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Yeap BB, Marriott RJ, Dwivedi G, Adams RJ, Antonio L, Ballantyne CM, Bauer DC, Bhasin S, Biggs ML, Cawthon PM, Couper DJ, Dobs AS, Flicker L, Handelsman DJ, Hankey GJ, Hannemann A, Haring R, Hsu B, Martin SA, Matsumoto AM, Mellström D, Ohlsson C, O'Neill TW, Orwoll ES, Quartagno M, Shores MM, Steveling A, Tivesten Å, Travison TG, Vanderschueren D, Wittert GA, Wu FCW, Murray K. Associations of Testosterone and Related Hormones With All-Cause and Cardiovascular Mortality and Incident Cardiovascular Disease in Men : Individual Participant Data Meta-analyses. Ann Intern Med 2024; 177:768-781. [PMID: 38739921 DOI: 10.7326/m23-2781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Whether circulating sex hormones modulate mortality and cardiovascular disease (CVD) risk in aging men is controversial. PURPOSE To clarify associations of sex hormones with these outcomes. DATA SOURCES Systematic literature review to July 2019, with bridge searches to March 2024. STUDY SELECTION Prospective cohort studies of community-dwelling men with sex steroids measured using mass spectrometry and at least 5 years of follow-up. DATA EXTRACTION Independent variables were testosterone, sex hormone-binding globulin (SHBG), luteinizing hormone (LH), dihydrotestosterone (DHT), and estradiol concentrations. Primary outcomes were all-cause mortality, CVD death, and incident CVD events. Covariates included age, body mass index, marital status, alcohol consumption, smoking, physical activity, hypertension, diabetes, creatinine concentration, ratio of total to high-density lipoprotein cholesterol, and lipid medication use. DATA SYNTHESIS Nine studies provided individual participant data (IPD) (255 830 participant-years). Eleven studies provided summary estimates (n = 24 109). Two-stage random-effects IPD meta-analyses found that men with baseline testosterone concentrations below 7.4 nmol/L (<213 ng/dL), LH concentrations above 10 IU/L, or estradiol concentrations below 5.1 pmol/L had higher all-cause mortality, and those with testosterone concentrations below 5.3 nmol/L (<153 ng/dL) had higher CVD mortality risk. Lower SHBG concentration was associated with lower all-cause mortality (median for quintile 1 [Q1] vs. Q5, 20.6 vs. 68.3 nmol/L; adjusted hazard ratio [HR], 0.85 [95% CI, 0.77 to 0.95]) and lower CVD mortality (adjusted HR, 0.81 [CI, 0.65 to 1.00]). Men with lower baseline DHT concentrations had higher risk for all-cause mortality (median for Q1 vs. Q5, 0.69 vs. 2.45 nmol/L; adjusted HR, 1.19 [CI, 1.08 to 1.30]) and CVD mortality (adjusted HR, 1.29 [CI, 1.03 to 1.61]), and risk also increased with DHT concentrations above 2.45 nmol/L. Men with DHT concentrations below 0.59 nmol/L had increased risk for incident CVD events. LIMITATIONS Observational study design, heterogeneity among studies, and imputation of missing data. CONCLUSION Men with low testosterone, high LH, or very low estradiol concentrations had increased all-cause mortality. SHBG concentration was positively associated and DHT concentration was nonlinearly associated with all-cause and CVD mortality. PRIMARY FUNDING SOURCE Medical Research Future Fund, Government of Western Australia, and Lawley Pharmaceuticals. (PROSPERO: CRD42019139668).
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Affiliation(s)
- Bu B Yeap
- Medical School, University of Western Australia, and Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia (B.B.Y.)
| | - Ross J Marriott
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia (R.J.M., K.M.)
| | - Girish Dwivedi
- Medical School, University of Western Australia; Harry Perkins Institute of Medical Research; and Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia (G.D.)
| | - Robert J Adams
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, South Australia, Australia (R.J.A.)
| | - Leen Antonio
- Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium (L.A., D.V.)
| | | | - Douglas C Bauer
- General Internal Medicine, University of California, San Francisco, San Francisco, California (D.C.B.)
| | - Shalender Bhasin
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (S.B.)
| | - Mary L Biggs
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington (M.L.B.)
| | - Peggy M Cawthon
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California (P.M.C.)
| | - David J Couper
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (D.J.C.)
| | - Adrian S Dobs
- School of Medicine, Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University, Baltimore, Maryland (A.S.D.)
| | - Leon Flicker
- Medical School, University of Western Australia, and Western Australian Centre for Healthy Ageing, University of Western Australia, Perth, Western Australia, Australia (L.F.)
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Australia (D.J.H.)
| | - Graeme J Hankey
- Medical School, University of Western Australia, and Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia (G.J.H.)
| | - Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, and German Centre for Cardiovascular Research, Partner Site Greifswald, Greifswald, Germany (A.H.)
| | - Robin Haring
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia, and European University of Applied Sciences, Faculty of Applied Public Health, Rostock, Germany (R.H.)
| | - Benjumin Hsu
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia (B.H.)
| | - Sean A Martin
- Australian Institute of Family Studies, Southbank, Victoria, Australia (S.A.M.)
| | - Alvin M Matsumoto
- Department of Medicine, University of Washington School of Medicine, and Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington (A.M.M.)
| | - Dan Mellström
- Centre for Bone and Arthritis Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden (D.M., C.O.)
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden (D.M., C.O.)
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom (T.W.O.)
| | - Eric S Orwoll
- Oregon Health & Science University, Portland, Oregon (E.S.O.)
| | - Matteo Quartagno
- MRC Clinical Trials Unit, University College London, London, United Kingdom (M.Q.)
| | - Molly M Shores
- School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington (M.M.S.)
| | - Antje Steveling
- Department of Internal Medicine, University Medicine Greifswald, Greifswald, Germany (A.S.)
| | - Åsa Tivesten
- Wallenberg Laboratory for Cardiovascular and Metabolic Research, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Department of Endocrinology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden (Å.T.)
| | - Thomas G Travison
- Brigham and Women's Hospital, Harvard Medical School, and Institute for Aging Research, Hebrew Senior Life, Beth Israel Deaconess Medical Center, Boston, Massachusetts (T.G.T.)
| | - Dirk Vanderschueren
- Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium (L.A., D.V.)
| | - Gary A Wittert
- Freemasons Centre for Men's Health and Wellbeing, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia (G.A.W.)
| | - Frederick C W Wu
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, United Kingdom (F.C.W.W.)
| | - Kevin Murray
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia (R.J.M., K.M.)
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2
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Green DJ, Chasland LC, Naylor LH, Yeap BB. New Horizons: Testosterone or Exercise for Cardiometabolic Health in Older Men. J Clin Endocrinol Metab 2023; 108:2141-2153. [PMID: 36964918 PMCID: PMC10438896 DOI: 10.1210/clinem/dgad175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 03/27/2023]
Abstract
Middle-aged and older men have typically accumulated comorbidities, are increasingly sedentary, and have lower testosterone concentrations (T) compared to younger men. Reduced physical activity (PA) and lower T both are associated with, and may predispose to, metabolically adverse changes in body composition, which contribute to higher risks of cardiometabolic disease. Exercise improves cardiometabolic health, but sustained participation is problematic. By contrast, rates of T prescription have increased, particularly in middle-aged and older men without organic diseases of the hypothalamus, pituitary, or testes, reflecting the unproven concept of a restorative hormone that preserves health. Two recent large randomized trials of T, and meta-analyses of randomized trials, did not show a signal for adverse cardiovascular (CV) events, and T treatment on a background of lifestyle intervention reduced type 2 diabetes by 40% in men at high risk. Men with both higher endogenous T and higher PA levels have lower CV risk, but causality remains unproven. Exercise training interventions improve blood pressure and endothelial function in middle-aged and older men, without comparable benefits or additive effects of T treatment. Therefore, exercise training improves cardiometabolic health in middle-aged and older men when effectively applied as a supervised regimen incorporating aerobic and resistance modalities. Treatment with T may have indirect cardiometabolic benefits, mediated via favorable changes in body composition. Further evaluation of T as a pharmacological intervention to improve cardiometabolic health in aging men could consider longer treatment durations and combination with targeted exercise programs.
