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Published on: August 13, 2019
Androgens and cardiovascular disease in women and men
Eleni Armeni1, Irene Lambrinoudaki1
12nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece.
Insights
This review examines how androgens affect cardiovascular disease (CVD) risk in men and women. While low testosterone is linked to CVD in men, its role in women is complex, with conflicting evidence for testosterone therapy safety.
Area of Science:
- Endocrinology
- Cardiology
- Reproductive Health
Background:
- Cardiovascular disease (CVD) is a leading cause of mortality globally.
- Sex hormones, particularly androgens, significantly influence cardiovascular health.
- Androgens exert direct and indirect effects on vascular function.
Purpose of the Study:
- To review the association between endogenous and exogenous androgens and CVD in women and men.
- To explore potential mediating factors in observed associations.
- To evaluate the cardiovascular safety of testosterone therapy.
Main Methods:
- Systematic review of existing literature.
- Analysis of studies on endogenous androgen levels and CVD.
- Examination of data on exogenous androgen use (testosterone therapy) and cardiovascular outcomes.
Main Results:
- In women, associations between endogenous androgens and CVD are inconsistent; high and low levels have been implicated, possibly mediated by adiposity, metabolism, lipids, and estrogen.
- Large prospective studies on testosterone therapy in women are lacking.
- In men, low circulating testosterone is generally associated with increased CVD risk, but causality is unproven.
- Cardiovascular safety data for testosterone replacement therapy in men is conflicting.
Conclusions:
- The relationship between androgens and cardiovascular disease is complex and sex-specific.
- Further research is needed to clarify the role of androgens in CVD pathogenesis and the safety of testosterone therapy in both sexes.
Abstract:
Cardiovascular disease is the leading cause of death in both women and men. Its pathogenesis is multifactorial, with sex hormones playing an important role. Androgens have both direct and indirect effects on the vasculature. This review summarizes evidence on the association of both endogenous and exogenous androgens with subclinical and overt cardiovascular disease in women and men. Concerning women, both high and low levels of endogenous androgens have been associated with cardiovascular disease, while other studies have reported no association. Adiposity, impaired glucose metabolism, dyslipidemia and estrogen levels may mediate the observed associations. Regarding testosterone therapy in women, there have been no large prospective studies on cardiovascular outcomes. Concerning men, most studies indicate that low levels of circulating testosterone are associated with increased rates of cardiovascular disease in the general population; the causality, however, of this association remains to be proven. Testosterone replacement therapy in men with symptoms of hypogonadism and low serum testosterone merits caution with regard to cardiovascular safety, as evidence is still conflicting.
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