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The influence of testosterone on the risk of cardiovascular events after percutaneous coronary intervention
Cheng-Hung Chiang1,2, Wan-Ting Hung3, En-Shao Liu1
1Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Insights
Low testosterone levels in men increase the risk of major adverse cardiovascular events (MACE) and target lesion revascularization (TLR/TVR) after percutaneous coronary intervention (PCI). This finding highlights the importance of monitoring testosterone in cardiovascular patient care.
Area of Science:
- Cardiology
- Endocrinology
- Men's Health
Background:
- Testosterone plays a crucial role in male physiology, and low levels have been implicated in various health issues.
- Percutaneous coronary intervention (PCI) is a common procedure for treating coronary artery disease, but post-procedural complications remain a concern.
Purpose of the Study:
- To investigate the association between low serum testosterone levels and the risk of major adverse cardiovascular events (MACE) following PCI.
- To evaluate the impact of testosterone levels on specific cardiovascular outcomes, including target lesion revascularization/target vessel revascularization (TLR/TVR) and myocardial infarction.
Main Methods:
- A cohort of 580 men undergoing PCI between 2015 and 2018 was divided into low (<3.25 ng/mL) and normal (≥3.25 ng/mL) serum testosterone groups.
- Major adverse cardiovascular event (MACE) was defined as a composite of cardiovascular death, myocardial infarction, and TLR/TVR.
- Statistical analyses, including logistic and Cox regression, were employed to assess the association between testosterone levels and MACE, adjusting for relevant variables.
Main Results:
- Patients with low testosterone exhibited a significantly higher overall MACE rate (26.13%) compared to those with normal testosterone (13.01%, p=0.0006).
- Low testosterone was associated with increased rates of TLR/TVR (20.72% vs. 11.73%, p=0.0125) and myocardial infarction (3.6% vs. 0.85%, p=0.0255).
- Event-free survival for MACE was shorter in the low testosterone group (25.22 months) versus the normal testosterone group (35.09 months, log-rank p=0.0004). Logistic regression showed low testosterone as an independent predictor of MACE (OR: 2.06, p=0.0081), and Cox regression confirmed higher HRs for MACE (HR: 1.88, p=0.0058) and TLR/TVR (HR: 1.73, p=0.0290).
Conclusions:
- Low serum testosterone concentrations are significantly associated with an elevated risk of MACE and TLR/TVR after PCI.
- These findings suggest that testosterone levels may be an important prognostic factor in men undergoing PCI.
Methods:
Between 2015 and 2018, 580 men undergoing PCI at a tertiary referral hospital were divided into low (<3.25 ng/mL) and normal (≥3.25 ng/mL) testosterone groups. Major adverse cardiovascular event (MACE) was defined as the composite outcome of CV death, myocardial infarction, and target lesion revascularization/target vessel revascularization (TLR/TVR) during up to 48 months follow-up after PCI.
Results:
There were 111 and 469 patients in the low and normal testosterone groups, respectively, with the overall MACE rate of the former being higher than the latter (26.13% vs. 13.01%, p = 0.0006). Moreover, the overall TLR/TVR (20.72% vs. 11.73%, p = 0.0125) and myocardial infarction (3.6% vs. 0.85%, p = 0.0255) rates were significantly higher in those with low serum testosterone who also had a shorter average event-free survival analysis of MACE (25.22 ± 0.88 months) than those with normal testosterone levels (35.09 ± 0.47 months, log-rank p = 0.0004). Multiple logistic regression demonstrated an association between low serum testosterone (<3.25 ng/mL) and a higher MACE rate [odds ratio: 2.06, 95% confidence interval (CI) 1.21-3.51, p = 0.0081]. After adjusting for variables in a Cox regression model, hazard ratios (HRs) for MACE (HR: 1.88, 95% CI: 1.20-2.95, p = 0.0058) and TLR/TVR (HR: 1.73, 95% CI: 1.06-2.83, p = 0.0290) rates were higher in the low testosterone group than those in the normal testosterone group.
Conclusion:
Low serum testosterone concentrations were associated with a higher risk of MACE and TLR/TVR after PCI than those with normal testosterone levels.
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