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Affiliation(s)
- Daniel J Green
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, WA, 6009, Australia
| | - Lauren C Chasland
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, WA, 6009, Australia
- Allied Health Department, Fiona Stanley Hospital, Perth, WA, 6150, Australia
| | - Louise H Naylor
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, WA, 6009, Australia
- Allied Health Department, Fiona Stanley Hospital, Perth, WA, 6150, Australia
| | - Bu B Yeap
- Medical School, The University of Western Australia, Perth, WA, 6009, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, 6150, Australia
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3
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Chen Y, Fan Q, Liu Y, Shi Y, Luo H. Cardiovascular toxicity induced by SSRIs: Analysis of spontaneous reports submitted to FAERS. Psychiatry Res 2023; 326:115300. [PMID: 37364503 DOI: 10.1016/j.psychres.2023.115300] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 06/28/2023]
Abstract
Depression diagnoses have surged recently, and selective serotonin reuptake inhibitors (SSRIs) are the go-to treatment. However, studies indicate that long-term use of SSRIs can increase cardiovascular risk without systematic evaluation of the drug class. To offer clinical guidance, we performed an evaluation of the association between the six most commonly prescribed SSRIs and cardiovascular adverse events. Using the FDA Adverse Event Reporting System (FAERS) from Q1 2004 to Q2 2022, we conducted a disproportionality analysis and determined the magnitude of significant signals using statistical shrinkage transformations. Our study revealed that arrhythmias, torsades de pointes/QT prolongation, cardiomyopathy, and hypertension were among the most prevalent adverse events linked to SSRIs. Our analysis also showed a significant association between SSRIs and the aforementioned adverse events, with higher incidence in middle-aged and elderly patients and women. We further observed a rising trend in the incidence of arrhythmias, torsades de pointes/QT prolongation, and hypertension, highlighting the need for heightened cardiac monitoring in patients on SSRIs.
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Affiliation(s)
- Yukun Chen
- Department of Pharmacy, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China; School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China
| | - Qingze Fan
- Department of Pharmacy, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yang Liu
- Department of Pharmacy, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China; School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China
| | - Yue Shi
- Department of Pharmacy, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China; School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China
| | - Hongli Luo
- Department of Pharmacy, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
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4
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Li J, Zheng L, Chan KHK, Zou X, Zhang J, Liu J, Zhong Q, Madsen TE, Wu WC, Manson JE, Yu X, Liu S. Sex Hormone-Binding Globulin and Risk of Coronary Heart Disease in Men and Women. Clin Chem 2023; 69:374-385. [PMID: 36702572 DOI: 10.1093/clinchem/hvac209] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/14/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND The role of sex hormone-binding globulin (SHBG) levels in clinical risk stratification and intervention for coronary heart disease (CHD) remains uncertain. We aimed to examine whether circulating levels of SHBG are predictive of CHD risk in men and women. METHODS We investigated the association between SHBG and the risk of incident CHD in 128 322 men and 135 103 women free of CHD at baseline in the prospective United Kingdom Biobank (UKB) cohort. The unconfounded associations were estimated using Mendelian randomization (MR) analysis. We further conducted a meta-analysis to integrate currently available prospective evidence. CHD events included nonfatal and fatal myocardial infarction and coronary revascularization. RESULTS In the UKB, during a median of 11.7 follow-up years, 10 405 men and 4512 women developed CHD. Serum levels of SHBG were monotonically associated with a decreased risk of CHD in both men (adjusted hazard ratio [HR] per log nmol/L increase in SHBG: 0.88 [0.83-0.94]) and women (HR: 0.89 [0.83-0.96]). MR-based analyses suggested causality and a dose-response relationship of SHBG with CHD risk. A cumulative meta-analysis including 216 417 men and 138 282 women from 11 studies showed that higher levels of SHBG were prospectively associated with decreased CHD risk in men comparing the highest with the lowest quartile: pooled relative risk (RR) 0.81 (0.74-0.89) and women (pooled RR: 0.86 [0.78-0.94]). CONCLUSIONS Higher circulating SHBG levels were directly and independently predictive of lower CHD risk in both men and women. The utility of SHBG for CHD risk stratification and prediction warrants further study.
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Affiliation(s)
- Jie Li
- Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510280, China
- School of Medicine, South China University of Technology, Guangzhou 510006, China
- Department of Epidemiology and Center for Global Cardiometabolic Health, School of Public Health, Brown University, Providence, RI, USA
| | - Lingling Zheng
- Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kei Hang Katie Chan
- Department of Epidemiology and Center for Global Cardiometabolic Health, School of Public Health, Brown University, Providence, RI, USA
- Departments of Biomedical Sciences and Electrical Engineering, City University of Hong Kong, Hong Kong SAR, China
| | - Xia Zou
- Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jihui Zhang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jundong Liu
- Departments of Biomedical Sciences and Electrical Engineering, City University of Hong Kong, Hong Kong SAR, China
| | - Qingwei Zhong
- Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tracy E Madsen
- Department of Epidemiology and Center for Global Cardiometabolic Health, School of Public Health, Brown University, Providence, RI, USA
- Department of Emergency Medicine, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Wen-Chih Wu
- Department of Epidemiology and Center for Global Cardiometabolic Health, School of Public Health, Brown University, Providence, RI, USA
- Department of Medicine, Division of Cardiology, Providence VA Medical Center and Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Xueqing Yu
- Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Nephrology, Guangdong-Hong Kong Joint Laboratory on Immunological and Genetic Kidney Diseases, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Simin Liu
- Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Epidemiology and Center for Global Cardiometabolic Health, School of Public Health, Brown University, Providence, RI, USA
- Departments of Medicine and Surgery, The Warren Alpert Medical School, Brown University, Providence, RI, USA
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5
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Appiah D, Luitel S, Nwabuo CC, Ebong I, Winters SJ. Low endogenous estradiol levels are associated with elevated risk of cardiovascular disease mortality in young and middle-aged men in the United States. Atherosclerosis 2022; 361:34-40. [PMID: 36210243 DOI: 10.1016/j.atherosclerosis.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/18/2022] [Accepted: 09/14/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Evidence for the association of total estradiol (E2) with cardiovascular disease (CVD) in young men is limited. We investigated the association of total E2 or free estradiol (FE2) and CVD mortality in a nationally representative multiracial sample of young and middle-aged men in the United States. METHODS Data were from 954 men without CVD, cancer, diabetes and not on androgen therapy or taking anabolic steroids, who participated in the National Health and Nutrition Examination Survey (1988-1991), for whom E2 was measured, and were followed for mortality through to 2015. Fasting serum levels of E2 were measured using competitive electrochemiluminescence immunoassays. Free estradiol was estimated from the levels of estradiol, sex hormone binding globulin, and albumin. International Classification of Diseases codes were used to define CVD mortality. Cox regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS The average age of participants at baseline was 35.7 ± 11.6 years, with 11% and 6% reporting Black and Hispanic race and ethnicity, respectively. During a median follow-up of 25.2 years, 40 CVD deaths were recorded. Controlling for baseline demographic and CVD risk factors, and total testosterone levels, a 1 standard deviation decrement in log E2 (HR: 2.33, 95%CI: 1.11-5.00) or FE2 (HR: 1.89, 95%CI: 1.01-3.57) was associated with elevated risk of CVD mortality. This elevated risk was largely limited to non-Hispanic White men. CONCLUSIONS In this study, low levels of E2 or FE2 were associated with elevated risk of CVD mortality.
