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Low testosterone level as a predictor of cardiovascular events in Japanese men with coronary risk factors
Masahiro Akishita1, Masayoshi Hashimoto, Yumiko Ohike
1Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. akishita-tky@umin.ac.jp
Insights
Low testosterone levels significantly increase cardiovascular event risk in middle-aged Japanese men, independent of other risk factors. This study highlights testosterone
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Epidemiology
Background:
- Testosterone deficiency is linked to higher mortality, particularly from cardiovascular disease, in older men.
- Understanding this association in middle-aged men with coronary risk factors is crucial.
Purpose of the Study:
- To investigate if low plasma testosterone levels predict cardiovascular events in middle-aged Japanese men with existing coronary risk factors.
Main Methods:
- 171 male outpatients (30-69 years) with coronary risk factors were followed for 77 months.
- Baseline assessments included coronary risk factors, flow-mediated dilation (FMD), and plasma hormone levels (testosterone, DHEA-S, estradiol, cortisol).
Main Results:
- 20 cardiovascular events occurred during follow-up.
- Lowest testosterone tertile (<14.2 nmol/L) showed a significantly higher risk of cardiovascular events (multivariate-adjusted HR, 4.61).
- No significant association was found between DHEA-S, estradiol, or cortisol and cardiovascular events.
Conclusions:
- Low plasma testosterone is an independent predictor of cardiovascular events in middle-aged Japanese men.
- This is the first study to demonstrate this relationship in an Asian population.
- Findings emphasize the importance of testosterone levels in cardiovascular risk assessment.
Objective:
Recent epidemiological studies have found that testosterone deficiency is associated with higher mortality largely due to cardiovascular (CV) disease in community-dwelling older men. We investigated whether a low plasma testosterone level could predict cardiovascular events in middle-aged Japanese men with coronary risk factors.
Methods:
One hundred and seventy-one male outpatients (30-69 years old, mean+/-SD=48+/-13 years) who had any coronary risk factor (hypertension, diabetes, dyslipidemia, smoking, and obesity) without a previous history of CV disease were followed up. At baseline, the subjects underwent examination of coronary risk factors, measurement of flow-mediated dilation (FMD) of the brachial artery as an indicator of vascular endothelial function and assays of plasma total testosterone, dehydroepiandrosterone-sulfate (DHEA-S), estradiol and cortisol.
Results:
During the mean follow-up period of 77 months, a total of 20 CV events occurred. Kaplan-Meier survival analysis by tertile of plasma hormone levels revealed that the subjects with the lowest testosterone tertile were more likely to develop CV events than those with the highest tertile (P<0.01 by log-rank test). Cox proportional hazards models showed that the subjects with the lowest tertile of plasma testosterone (<14.2 nmol/L) had an approximately 4-fold higher CV event risk compared to those with the higher testosterone tertiles after adjustment for coronary risk factors including medication and FMD (unadjusted hazard ratio, 3.61; 95% CI, 1.47-8.86: multivariate-adjusted hazard ratio, 4.61; 95% CI, 1.02-21.04). Multivariate analysis did not show any significant association of DHEA-S, estradiol or cortisol with CV events.
Conclusions:
A low plasma testosterone level is associated with CV events in middle-aged Japanese men, independent of coronary risk factors and endothelial function. This is the first report to show the relationship between endogenous testosterone and CV events in Asian population.
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