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Testosterone, dihydrotestosterone, and incident cardiovascular disease and mortality in the cardiovascular health
Molly M Shores1, Mary L Biggs, Alice M Arnold
1VA Puget Sound Health Care System (M.M.S., N.L.S., A.M.M.), VA Epidemiologic Research and Information Center (N.L.S.), and Geriatric Research, Education, and Clinical Care (A.M.M.), Seattle, Washington 98108; Departments of Psychiatry and Behavioral Sciences (M.M.S.), Biostatistics (M.L.B., A.M.A.), Epidemiology (N.L.S., W.T.L.), Neurology (W.T.L.), and Medicine (A.M.M.), Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington 98195; Department of Medicine and Department of Epidemiology and Population Health (J.R.K.), Albert Einstein College of Medicine, Bronx, New York 10461; Department of Internal Medicine (C.H.H.), Geriatric Medicine, University of California-Davis, Davis, California 95616; and Department of Internal Medicine (A.R.C.), Endocrinology Division, University of Pennsylvania, Philadelphia, Pennsylvania 19104.
Context:
Low testosterone (T) is associated with prevalent cardiovascular disease (CVD) and mortality. DHT, a more potent androgen, may also be associated with CVD and mortality, but few studies have examined this.
Objective:
The study objective was to examine whether T and DHT are risk factors for incident CVD and mortality.
Design:
In a longitudinal cohort study, we evaluated whether total T, calculated free T (cFT), DHT, and calculated free DHT were associated with incident CVD and mortality in men in the Cardiovascular Health Study (mean age 76, range 66-97 years) who were free of CVD at the time of blood collection.
Main Outcome:
The main outcomes were incident CVD and all-cause mortality.
Results:
Among 1032 men followed for a median of 9 years, 436 incident CVD events and 777 deaths occurred. In models adjusted for cardiovascular risk factors, total T and cFT were not associated with incident CVD or all-cause mortality, whereas DHT and calculated free DHT had curvilinear associations with incident CVD (P < .002 and P = .04, respectively) and all-cause mortality (P < .001 for both).
Conclusions:
In a cohort of elderly men, DHT and calculated free DHT were associated with incident CVD and all-cause mortality. Further studies are needed to confirm these results and to clarify the underlying physiologic mechanisms.
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