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Affiliation(s)
- Duke Appiah
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
| | - Sujata Luitel
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Chike C Nwabuo
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Imo Ebong
- Division of Cardiovascular Sciences, University of California, Davis, Sacramento, CA, USA
| | - Stephen J Winters
- Division of Endocrinology, Metabolism and Diabetes, University of Louisville, Louisville, KY, USA
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Enina TN, Kuznetsov VA, Soldatova AM. [Testosterone and congestive heart failure]. KARDIOLOGIIA 2022; 62:61-67. [PMID: 35989631 DOI: 10.18087/cardio.2022.7.n1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/11/2020] [Indexed: 06/15/2023]
Abstract
This article summarizes current information about the interrelation between testosterone concentrations and chronic heart failure (CHF). The authors described key publications that address the prevalence of testosterone deficiency in patients with CHF, the effect of endogenous and exogenous testosterone on the cardiovascular system, the relationship between testosterone levels and the severity and prognosis of CHF, and the efficacy of interventional treatments for CHF.
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Affiliation(s)
- T N Enina
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Tomsk
| | - V A Kuznetsov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Tomsk
| | - A M Soldatova
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Tomsk
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Raparelli V, Nocella C, Proietti M, Romiti GF, Corica B, Bartimoccia S, Stefanini L, Lenzi A, Viceconte N, Tanzilli G, Cammisotto V, Pilote L, Cangemi R, Basili S, Carnevale R. Testosterone-to-estradiol ratio and platelet thromboxane release in ischemic heart disease: the EVA project. J Endocrinol Invest 2022; 45:1367-1377. [PMID: 35262860 PMCID: PMC9184432 DOI: 10.1007/s40618-022-01771-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/16/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Data on the interplay between sexual hormones balance, platelet function and clinical outcomes of adults with ischemic heart disease (IHD) are still lacking. OBJECTIVE To assess the association between the Testosterone (T)-to-Estradiol (E2) Ratio (T/E2) and platelet activation biomarkers in IHD and its predictive value on adverse outcomes. METHODS The EVA study is a prospective observational study of consecutive hospitalized adults with IHD undergoing coronary angiography and/or percutaneous coronary interventions. Serum T/E2 ratios E2, levels of thromboxane B2 (TxB2) and nitrates (NO), were measured at admission and major adverse events, including all-cause mortality, were collected during a long-term follow-up. RESULTS Among 509 adults with IHD (mean age 67 ± 11 years, 30% females), males were older with a more adverse cluster of cardiovascular risk factors than females. Acute coronary syndrome and non-obstructive coronary artery disease were more prevalent in females versus males. The lower sex-specific T/E2 ratios identified adults with the highest level of serum TxB2 and the lowest NO levels. During a median follow-up of 23.7 months, the lower sex-specific T/E2 was associated with higher all-cause mortality (HR 3.49; 95% CI 1.24-9.80; p = 0.018). In in vitro, platelets incubated with T/E2 ratios comparable to those measured in vivo in the lowest quartile showed increased platelet activation as indicated by higher levels of aggregation and TxB2 production. CONCLUSION Among adults with IHD, higher T/E2 ratio was associated with a lower long-term risk of fatal events. The effect of sex hormones on the platelet thromboxane release may partially explain such finding.
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Affiliation(s)
- V Raparelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
- Department of Translational Medicine, University of Ferrara, via Luigi Borsari, 46, 44121, Ferrara, Italy.
- University Center for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy.
| | - C Nocella
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - M Proietti
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - G F Romiti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - B Corica
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - S Bartimoccia
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - L Stefanini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - A Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - N Viceconte
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - G Tanzilli
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - V Cammisotto
- Department of General Surgery and Surgical Speciality Paride Stefanini, Sapienza University of Rome, Rome, Italy
| | - L Pilote
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC, Canada
| | - R Cangemi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - S Basili
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - R Carnevale
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro-Napoli, Naples, Italy
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8
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Yeap BB, Marriott RJ, Antonio L, Raj S, Dwivedi G, Reid CM, Anawalt BD, Bhasin S, Dobs AS, Handelsman DJ, Hankey GJ, Haring R, Matsumoto AM, Norman PE, O'Neill TW, Ohlsson C, Orwoll ES, Vanderschueren D, Wittert GA, Wu FCW, Murray K. Associations of Serum Testosterone and Sex Hormone-Binding Globulin With Incident Cardiovascular Events in Middle-Aged to Older Men. Ann Intern Med 2022; 175:159-170. [PMID: 34958606 DOI: 10.7326/m21-0551] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The influence of testosterone on risk for cardiovascular events in men is uncertain. Previous observational studies of sex hormones and incident cardiovascular disease in men have reported inconsistent findings, limited by cohort sizes and different selection criteria. OBJECTIVE To analyze associations of serum total testosterone and sex hormone-binding globulin (SHBG) with incident cardiovascular events in men. DESIGN Cohort study. SETTING UK Biobank prospective cohort. PARTICIPANTS Community-dwelling men aged 40 to 69 years. MEASUREMENTS Testosterone and SHBG were assayed, and free testosterone was calculated. Cox proportional hazards regression was done, with outcomes of incident myocardial infarction (MI), hemorrhagic stroke (HS), ischemic stroke (IS), heart failure (HF), and major adverse cardiovascular events (MACE), adjusted for sociodemographic, lifestyle, and medical factors. RESULTS Of 210 700 men followed for 9 years, 8790 (4.2%) had an incident cardiovascular event. After adjustment for key variables, lower total testosterone concentrations (quintile 1 vs. quintile 5) were not associated with incident MI (fully adjusted hazard ratio [HR], 0.89 [95% CI, 0.80 to 1.00]), HS (HR, 0.94 [CI, 0.70 to 1.26]), IS (HR, 0.95 [CI, 0.82 to 1.10]), HF (HR, 1.15 [CI, 0.91 to 1.45]), or MACE (HR, 0.92 [CI, 0.84 to 1.00]). Men with lower calculated free testosterone values had a lower incidence of MACE (HR, 0.90 [CI, 0.84 to 0.97]). Lower SHBG concentrations were associated with higher incidence of MI (HR, 1.23 [CI, 1.09 to 1.38]) and lower incidence of IS (HR, 0.79 [CI, 0.67 to 0.94]) and HF (HR, 0.69 [CI, 0.54 to 0.89]), but not with HS (HR, 0.81 [CI, 0.57 to 1.14]) or MACE (HR, 1.01 [CI, 0.92 to 1.11]). LIMITATION Observational study; single baseline measurement of testosterone and SHBG. CONCLUSION Men with lower total testosterone concentrations were not at increased risk for MI, stroke, HF, or MACE. Calculated free testosterone may be associated with risk for MACE. Men with lower SHBG concentrations have higher risk for MI but lower risk for IS and HF, with causality to be determined. PRIMARY FUNDING SOURCE Western Australian Health Translation Network, Medical Research Future Fund, and Lawley Pharmaceuticals.
