients [14].…”

Serum dihydrotestosterone levels are associated with adverse myocardial remodeling in patients with severe aortic valve stenosis before and after aortic valve replacement

“…Androgen receptors are present in healthy male and female hearts, and higher free testosterone levels have been associated with elevated left ventricular muscle mass (LVM) ( 3 , 4 ). Antiandrogenic therapy in male patients with prostate cancer and heart failure was associated with lower LV septal thickness, and in male patients with type I diabetes, testosterone serum levels were associated with higher LVM ( 5 , 6 ).…”

Substance Use in Adults With Type 1 Diabetes in the T1D Exchange

“…Although studies report upon rates of smoking and sometimes drinking in adult patients with type 1 diabetes, [2][3][4][5][6][7] very little is known about rates of other psychoactive substance use and substance use problems in this patient population. The limited data on illicit substance use are primarily confined to nonrepresentative samples of youth or young adults with type 1 diabetes.…”

“…5,8,9 Rates of smoking and alcohol use are usually limited to responses to single-item questions, without indication of frequencies of use or problem use. [2][3][4][5][6][7] The purpose of this study was to evaluate the frequency of use, as well as problem use, of psychoactive substances in adults with type 1 diabetes. The infrastructure and recruitment capability of the T1D Exchange (T1DX) registry was leveraged to conduct a cross-sectional, web-based self-report investigation to assess the proportions of adult participants with type 1 diabetes who report current and past smoking, drinking, and psy-choactive drug use, as well as proportions with current problematic substance use.…”

“…5,8,9 Rates of smoking and alcohol use are usually limited to responses to single-item questions, without indication of frequencies of use or problem use. 2-7…”