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Low circulating androgens and mortality risk in heart failure
G Güder1, S Frantz, J Bauersachs
1Medizinische Klinik und Poliklinik I - Herz-Kreislaufzentrum, Klinikum der Universität Würzburg, Oberdürrbacher Strasse 6, D - 97080 Würzburg, Germany. stoerk_s@klinik.uni-wuerzburg.de
Insights
Low serum androgen levels in men with heart failure (HF) are linked to worse outcomes. However, this association is confounded by poor health status, suggesting androgens decrease as a consequence of HF progression.
Area of Science:
- Endocrinology
- Cardiology
- Clinical Medicine
Background:
- Anabolic sex steroid deficiency is common in heart failure (HF).
- The clinical significance of low serum androgen levels in HF remains incompletely understood.
- This study investigates the prognostic implications of androgen deficiency in male HF patients.
Purpose of the Study:
- To determine the association between serum androgen levels and prognosis in men with heart failure.
- To investigate the relationship between free testosterone, dehydroepiandrosterone sulfate (DHEAS), sex hormone-binding globulin (SHBG), and heart failure severity (NYHA class).
Main Methods:
- Prospective cohort study of 191 men with heart failure (mean age 64 years).
- Measurement of total and free serum testosterone, DHEAS, and SHBG.
- Follow-up for all-cause mortality over a median of 859 days.
Main Results:
- Reduced free testosterone (79%) and DHEAS (23%) were prevalent; total testosterone was mostly normal.
- Lower free testosterone and DHEAS, and higher SHBG were associated with increased mortality risk.
- These associations were attenuated after adjustment for confounding factors related to poor health status.
Conclusions:
- Low serum androgen levels in male HF patients correlate with adverse prognosis.
- The observed association is confounded by indicators of a poor health state.
- Low serum androgens likely result from the systemic effects of advanced heart failure.
Objective:
Deficiency of anabolic sex steroids is common in heart failure (HF). The pathophysiological implications of this phenomenon, however, have not been fully elucidated. This clinical study investigated the significance of low serum androgen levels in HF.
Design:
Prospective cohort study. Patients and Methods In 191 consecutively recruited men with HF (mean age 64 years; New York Heart Association (NYHA) class I-IV 24%/35%/35%/6%) and reduced (ejection fraction (EF)
Results:
During follow-up 53 patients (28%) died. Whereas total serum testosterone was normal in most patients (91%), free testosterone and DHEAS were reduced in 79% and 23%, respectively. DHEAS and free testosterone, but not total testosterone, were inversely associated with NYHA class (both p<0.01). Lower free testosterone and DHEAS and higher SHBG predicted all-cause mortality risk (hazard ratio (HR) 0.89, 95% CI 0.82 to 0.96 per 1 ng/dl free testosterone, p=0.004; HR 0.95, 95% CI 0.89 to 1.00 per 10 microg/dl DHEAS, p=0.058; and HR 1.18, 95% CI 1.05 to 1.33 per 10 nmol/l SHBG, p=0.006, respectively; adjusted for age and NYHA class). However, further adjustment for carefully selected confounding factors abolished these associations.
Conclusion:
In male HF patients, low serum levels of androgens are associated with adverse prognosis, but this relation is confounded by indicators of a poor health state. The results suggest that low serum androgens develop as a sequel of this progressive multifaceted systemic disorder.
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