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Affiliation(s)
- Bu B Yeap
- Medical School, University of Western Australia, and Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia (B.B.Y.)
| | - Ross J Marriott
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia (R.J.M., K.M.)
| | - Leen Antonio
- Laboratory of Clinical and Experimental Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium (L.A., D.V.)
| | - Suchitra Raj
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia (S.R.)
| | - Girish Dwivedi
- Medical School, University of Western Australia, Harry Perkins Institute of Medical Research, and Fiona Stanley Hospital, Perth, Western Australia, Australia (G.D.)
| | - Christopher M Reid
- School of Population Health, Curtin University, Perth, Western Australia, Australia (C.M.R.)
| | - Bradley D Anawalt
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington (B.D.A.)
| | - Shalender Bhasin
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (S.B.)
| | - Adrian S Dobs
- Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Maryland (A.S.D.)
| | - David J Handelsman
- Anzac Research Institute, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia (D.J.H.)
| | - Graeme J Hankey
- Medical School, University of Western Australia, Perth, Western Australia, Australia (G.J.H., P.E.N.)
| | - Robin Haring
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia, and Faculty of Applied Public Health, European University of Applied Sciences, Rostock, Germany (R.H.)
| | - Alvin M Matsumoto
- Department of Medicine, University of Washington School of Medicine, and Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington (A.M.M.)
| | - Paul E Norman
- Medical School, University of Western Australia, Perth, Western Australia, Australia (G.J.H., P.E.N.)
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, University of Manchester, and National Institute for Health Research Manchester Biomedical Research Centre, Manchester University National Health Service Foundation Trust, Manchester, United Kingdom (T.W.O.)
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, and Region Vastra Gotaland, Sahlgrenska University Hospital, Gothenburg, Sweden (C.O.)
| | - Eric S Orwoll
- Oregon Health & Science University, Portland, Oregon (E.S.O.)
| | - Dirk Vanderschueren
- Laboratory of Clinical and Experimental Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium (L.A., D.V.)
| | - Gary A Wittert
- Freemasons Centre for Men's Health and Wellbeing, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia (G.A.W.)
| | - Frederick C W Wu
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, United Kingdom (F.C.W.)
| | - Kevin Murray
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia (R.J.M., K.M.)
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9
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Singh P, Covassin N, Marlatt K, Gadde KM, Heymsfield SB. Obesity, Body Composition, and Sex Hormones: Implications for Cardiovascular Risk. Compr Physiol 2021; 12:2949-2993. [PMID: 34964120 PMCID: PMC10068688 DOI: 10.1002/cphy.c210014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Cardiovascular disease (CVD) continues to be the leading cause of death in adults, highlighting the need to develop novel strategies to mitigate cardiovascular risk. The advancing obesity epidemic is now threatening the gains in CVD risk reduction brought about by contemporary pharmaceutical and surgical interventions. There are sex differences in the development and outcomes of CVD; premenopausal women have significantly lower CVD risk than men of the same age, but women lose this advantage as they transition to menopause, an observation suggesting potential role of sex hormones in determining CVD risk. Clear differences in obesity and regional fat distribution among men and women also exist. While men have relatively high fat in the abdominal area, women tend to distribute a larger proportion of their fat in the lower body. Considering that regional body fat distribution is an important CVD risk factor, differences in how men and women store their body fat may partly contribute to sex-based alterations in CVD risk as well. This article presents findings related to the role of obesity and sex hormones in determining CVD risk. Evidence for the role of sex hormones in determining body composition in men and women is also presented. Lastly, the clinical potential for using sex hormones to alter body composition and reduce CVD risk is outlined. © 2022 American Physiological Society. Compr Physiol 12:1-45, 2022.
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Affiliation(s)
- Prachi Singh
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
| | | | - Kara Marlatt
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
| | - Kishore M Gadde
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
| | - Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
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10
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Marriott RJ, Harse J, Murray K, Yeap BB. Systematic review and meta-analyses on associations of endogenous testosterone concentration with health outcomes in community-dwelling men. BMJ Open 2021; 11:e048013. [PMID: 34728442 PMCID: PMC8565564 DOI: 10.1136/bmjopen-2020-048013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The overall study aim is to clarify the relation of endogenous sex hormones with major health outcomes in men. This paper reports a systematic review focusing on published estimates for testosterone associations. SETTING Community-dwelling men. PARTICIPANTS 20 180 adult men participated in the final set of studies identified and selected from a systematic review. Eligible studies included prospective cohort studies with plasma or serum testosterone concentrations measured for adult men using mass spectrometry with at least 5 years of follow-up data and one of the specified outcome measures recorded. Only published or grey literature items written in English were considered. PRIMARY AND SECONDARY OUTCOME MEASURES Planned prospective outcome measures: cardiovascular disease (CVD) events, CVD deaths, all-cause mortality, cancer deaths, cancer diagnoses, cognitive decline, dementia. Meta-analyses were of the most frequently reported outcomes in selected studies: CVD deaths and all-cause mortality. Succinct characterisations of testosterone associations with other outcomes are also presented. RESULTS Screening of 1994 deduplicated items identified 9 suitable studies, with an additional 2 identified by colleagues (11 in total). Summary estimates of mean testosterone concentration and age at recruitment for 20 180 adult men were 15.4±0.7 nmol/L and 64.9±3.3 year. Despite considerable variation in mean testosterone, a metaregression estimated no significant dependence on mean age at recruitment among studies (slope=-0.03, 95% CI -0.11 to 0.06). Meta-analyses demonstrated negligible heterogeneity and no significant effect of a 5 nmol/L increase in testosterone on the risk of all-cause mortality (HR=0.96, 95% CI 0.89 to 1.03) or death from CVD (HR=0.95, 95% CI 0.83 to 1.08). CONCLUSIONS Analyses of published estimates did not demonstrate associations of endogenous testosterone with CVD deaths or with all-cause mortality. Suggested further research includes the planned individual participant data meta-analyses for selected studies, enabling the investigation of non-linear summary effects. PROSPERO REGISTRATION NUMBER PROSPERO: CRD42019139668.
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Affiliation(s)
- Ross James Marriott
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Janis Harse
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Bu Beng Yeap
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia
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11
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Cittadini A, Isidori AM, Salzano A. Testosterone therapy and cardiovascular diseases. Cardiovasc Res 2021; 118:2039-2057. [PMID: 34293112 DOI: 10.1093/cvr/cvab241] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/16/2021] [Indexed: 11/14/2022] Open
Abstract
Since it was first synthesised in 1935, testosterone (T) has been viewed as the mythical Fountain of Youth, promising rejuvenation, restoring sexual appetites, growing stronger muscles, and quicker thinking. T is endowed with direct effects on myocardial and vascular structure and function, as well as on risk factors for cardiovascular (CV) disease. Indeed, low serum T levels are a risk factor for diabetes, metabolic syndrome, inflammation, and dyslipidaemia. Moreover, many studies have shown that T deficiency per se is an independent risk factor of CV and all-cause mortality. On this background and due to direct-to-patient marketing by drug companies, we have witnessed to the widespread use of T replacement therapy (TT) without clear indications particularly in late-life onset hypogonadism. The current review will dwell upon current evidence and controversies surrounding the role of T in the pathophysiology of CV diseases, the link between circulating T levels and CV risk, and the use of replacing T as a possible adjuvant treatment in specific CV disorders. Specifically, recent findings suggest that heart failure and type 2 diabetes mellitus represent two potential targets of T therapy once that a state of hypogonadism is diagnosed. However, only if ongoing studies solve the CV safety issue the T orchid may eventually 'bloom'.
