Effects of androgens on the cardiovascular system

The evidence that men have a greater incidence of coronary artery disease than women of similar age, together with the fact that android fat distribution is associated with a greater incidence of coronary heart disease, have suggested that high testosterone levels are associated with an increased risk for coronary artery disease. The possible causal role of androgens in the development of cardiovascular disease has not been proven and, to date, there are no epidemiological and pathophysiological evidences to support that an hyper-androgenic state or androgen replacement is associated with cardiovascular disease in both sexes. Clinical studies have suggested that physiological testosterone supplementation in ageing males has a positive effect upon lipid profile. Additional potential protective cardiovascular effects of androgens may be related to their effect upon endothelial function and vasomotor tone. Few data are currently available on the correlation between plasma testosterone levels and coronary artery disease in men. Cross-sectional studies reported either reduced or similar plasma testosterone levels and/or androgens in patients with coronary artery disease as compared to controls without cardiovascular symptoms. Epidemiological studies addressing the importance of androgen levels upon cardiovascular mortality and morbidity have gathered inconclusive results. Prospective studies found no significant association between plasma testosterone and cardiac events in both sexes, while most cross-sectional studies have repetitively found an association between hypotestosteronemia and cardiovascular morbidity. In conclusion, androgens in general and testosterone in particular may have some protective effects on the cardiovascular system through their metabolic and direct effects upon human vasculature.