Major cardiovascular disease risk in men with testosterone deficiency (hypogonadism): appraisal of short, medium and long-term testosterone therapy - a narrative review

Metabolomic machine learning predictor for arsenic-associated hypertension risk in male workers

Arsenic (As)-induced hypertension is a significant public health concern, highlighting the need for early risk prediction. This study aimed to develop a predictive model for occupational As exposure and hypertension using metabolomics and machine learning. A total of 365 male smelting workers from southern regions were selected. Forty workers from high and low urinary arsenic (U-As) exposure groups were chosen for non-targeted metabolomics analysis. Univariate analysis revealed that U-As is a risk factor for blood pressure and hypertension (P < 0.05). Restricted cubic spline (RCS) analysis showed that both systolic and diastolic blood pressure, as well as hypertension risks, increased with U-As, with a threshold at 32 µg/L. Of 1145 metabolites, 383 differentially expressed metabolites (382 upregulated, 1 downregulated) were identified. Least absolute shrinkage and selection operator (LASSO) regression was used to construct a predictive model for occupational hypertension, with N-hexosyl leucine, myristic acid, gamma-glutamylvaline, and pregnanediol disulfate as predictors. The area under the curve (AUC) of the receiver operating characteristic (ROC) for the predictive model was 0.917, indicating strong predictability and accuracy. This model, based on metabolomics and machine learning, provides an effective tool for early identification and intervention for occupational populations at high risk of hypertension due to As exposure.

Bidirectional association between cardiovascular disease and hip fracture: a systematic review and meta-analysis

BACKGROUND

The aim of this study was to comprehensively analyze the bidirectional association between cardiovascular disease (CVD) and hip fracture (HF).

METHODS

We searched PubMed, EMBASE, Web of Sciences, Cochrane Library, ScienceDirect and China National Knowledge Infrastructure for relevant studies. The Newcastle-Ottawa scale was used to evaluate the risk of bias. We conducted random effects model for meta-analysis and subgroup analysis of different ethnic groups. Sensitivity analysis and publication bias of this study were also evaluated. This study followed the PRISMA and MOOSE guidelines for systematic reviews and meta-analyses.

RESULTS

This research included 18 cohort studies and case-control studies with a total sample of 1,854,441 individuals. The results showed ischemic heart disease might increase the risk of HF (OR = 1.41, 95%CI[1.05, 1.89], I2 = 96%). Stroke might be a risk factor for HF (OR = 2.23, 95%[1.18, 4.19], I2 = 97%), and HF might likewise be a risk factor for Stroke ( OR = 2.22, 95% CI [1.81, 2.71], I2 = 78%). Heart failure might increase the risk of HF (OR = 2.89, 95%CI [1.22, 6.85], I2 = 91%), and HF might increase the risk of heart failure (OR = 2.74, 95%CI [1.27, 5.89], I2 = 92%). Hypertension might increase the risk of HF (OR = 1.55, 95%CI[1.34, 1.8], I2 = 87%), and HF might increase the risk of hypertension (OR = 3.75, 95%CI[3.3, 4.26], I2 = 98%). Cerebrovascular disease (OR = 1.96, 95%CI[1.61, 2.4], I2 = 79%) and diseases of arteries, arterioles, and capillaries (OR = 1.58, 95%CI[1.49, 1.68], I2 = 0%) might increase the risk of HF. HF might increase the risk of myocardial infarction (OR = 2, 95%CI[1.17, 3.41], I2 = 97%) and CVD-related death (OR = 1.78, 95%CI[1.05, 3.02], I2 = 50%). Subgroup analyses showed that among Asians IHD might not raise the risk of HF (OR = 1.33, 95% CI [1.00, 1.78], I2 = 95%). In caucasians, IHD might also not raise HF risk (OR = 1.52, 95%CI [0.64, 4.56], I2 = 95%).

CONCLUSIONS

This study supports possible bidirectional associations between CVD and HF, but more mechanistic studies of CVD and HF were warranted. However, high heterogeneity and potential confounding by unmeasured variables warrant cautious interpretation.

Positive Association Between the Cardiometabolic Index and the Risk of Male Biochemical Androgen Deficiency in Adults

Metabolic disorders are associated with testosterone deficiency, and the cardiometabolic index (CMI) is a recently identified metabolic indicator. The relationship between male biochemical androgen deficiency (MBAD), a precursor to testosterone deficiency, and CMI remains unclear. In this cross-sectional study, we analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2013-2016 to investigate the relationship between MBAD and CMI in men. This study included 1229 participants; among which, 209 participants had MBAD. Machine learning models identified that the importance of CMI on MBAD was in the top three. After adjusting for all covariates, we found a positive association between CMI and MBAD. Restricted cubic spline (RCS) curves validated this association both in age and body mass index subgroups. Trend regression showed that participants with a higher CMI tended to have a higher risk of MBAD. The positive association between CMI and MBAD persisted after multiple interpolations, validating the robustness of the results. Altogether, this study suggests that CMI exhibits a stable positive relationship with MBAD.