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Affiliation(s)
- Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Interdisciplinary Research Centre on Biomaterials (CRIB), Federico II University, Naples, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Andrea Salzano
- IRCCS SDN, Diagnostic and Nuclear Research Institute, Naples, Italy
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12
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Yaglova NV, Tsomartova DA, Obernikhin SS, Yaglov VV, Nazimova SV, Tsomartova ES, Chereshneva EV, Ivanova MY, Lomanovskaya TA. Differential Disrupting Effects of Prolonged Low-Dose Exposure to Dichlorodiphenyltrichloroethane on Androgen and Estrogen Production in Males. Int J Mol Sci 2021; 22:3155. [PMID: 33808818 PMCID: PMC8003643 DOI: 10.3390/ijms22063155] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 02/06/2023] Open
Abstract
Dichlorodiphenyltrichloroethane (DDT) is the most widespread, persistent pollutant and endocrine disruptor on the planet. Although DDT has been found to block androgen receptors, the effects of its low-dose exposure in different periods of ontogeny on the male reproductive system remain unclear. We evaluate sex steroid hormone production in the pubertal period and after maturation in male Wistar rats exposed to low doses of o,p'-DDT, either during prenatal and postnatal development or postnatal development alone. Prenatally and postnatally exposed rats exhibit lower testosterone production and increased estradiol and estriol serum levels after maturation, associated with the delayed growth of gonads. Postnatally exposed rats demonstrate accelerated growth of gonads and higher testosterone production in the pubertal period. In contrast to the previous group, they do not present raised estradiol production. All of the exposed animals exhibit a reduced conversion of progesterone to 17OH-progesterone after sexual maturation, which indicates putative attenuation of sex steroid production. Thus, the study reveals age-dependent outcomes of low-dose exposure to DDT. Prenatal onset of exposure results in the later onset of androgen production and the enhanced conversion of androgens to estrogens after puberty, while postnatal exposure induces the earlier onset of androgen secretion.
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Affiliation(s)
- Nataliya V. Yaglova
- Laboratory of Endocrine System Development, Federal State Budgetary Scientific Institution “Research Institute of Human Morphology”, 117418 Moscow, Russia; (D.A.T.); (S.S.O.); (V.V.Y.); (S.V.N.); (E.S.T.)
| | - Dibakhan A. Tsomartova
- Laboratory of Endocrine System Development, Federal State Budgetary Scientific Institution “Research Institute of Human Morphology”, 117418 Moscow, Russia; (D.A.T.); (S.S.O.); (V.V.Y.); (S.V.N.); (E.S.T.)
- Department of Histology, Cytology, and Embryology, Federal State Funded Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University, 119435 Moscow, Russia; (E.V.C.); (M.Y.I.); (T.A.L.)
| | - Sergey S. Obernikhin
- Laboratory of Endocrine System Development, Federal State Budgetary Scientific Institution “Research Institute of Human Morphology”, 117418 Moscow, Russia; (D.A.T.); (S.S.O.); (V.V.Y.); (S.V.N.); (E.S.T.)
| | - Valentin V. Yaglov
- Laboratory of Endocrine System Development, Federal State Budgetary Scientific Institution “Research Institute of Human Morphology”, 117418 Moscow, Russia; (D.A.T.); (S.S.O.); (V.V.Y.); (S.V.N.); (E.S.T.)
| | - Svetlana V. Nazimova
- Laboratory of Endocrine System Development, Federal State Budgetary Scientific Institution “Research Institute of Human Morphology”, 117418 Moscow, Russia; (D.A.T.); (S.S.O.); (V.V.Y.); (S.V.N.); (E.S.T.)
| | - Elina S. Tsomartova
- Laboratory of Endocrine System Development, Federal State Budgetary Scientific Institution “Research Institute of Human Morphology”, 117418 Moscow, Russia; (D.A.T.); (S.S.O.); (V.V.Y.); (S.V.N.); (E.S.T.)
- Department of Histology, Cytology, and Embryology, Federal State Funded Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University, 119435 Moscow, Russia; (E.V.C.); (M.Y.I.); (T.A.L.)
| | - Elizaveta V. Chereshneva
- Department of Histology, Cytology, and Embryology, Federal State Funded Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University, 119435 Moscow, Russia; (E.V.C.); (M.Y.I.); (T.A.L.)
| | - Marina Y. Ivanova
- Department of Histology, Cytology, and Embryology, Federal State Funded Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University, 119435 Moscow, Russia; (E.V.C.); (M.Y.I.); (T.A.L.)
| | - Tatiana A. Lomanovskaya
- Department of Histology, Cytology, and Embryology, Federal State Funded Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University, 119435 Moscow, Russia; (E.V.C.); (M.Y.I.); (T.A.L.)
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13
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Belladelli F, Del Giudice F, Kasman A, Salonia A, Eisenberg ML. The association between testosterone, estradiol and their ratio and mortality among US men. Andrologia 2021; 53:e13993. [PMID: 33666951 DOI: 10.1111/and.13993] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 11/29/2022] Open
Abstract
While studies have suggested that testosterone is associated with a man's health, the relationship with other sex steroids remains uncertain. The current study aimed to investigate the association between sex steroids (i.e. testosterone, estradiol and the testosterone:estradiol ratio) and mortality in a representative sample of 1,109 US men. Three NHANES continuous cycles (1999-2000, 2001-2002, 2003-2004) were included in our study. Serum testosterone and estradiol levels were evaluated along with sociodemographic, lifestyle and health factors. Cox proportional hazards models were used. The adjusted risk of death for men with low testosterone levels was 1.66 (95% CI = 1.00-2.74, p = .05). The adjusted risk of death for men with abnormal estradiol levels was 0.96 (95% CI = 0.48-1.91, p = .91). The adjusted risk of death for men with low testosterone to estradiol ratio was 1.27 (95% CI = 0.82-1.97, p = .88). Relevant lifestyle and health factors significantly attenuated the associations. The adjusted risk of CVD-related death for men with low testosterone levels was 2.43 (95% CI = 1.07-5.50, p = .03). In conclusion, a significant association between testosterone and mortality and testosterone to estradiol ratio and CVD-related mortality was identified.
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Affiliation(s)
- Federico Belladelli
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy.,Department of Urology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Francesco Del Giudice
- Department of Urology, School of Medicine, Stanford University, Stanford, CA, USA.,Department of Urology, University Sapienza, Rome, Italy
| | - Alex Kasman
- Department of Urology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Michael L Eisenberg
- Department of Urology, School of Medicine, Stanford University, Stanford, CA, USA
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14
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Garibotto G, Esposito P, Picciotto D, Verzola D. Testosterone Disorders and Male Hypogonadism in Kidney Disease. Semin Nephrol 2021; 41:114-125. [PMID: 34140090 DOI: 10.1016/j.semnephrol.2021.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic kidney disease (CKD) causes substantial alterations in the male endocrine system, which affect puberty, libido, and sexual function. A major effect of CKD is a reduction in testosterone levels because of both primary and hypogonadotrophic hypogonadism. In addition to impairment of pubertal growth and sexual maturation in children with CKD, clinical evidence suggests that uremic hypogonadism strongly contributes to several CKD complications, including erectile dysfunction, muscle wasting and frailty, anemia, decreased bone mineralization, depression, and cognitive impairment. This review focuses on a reappraisal of the physiologic role of testosterone, with an emphasis on the hypogonadal condition linked to CKD and its complications.
