Connecting the Lines between Hypogonadism and Atherosclerosis
Akl C Fahed1, Joanna M Gholmieh, Sami T Azar
1Department of Genetics, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA 02115, USA.
Insights
Aging males with hypogonadism face higher risks of atherosclerotic cardiovascular disease. This review clarifies the links between low testosterone, atherosclerosis, and related risk factors, offering clinical recommendations.
Area of Science:
- Cardiovascular Science
- Endocrinology
- Gerontology
Background:
- Atherosclerotic cardiovascular disease (ASCVD) is a major global health concern, with older males at higher risk.
- Hypogonadism, or low testosterone, is an underdiagnosed condition linked to ASCVD risk factors.
- The relationship between testosterone levels and atherosclerosis is complex and not fully understood.
Purpose of the Study:
- To review the evidence linking hypogonadism to atherosclerotic cardiovascular disease and its risk factors.
- To elucidate the mechanistic pathways connecting testosterone deficiency to atherosclerosis.
- To provide clinical guidance and identify future research needs.
Main Methods:
- Comprehensive literature review of epidemiological studies.
- Analysis of animal and laboratory experimental data.
- Examination of clinical data from androgen deprivation therapy and testosterone-treated patients.
Main Results:
- Epidemiological data indicate a higher incidence of ASCVD in aging males with hypogonadism.
- Mechanistic studies suggest testosterone influences lipid metabolism, inflammation, and endothelial function, key in atherosclerosis.
- Clinical studies show varied cardiovascular outcomes with testosterone therapy, underscoring the need for individualized treatment.
Conclusions:
- Hypogonadism is a significant, often overlooked, risk factor for atherosclerotic cardiovascular disease in aging men.
- Understanding the interplay between testosterone and cardiovascular health is crucial for effective prevention and management.
- Further research is needed to optimize testosterone replacement therapy and its cardiovascular impact.
Abstract:
Epidemiological studies show that atherosclerotic cardiovascular disease is a leading cause of morbidity and mortality worldwide and point to gender differences with ageing males being at highest risk. Atherosclerosis is a complex process that has several risk factors and mediators. Hypogonadism is a commonly undiagnosed disease that has been associated with many of the events, and risk factors leading to atherosclerosis. The mechanistic relations between testosterone levels, atherosclerotic events, and risk factors are poorly understood in many instances, but the links are clear. In this paper, we summarize the research journey that explains the link between hypogonadism, each of the atherosclerotic events, and risk factors. We look into the different areas from which lessons could be learned, including epidemiological studies, animal and laboratory experiments, studies on androgen deprivation therapy patients, and studies on testosterone-treated patients. We finish by providing recommendations for the clinician and needs for future research.
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