Effects of Testosterone Replacement Therapy on Metabolic Syndrome in Male Patients-Systematic Review

Metabolic syndrome (MS) comprises several symptoms or disorders that significantly increase the risk of developing atherosclerosis and type 2 diabetes. This study aims to determine the direct impact of testosterone therapy on the components of MS; although excluding type 2 diabetes cases. The authors conducted a systematic literature search of PubMed, Scopus, and Cochrane databases without date limits, using keywords such as "testosterone therapy", "metabolic syndrome" and "men". The studies included in our review focused on the effects of testosterone replacement therapy (TRT) in male patients with MS, yet rejecting individuals where type 2 diabetes constituted the only diagnosis. A meta-analysis was performed using PQStat v1.8.6 software. The overall effect size (mean difference) was calculated using a random effects model. Our meta-analysis indicates that testosterone therapy leads to improvement in the components of MS. Significant reductions were observed in waist circumference (WC) (95% CI: -0.709 to 0.094; p = 0.011), as well as in triglycerides (TG) (95% CI: -0.474 to 0.120; p = 0.039). These findings support the potential therapeutic benefits of testosterone treatment in managing MS. However, further research is vital to explore the long-term effects and the safety of this therapy in patients with metabolic syndrome.

Rat Model of Menopausal/Andropausal Hypertension with Different Sensitivities to Non-Genomic Antihypertensive Responses of Female and Male Sex Steroids

INTRODUCTION

Hypertension is prevalent in older women and men, but the impact of sex differences is unclear.

METHODS

Blood pressure (BP) was evaluated weekly for 15 weeks using tail-cuff plethysmography in intact or gonadectomized female and male rats. Similarly, gonadectomized rats were subcutaneously treated daily for 15 weeks with estradiol in females or testosterone in males. Treatment with estrogen in males and androgen in females for BP was also examined. The non-genomic antihypertensive potency and efficacy of different sex steroids were determined; catheters were implanted in the carotid artery of hypertensive rats for BP recording with bolus injections in the jugular vein at cumulative doses (1 × 10-7-1 × 10-4M kg-1 min-1) of dehydroepiandrosterone (DHEA), estradiol, testosterone, or 5β-dihydrotestosterone (5β-DHT).

RESULTS

Data showed a time-dependent increase in BP after gonadectomy in female and male rats until hypertension values were reached. Males are more sensitive to the development of hypertension than females. The increases in BP in females and males were completely prevented by estradiol or testosterone, respectively. Testosterone completely prevented hypertension in females, whereas estradiol only partially in males. Antihypertensive potencies in conscious hypertensive rats were DHEA = 5β-DHT = testosterone >> estradiol, in females and DHEA = 5β-DHT >> testosterone >> estradiol in males. The efficacy was DHEA = 5β-DHT = testosterone >> estradiol in females and 5β-DHT = DHEA >> testosterone >> estradiol in males.

CONCLUSION

Gonadectomized males developed hypertension faster than females, suggesting that androgen deficiency plays an important role in BP reduction. Antihypertensive responses of steroids are structure-dependent; estradiol demonstrated the lowest potency, whereas 5β-DHT was a potent antihypertensive without estrogenic and androgenic actions, suggesting it is as a therapeutic candidate for controlling hypertension in both sexes.

The challenges of assessing adiposity in a clinical setting

To tackle the burden of obesity-induced cardiometabolic disease, the scientific community relies on accurate and reproducible adiposity measurements in the clinic. These measurements guide our understanding of underlying biological mechanisms and clinical outcomes of human trials. However, measuring adiposity and adipose tissue distribution in a clinical setting can be challenging, and different measurement methods pose important limitations. BMI is a simple and high-throughput measurement, but it is associated relatively poorly with clinical outcomes when compared with waist-to-hip and sagittal abdominal diameter measurements. Body composition measurements by dual energy X-ray absorptiometry or MRI scans would be ideal due to their high accuracy, but are not high-throughput. Another important consideration is that adiposity measurements vary between men and women, between adults and children, and between people of different ethnic backgrounds. In this Perspective article, we discuss how these critical challenges can affect our interpretation of research data in the field of obesity and the design and implementation of clinical guidelines.

