Testosterone and the risk of incident atrial fibrillation in older men: further analysis of the ASPREE study

Area of Science:

• Cardiology
• Endocrinology
• Geriatrics

Background:

• Previous cardiovascular safety trials noted increased atrial fibrillation (AF) in men receiving testosterone therapy.
• The relationship between endogenous testosterone levels and AF risk in healthy older men remains unclear.

Purpose of the Study:

• To investigate the association between endogenous testosterone concentrations and the risk of developing incident AF in healthy older men.

Main Methods:

• A post-hoc analysis of 4570 male participants from the ASPirin in Reducing Events in the Elderly (ASPREE) study.
• Participants were men aged 70 years or older with no prior cardiovascular disease or other relevant conditions.
• Cox proportional hazards regression was used to model the risk of AF.

Main Results:

• During a median follow-up of 4.4 years, 286 men developed AF.
• Men who developed incident AF had higher baseline testosterone levels compared to those who did not.
• A non-linear association was observed, with testosterone levels in the 4th and 5th quintiles showing a significantly increased risk of AF (HR=1.91 and 1.98, respectively).

Conclusions:

• Elevated testosterone concentrations within the high-normal range are independently associated with an increased risk of incident AF in healthy older men.
• High-normal total testosterone may be an adverse consequence contributing to AF development.