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Affiliation(s)
- Giacomo Garibotto
- Division of Nephrology, Dialysis and Transplantation, University of Genova, Genova, Italy Department of Internal Medicine, Istituto di Ricerca a Carattere Scientifico Ospedale Policlinico San Martino, Genova Italy.
| | - Pasquale Esposito
- Division of Nephrology, Dialysis and Transplantation, University of Genova, Genova, Italy Department of Internal Medicine, Istituto di Ricerca a Carattere Scientifico Ospedale Policlinico San Martino, Genova Italy
| | - Daniela Picciotto
- Division of Nephrology, Dialysis and Transplantation, University of Genova, Genova, Italy Department of Internal Medicine, Istituto di Ricerca a Carattere Scientifico Ospedale Policlinico San Martino, Genova Italy
| | - Daniela Verzola
- Division of Nephrology, Dialysis and Transplantation, University of Genova, Genova, Italy Department of Internal Medicine, Istituto di Ricerca a Carattere Scientifico Ospedale Policlinico San Martino, Genova Italy
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15
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Yeap BB, Marriott RJ, Antonio L, Chan YX, Raj S, Dwivedi G, Reid CM, Anawalt BD, Bhasin S, Dobs AS, Hankey GJ, Matsumoto AM, Norman PE, O'Neill TW, Ohlsson C, Orwoll ES, Vanderschueren D, Wittert GA, Wu FCW, Murray K. Serum Testosterone is Inversely and Sex Hormone-binding Globulin is Directly Associated with All-cause Mortality in Men. J Clin Endocrinol Metab 2021; 106:e625-e637. [PMID: 33059368 DOI: 10.1210/clinem/dgaa743] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Indexed: 02/07/2023]
Abstract
CONTEXT Serum testosterone concentrations decline with age, while serum sex hormone-binding globulin (SHBG) concentrations increase. OBJECTIVE To analyze associations of baseline serum testosterone and SHBG concentrations, and calculated free testosterone (cFT) values, with all-cause and cause-specific mortality in men. DESIGN, SETTING, AND PARTICIPANTS The UK Biobank prospective cohort study of community-dwelling men aged 40-69 years old, followed for 11 years. MAIN OUTCOME MEASURES All-cause, atherosclerotic cardiovascular disease (CVD) and cancer-related mortality. Cox proportional hazards regression was performed, adjusting for age, waist circumference, medical conditions, and other covariates. Models for testosterone included SHBG and vice versa. RESULTS In a complete case analysis of 149 436 men with 10 053 deaths (1925 CVD and 4927 cancer-related), men with lower testosterone had a higher mortality rate from any cause (lowest vs highest quintile, Q1 vs Q5, fully-adjusted hazard ratio [HR] = 1.14, 95% confidence interval [CI] = 1.06-1.22, overall trend P < 0.001), and cancer (HR = 1.20, CI = 1.09-1.33, P < 0.001), with no association for CVD deaths. Similar results were seen for cFT. Men with lower SHBG had a lower mortality rate from any cause (Q1 vs Q5, HR = 0.68, CI = 0.63-0.73, P < 0.001), CVD (HR = 0.70, CI = 0.59-0.83, P < 0.001), and cancer (HR = 0.80, CI = 0.72-0.89, P < 0.001). A multiply imputed dataset (N = 208 425, 15 914 deaths, 3128 CVD-related and 7468 cancer-related) and analysis excluding deaths within the first 2 years (9261, 1734, and 4534 events) yielded similar results. CONCLUSIONS Lower serum testosterone is independently associated with higher all-cause and cancer-related, but not CVD-related, mortality in middle-aged to older men. Lower SHBG is independently associated with lower all-cause, CVD-related, and cancer-related mortality. Confirmation and determination of causality requires mechanistic studies and prospective trials.
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Affiliation(s)
- Bu B Yeap
- Medical School, University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Australia
| | - Ross J Marriott
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Leen Antonio
- Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Yi X Chan
- Medical School, University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Australia
| | - Suchitra Raj
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Australia
| | - Girish Dwivedi
- Medical School, University of Western Australia, Perth, Australia
- Harry Perkins Institute of Medical Research and Fiona Stanley Hospital, Perth, Australia
| | | | - Bradley D Anawalt
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Shalender Bhasin
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Adrian S Dobs
- Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Graeme J Hankey
- Medical School, University of Western Australia, Perth, Australia
| | - Alvin M Matsumoto
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
- Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington
| | - Paul E Norman
- Medical School, University of Western Australia, Perth, Australia
| | - Terence W O'Neill
- Manchester Institute for Collaborative Research on Ageing, University of Manchester, Manchester, UK
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Vastra Gotaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eric S Orwoll
- Oregon Health and Science University, Portland, Oregon
| | - Dirk Vanderschueren
- Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Gary A Wittert
- Freemasons Centre for Men's Health and Wellbeing, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Frederick C W Wu
- Division of Endocrinology, Diabetes and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Kevin Murray
- School of Population and Global Health, University of Western Australia, Perth, Australia
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16
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Kharaba ZJ, Buabeid MA, Ibrahim NA, Jirjees FJ, Obaidi HJA, Kaddaha A, Khajehkarimoddini L, Alfoteih Y. Testosterone therapy in hypogonadal patients and the associated risks of cardiovascular events. Biomed Pharmacother 2020; 129:110423. [PMID: 32570122 DOI: 10.1016/j.biopha.2020.110423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/06/2020] [Accepted: 06/13/2020] [Indexed: 10/24/2022] Open
Abstract
Since the male secondary sex characters, libido and fertility are attributed to their major androgen hormone testosterone, the sub-optimum levels of testosterone in young adults may cause infertility and irregularities in their sexual behaviour. Such deficiency is often secondary to maladies involving testes, pituitary or hypothalamus that could be treated with an administration of exogenous testosterone. In the last few decades, the number of testosterone prescriptions has markedly increased to treat sub-optimal serum levels even though its administration in such conditions is not yet approved. On account of its associated cardiovascular hazards, the food and drug authority in the United States has issued safety alerts on testosterone replacement therapy (TRT). Owing to a great degree of conflict among their findings, the published clinical trials seem struggling in presenting a decisive opinion on the matter. Hence, the clinicians remain uncertain about the possible cardiovascular adversities while prescribing TRT in hypogonadal men. The uncertainty escalates even further while prescribing such therapy in older men with a previous history of cardiovascular ailments. In the current review, we analysed the pre-clinical and clinical studies to evaluate the physiological impact of testosterone on cardiovascular and related parameters. We have enlisted studies on the association of cardiovascular health and endogenous testosterone levels with a comprehensive analysis of epidemiological studies, clinical trials, and meta-analyses on the cardiovascular risk of TRT. The review is aimed to assist clinicians in making smart decisions regarding TRT in their patients.
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Affiliation(s)
- Zelal Jaber Kharaba
- Department of Clinical Sciences, College of Pharmacy, Al-Ain University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Manal Ali Buabeid
- Department of Clinical Sciences, Ajman University, Ajman, 346, United Arab Emirates
| | - Nihal A Ibrahim
- Department of Clinical Sciences, Ajman University, Ajman, 346, United Arab Emirates
| | | | | | | | | | - Yassen Alfoteih
- City University College of Ajman, Ajman, 18484, United Arab Emirates.