Sex Differences in Cardiovascular Diseases: Exploring the Role of Microbiota and Immunity

Cardiovascular diseases (CVDs) are the most common cause of mortality and morbidity in Western countries, thus representing a global health concern. CVDs show different patterns in terms of the prevalence and presentation in men and women. The role of sex hormones has been extensively implicated in these sex-specific differences, due to the presence of the menstrual cycle and menopause in women. Moreover, the gut microbiota (GM) has been implicated in cardiovascular health, considering the growing evidence that it is involved in determining the development of specific diseases. In particular, gut-derived metabolites have been linked to CVDs and kidney disorders, which can in turn promote the progression of CVDs. Considering the differences in the composition of GM between men and women, it is possible that gut microbiota act as a mediator in regard to the sex disparities in CVDs. This narrative review aims to comprehensively review the interplay between sex, GM, and CVDs, discussing potential mechanisms and therapeutic options.

The relationship between cooking fuel use and sex hormone levels: A cross-sectional study and Mendelian randomization study

PURPOSE

The aim of this study was to investigate the effect of solid fuel use on serum sex hormone levels. Furthermore, the effects of improved kitchen ventilation and duration of cooking time on the relationship between solid fuel use and serum sex hormone levels will be further explored.

METHODS

In this cross-sectional study, 5386 individuals were recruited. Gender and menopausal status modified associations between solid fuel type and serum sex hormone levels was investigated through generalized linear models and further analyzed by improving kitchen ventilation and length of cooking time on the relationship between solid fuel use and serum sex hormone levels. To identify the causal association, mendelian randomization of two-sample was performed.

RESULTS

In observational analyses, for ln-17-hydroxyprogesterone, ln-testosterone, and ln-androstenedione among premenopausal women, the estimated β and 95 % CI of sex hormone levels for the effect of solid fuel users was -0.337 (-0.657, -0.017), -0.233 (-0.47, 0.005), and - 0.240 (-0.452, -0.028) respectively, and - 0.150 (-0.296, -0.004) in ln-progesterone among postmenopausal women. It was found that combining solid fuels with long cooking periods or no ventilation more effectively reduced testosterone and androstenedione in premenopausal women. We further found the adverse effects of using solid fuel on progesterone, testosterone, and androstenedione levels were enhanced with the increases of PM1, PM2.5, PM10, and NO2. Corresponding genetic, the causal risk effect of solid fuel were - 0.056 (-0.513, 0.4) and 0.026 (-3.495, 3.547) for testosterone levels and sex hormone binding globulin, respectively.

CONCLUSION

Using gas or solid fuel was negatively related to sex hormone levels. A combination of using solid fuels, cooking for a long time, or cooking without ventilation had a stronger effect on sex hormone levels. However, genetic evidence did not support causality for the associations. WHAT IS ALREADY KNOWN ON THIS TOPIC?: The mechanisms underlying these associations household air pollution (HAP) from incomplete combustion of such fuels and occurrence of chronic diseases remained obscure. Recent years, extensive evidences from animal as well as human researches have suggested that progestogen and androgen hormones are involved in the development of diabetes, hypertension, and cardiovascular disease, which indicated that changes in serum progestogen and androgen hormones levels might play a role in these pathological mechanisms. However, limited evidence exists examining the effect of HAP from solid fuel use on serum sex hormone levels.

Refined metabolite profiling in the collateral circulation of chronic total occlusion of coronary arteries: Insights from a metabolomics investigation

Background and aims

To investigate the disparities in coronary collateral circulation (CCC) and peripheral serum metabolites among patients presenting with chronic total occlusion (CTO) of the coronary arteries, a non-targeted metabolic approach was employed.

Methods

A cohort of 22 patients diagnosed with CTO of coronary arteries in the context of coronary heart disease (CHD) was selected for blood sample collection from CCC and peripheral arteries. The patients were categorized into two groups, namely CTO-C and CTO-P. The Waters UPLC I-Class Plus is combined with the Q Exactive high-resolution mass spectrometer for metabolite separation and detection. The acquired raw data from mass spectrometry is subsequently imported into Compound Discoverer 3.2 software for comprehensive analysis, which seamlessly integrates the BGI Metabolome Database (BMDB), mzCloud database, and ChemSpider online database. Subsequently, the identified differential metabolites were subjected to a metabolic pathway enrichment analysis, as documented in the Kyoto Encyclopedia of Genes and Genomes (KEGG) database.

Results

A total of 403 differential metabolites were identified in CCC and peripheral serum samples from patients with CTO of coronary arteries in CHD. Compared to the CTO-P group, the CTO-C group exhibited decreased levels of metabolites such as Testosterone, dehydroepiandrosterone (DHA), deoxyacetone, while demonstrating increased levels of metabolites including Progesterone, androstanone, l-threonine. The biosynthesis pathway of steroid hormones emerges as the key metabolic pathway significantly associated with differential metabolites.

Conclusions

Through metabolomics analysis, distinct differences in the CCC and peripheral serum metabolites have been identified among patients with CTO of coronary artery. Notably, a significant association between the steroid hormone biosynthesis pathway and CCC has been observed.