Testosterone as a marker of coronary artery disease severity in middle aged males

Abstract

Historically, higher levels of serum testosterone were presumed deleterious to the cardiovascular system. In the last two decades, studies have suggested that low testosterone levels are associated with increased prevalence of risk factors for cardiovascular disease (CVD), including dyslipidemia and diabetes. This is a cross sectional study. The aim of our study was to determine the relationship between serum testosterone levels and angiographic severity of coronary artery disease (CAD). Serum testosterone levels were also correlated with flow mediated dilation of brachial artery (BAFMD) - an indicator of endothelial function. Consecutive male patients, aged 40-60 years, admitted for coronary angiography (CAG) with symptoms suggestive of CAD, were included in the study. Out of the 92 patients included in the study, 32 patients had normal coronaries and 60 had CAD on coronary angiography. Severity of CAD was determined by Gensini coronary score. The group with CAD had significantly lower levels of total serum testosterone (363±147.1 vs 532.09±150.5ng/dl, p<0.001), free testosterone (7.1215±3.012 vs 10.4419±2.75ng/dl, p<0.001) and bioavailable testosterone (166.17±64.810 vs 247.94±62.504ng/dl, p<0.001) when compared to controls. Adjusting for the traditional risk factors for CAD, a multiple linear regression analysis showed that low testosterone was an independent predictor of severity of CAD (β=-0.007, p<0.001). This study also showed that levels of total, free and bioavailable testosterone correlated positively with BAFMD %.

Testosterone and Cardiovascular Health

“…49,50 There have also been studies suggesting that testosterone levels serve as an independent predictor of CAD severity when assessed via Gensini score. 8 Studies involving men younger than 45 years with premature CAD have also found low testosterone levels in patients with CAD compared with controls. 7 Although the correlations have been demonstrated with reproducible results, it is not possible to determine a cause-and-effect relationship.…”

“…1 Contrary to this view, there is mounting evidence that normal physiologic levels of testosterone are beneficial to the male CV system and that testosterone deficiency is associated with an unfavorable metabolic profile, including increased adiposity, insulin resistance, diabetes, and adverse CVD events, such as myocardial infarction (MI) and mortality. [2][3][4][5][6][7][8][9][10][11][12] Despite the recurrence of these trends in the literature, no causal association has been proved, and results have been conflicting.…”

Genomic and non-genomic effects of androgens in the cardiovascular system: clinical implications

“…Men with low testosterone have a high prevalence of cardiovascular disease and metabolic syndrome [ 100 – 102 ] and testosterone therapy in these individuals has been associated with reduced obesity, fat mass, waist circumference and mortality as well as improved glycaemic control and overall cardiometabolic status compared with placebo [ 103 ]. On the other hand, testosterone supplements are known to increase haematocrit levels and reduce HDL (high-density lipoprotein) cholesterol levels and have been implicated in cases of cardiovascular morbidity and mortality [ 104 ].…”

Testosterone and dihydrotestosterone reduce platelet activation and reactivity in older men and women

“…The latter mechanism proposes that T affects the polarization state of smooth muscle cell membranes, thus facilitating the augmented vasorelaxing action of NO [ 7 ]. These observations imply that lower concentrations of T may be regarded as an independent factor of cardiovascular risk in men of different ages [ 8 , 9 ] and that the normalization of T concentrations with hormonal replacement therapy (HRT) exerts protective effects on cardiovascular system in men [ 10 ].…”