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Kharaba ZJ, Buabeid MA, Alfoteih YA. Effectiveness of testosterone therapy in hypogonadal patients and its controversial adverse impact on the cardiovascular system. Crit Rev Toxicol 2020; 50:491-512. [PMID: 32689855 DOI: 10.1080/10408444.2020.1789944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Testosterone is the major male hormone produced by testicles which are directly associated with man's appearance and secondary sexual developments. Androgen deficiency starts when the male hormonal level falls from its normal range though, in youngsters, the deficiency occurs due to disruption of the normal functioning of pituitary, hypothalamus glands, and testes. Thus, testosterone replacement therapy was already known for the treatment of androgen deficiency with lesser risks of producing cardiovascular problems. Since from previous years, the treatment threshold in the form of testosterone replacement therapy has effectively increased to that extent that it was prescribed for those conditions which it was considered as inappropriate. However, there are some research studies and clinical trials available that proposed the higher risk of inducing cardiovascular disease with the use of testosterone replacement therapy. Thus under the light of these results, the FDA has published the report of the increased risk of cardiovascular disease with the increased use of testosterone replacement therapy. Nevertheless, there is not a single trial available or designed that could evaluate the risk of cardiovascular events with the use of testosterone replacement therapy. As a result, the use of testosterone still questioned the cardiovascular safety of this replacement therapy. Thus, this literature outlines the distribution pattern of disease by investigating the data and link between serum testosterone level and the cardiovascular disease, also the prescription data of testosterone replacement therapy patients and their tendency of inducing cardiovascular disease, meta-analysis and the trials regarding testosterone replacement therapy and its connection with the risks of causing cardiovascular disease and lastly, the possible effects of testosterone replacement therapy on the cardiovascular system. This study aims to evaluate the available evidence regarding the use of testosterone replacement therapy when choosing it as a treatment plan for their patients.
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Affiliation(s)
- Zelal Jaber Kharaba
- Department of Clinical Sciences, College of Pharmacy, Al-Ain University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Manal Ali Buabeid
- Department of Clinical Sciences, Ajman University, Ajman, United Arab Emirates
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Yeap BB, Marriott RJ, Adams RJ, Antonio L, Ballantyne CM, Bhasin S, Cawthon PM, Couper DJ, Dobs AS, Flicker L, Karlsson M, Martin SA, Matsumoto AM, Mellström D, Norman PE, Ohlsson C, Orwoll ES, O'Neill TW, Shores MM, Travison TG, Vanderschueren D, Wittert GA, Wu FCW, Murray K. Androgens In Men Study (AIMS): protocol for meta-analyses of individual participant data investigating associations of androgens with health outcomes in men. BMJ Open 2020; 10:e034777. [PMID: 32398333 PMCID: PMC7239545 DOI: 10.1136/bmjopen-2019-034777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 02/25/2020] [Accepted: 04/08/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION This study aims to clarify the role(s) of endogenous sex hormones to influence health outcomes in men, specifically to define the associations of plasma testosterone with incidence of cardiovascular events, cancer, dementia and mortality risk, and to identify factors predicting testosterone concentrations. Data will be accrued from at least three Australian, two European and four North American population-based cohorts involving approximately 20 000 men. METHODS AND ANALYSIS Eligible studies include prospective cohort studies with baseline testosterone concentrations measured using mass spectrometry and 5 years of follow-up data on incident cardiovascular events, mortality, cancer diagnoses or deaths, new-onset dementia or decline in cognitive function recorded. Data for men, who were not taking androgens or drugs suppressing testosterone production, metabolism or action; and had no prior orchidectomy, are eligible. Systematic literature searches were conducted from 14 June 2019 to 31 December 2019, with no date range set for searches. Aggregate level data will be sought where individual participant data (IPD) are not available. One-stage IPD random-effects meta-analyses will be performed, using linear mixed models, generalised linear mixed models and either stratified or frailty-augmented Cox regression models. Heterogeneity in estimates from different studies will be quantified and bias investigated using funnel plots. Effect size estimates will be presented in forest plots and non-negligible heterogeneity and bias investigated using subgroup or meta-regression analyses. ETHICS AND DISSEMINATION Ethics approvals obtained for each of the participating cohorts state that participants have consented to have their data collected and used for research purposes. The Androgens In Men Study has been assessed as exempt from ethics review by the Human Ethics office at the University of Western Australia (file reference number RA/4/20/5014). Each of the component studies had obtained ethics approvals; please refer to respective component studies for details. Research findings will be disseminated to the scientific and broader community via the publication of four research articles, with each involving a separate set of IPD meta-analyses (articles will investigate different, distinct outcomes), at scientific conferences and meetings of relevant professional societies. Collaborating cohort studies will disseminate findings to study participants and local communities. PROSPERO REGISTRATION NUMBER CRD42019139668.
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Affiliation(s)
- Bu Beng Yeap
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Ross James Marriott
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Robert J Adams
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, South Australia, Australia
| | - Leen Antonio
- Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | | | | | - Peggy M Cawthon
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - David John Couper
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Adrian S Dobs
- School of Medicine, Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
| | - Leon Flicker
- WA Centre for Health & Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - Magnus Karlsson
- Department of Clinical Sciences and Orthopedic Surgery, Lund University, Lund, Sweden
| | - Sean A Martin
- Freemasons Foundation Centre for Men's Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Alvin M Matsumoto
- Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Medicine, Division of Gerontology & Geriatric Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Dan Mellström
- Centre for Bone and Arthritis Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Goteborg, Sweden
| | - Paul E Norman
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Goteborg, Sweden
| | - Eric S Orwoll
- Oregon Health & Science University, Portland, Oregon, USA
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester & NIHR Manchester Biomedical Research Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Molly M Shores
- VA Puget Sound Health Care System, Seattle, Washington, USA
- School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Thomas G Travison
- Harvard Medical School, Boston, Massachusetts, USA
- Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Dirk Vanderschueren
- Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), Laboratory of Clinical and Experimental Endocrinology, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Gary A Wittert
- Freemasons Foundation Centre for Men's Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Frederick C W Wu
- Division of Diabetes, Endocrinology and Gastroenterology, The University of Manchester, Manchester, UK
| | - Kevin Murray
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
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19
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Schederecker F, Cecil A, Prehn C, Nano J, Koenig W, Adamski J, Zeller T, Peters A, Thorand B. Sex hormone-binding globulin, androgens and mortality: the KORA-F4 cohort study. Endocr Connect 2020; 9:326-336. [PMID: 32168474 PMCID: PMC7219137 DOI: 10.1530/ec-20-0080] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/13/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Sex hormone-binding globulin (SHBG) and androgens have been associated with mortality in women and men, but controversy still exists. Our objective was to investigate associations of SHBG and androgens with all-cause and cause-specific mortality in men and women. DESIGN 1006 men and 709 peri- and postmenopausal women (age range: 45-82 years) from the German population-based KORA F4 cohort study were followed-up for a median of 8.7 years. METHODS SHBG was measured with an immunoassay, total testosterone (TT) and dihydrotestosterone (DHT) with mass-spectrometry in serum samples and we calculated free testosterone (cFT). To assess associations between SHBG and androgen levels and mortality, we calculated hazard ratios (HRs) with 95% CIs using Cox proportional-hazards models. RESULTS In the cohort, 128 men (12.7%) and 70 women (9.9%) died. In women, we observed positive associations of SHBG with all-cause (HR: 1.54, 95% CI: 1.16-2.04) and with other disease-related mortality (HR: 1.86, 95% CI: 1.08-3.20) and for DHT with all-cause mortality (HR: 1.32, 95% CI: 1.00-1.73). In men, we found a positive association of SHBG (HR: 1.24 95% CI: 1.00-1.54) and inverse associations of TT (HR: 0.87, 95% CI: 0.77-0.97) and cFT (HR: 0.84, 95% CI: 0.73-0.97) with all-cause mortality. No other associations were found for cause-specific mortality. CONCLUSIONS Higher SHBG levels were associated with increased risk of all-cause mortality in men and women. Lower TT and cFT levels in men and higher DHT levels in women were associated with increased risk of all-cause mortality. Future, well-powered population-based studies should further investigate cause-specific mortality risk.
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Affiliation(s)
- Florian Schederecker
- Institute of Epidemiology, Helmholtz Zentrum München – German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Alexander Cecil
- Molecular Endocrinology and Metabolism, Genome Analysis Center, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Cornelia Prehn
- Molecular Endocrinology and Metabolism, Genome Analysis Center, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Jana Nano
- Institute of Epidemiology, Helmholtz Zentrum München – German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Wolfgang Koenig
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
- Deutsches Herzzentrum München, Technische Universität München, DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jerzy Adamski
- Molecular Endocrinology and Metabolism, Genome Analysis Center, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Lehrstuhl für Experimentelle Genetik, Technische Universität München, Freising-Weihenstephan, Germany
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München – German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich, Munich, Germany
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München – German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Correspondence should be addressed to B Thorand:
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20
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van Koeverden ID, de Bakker M, Haitjema S, van der Laan SW, de Vries JPPM, Hoefer IE, de Borst GJ, Pasterkamp G, den Ruijter HM. Testosterone to oestradiol ratio reflects systemic and plaque inflammation and predicts future cardiovascular events in men with severe atherosclerosis. Cardiovasc Res 2020; 115:453-462. [PMID: 30052805 DOI: 10.1093/cvr/cvy188] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/19/2018] [Indexed: 11/13/2022] Open
Abstract
Aims The effects of testosterone on cardiovascular disease (CVD) as reported in literature have been ambiguous. Recently, the interplay between testosterone and oestradiol as assessed by testosterone/oestradiol (T/E2) ratio was suggested to be better informative on the normal physiological balance. Considering the role in CVD, we hypothesized that a low T/E2 ratio in men with CVD is associated with increased inflammation, a more unstable plaque and a worse cardiovascular outcome. Methods and results Testosterone and oestradiol concentrations were determined in blood samples of 611 male carotid endarterectomy patients included in the Athero-Express Biobank Study. T/E2 ratio was associated with baseline characteristics, atherosclerotic plaque specimens, inflammatory biomarkers, and 3 year follow-up information. Patients with low T/E2 ratio had more unfavourable inflammatory profiles compared with patients with high T/E2 as observed by higher levels of C-reactive protein [2.81 μg/mL vs. 1.22 μg/mL (P < 0.001)] and higher leucocyte counts [8.98*109/L vs. 7.75*109/L (P = 0.001)] in blood. In atherosclerotic plaques, a negative association between T/E2 ratio and number of neutrophils [B = -0.366 (P = 0.012)], plaque calcifications [OR: 0.816 (P = 0.044)], interleukin-6 (IL-6) [B = -0.15 (P = 0.009)], and IL-6 receptor [B = -0.13 (P = 0.024)] was found. Furthermore, in multivariate Cox regression analysis, low T/E2 ratio was independently associated with an increased risk for major cardiovascular events (MACE) during 3 year follow-up [hazard ratio 1.67 (95% confidence interval 1.02-2.76), P = 0.043]. In men with elevated body mass index (BMI), these effects were strongest. Conclusion In male patients with manifest atherosclerotic disease, low T/E2 ratio was associated with increased systemic inflammation, increased inflammatory plaque proteins, and an increased risk of future MACE as compared to men with normal T/E2 ratio. These effects are strongest in men with elevated BMI and are expected to be affected by aromatase activity in white fat tissues. Normalization of T/E2 ratio may be considered as target for the secondary prevention of CVD in men.
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Affiliation(s)
- Ian D van Koeverden
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Marie de Bakker
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Saskia Haitjema
- Laboratory of Clinical Chemistry and Haematology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Sander W van der Laan
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | | | - Imo E Hoefer
- Laboratory of Clinical Chemistry and Haematology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Gerard Pasterkamp
- Laboratory of Clinical Chemistry and Haematology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Hester M den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
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21
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Abstract
Testosterone is the main male sex hormone and is essential for the maintenance of male secondary sexual characteristics and fertility. Androgen deficiency in young men owing to organic disease of the hypothalamus, pituitary gland or testes has been treated with testosterone replacement for decades without reports of increased cardiovascular events. In the past decade, the number of testosterone prescriptions issued for middle-aged or older men with either age-related or obesity-related decline in serum testosterone levels has increased exponentially even though these conditions are not approved indications for testosterone therapy. Some retrospective studies and randomized trials have suggested that testosterone replacement therapy increases the risk of cardiovascular disease, which has led the FDA to release a warning statement about the potential cardiovascular risks of testosterone replacement therapy. However, no trials of testosterone replacement therapy published to date were designed or adequately powered to assess cardiovascular events; therefore, the cardiovascular safety of this therapy remains unclear. In this Review, we provide an overview of epidemiological data on the association between serum levels of endogenous testosterone and cardiovascular disease, prescription database studies on the risk of cardiovascular disease in men receiving testosterone therapy, randomized trials and meta-analyses evaluating testosterone replacement therapy and its association with cardiovascular events and mechanistic studies on the effects of testosterone on the cardiovascular system. Our aim is to help clinicians to make informed decisions when considering testosterone replacement therapy in their patients.
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22
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Gyawali P, Martin SA, Heilbronn LK, Vincent AD, Jenkins AJ, Januszewski AS, Adams RJT, O'Loughlin PD, Wittert GA. Higher Serum Sex Hormone-Binding Globulin Levels Are Associated With Incident Cardiovascular Disease in Men. J Clin Endocrinol Metab 2019; 104:6301-6315. [PMID: 31390027 DOI: 10.1210/jc.2019-01317] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/01/2019] [Indexed: 01/14/2023]
Abstract
CONTEXT Sex hormone-binding globulin (SHBG) levels are associated with cardiovascular disease (CVD) risk factors. However, prospective data on the association between SHBG levels and CVD events are sparse, with conflicting results. OBJECTIVES To examine associations between serum SHBG, total testosterone (TT), and incident CVD and CVD-related mortality in middle-aged to elderly men. DESIGN AND METHODS Data on 2563 community-dwelling men (35 to 80 years) were obtained from participants in the Men Androgen Inflammation Lifestyle Environment and Stress cohort. The analytic sample included 1492 men without baseline (2002 to 2007) CVD and with fasted morning serum SHBG and TT available at both baseline and follow-up (2007 to 2010) and without medications affecting TT or SHBG. Associations of baseline SHBG and TT, with incident CVD and CVD mortality, were analyzed using logistic regression for incident CVD and Cox proportional hazard regression for CVD mortality, adjusting for established CVD risk factors. RESULTS In multivariable models, elevated baseline SHBG and lower baseline TT were independently associated with incident CVD (SHBG: OR, 1.54; 95% CI, 1.15 to 2.06 per SD increase in SHBG, P = 0.003; TT: OR, 0.71; 95% CI, 0.52 to 0.97 per SD decrease in TT; P = 0.03). A decrease in TT between time points was associated with incident CVD (OR, 0.72; 95% CI, 0.56 to 0.92; P = 0.01). Neither SHBG nor TT was significantly associated with all-age CVD mortality [hazard ratio (HR), 0.69; 95% CI, 0.29 to 1.63; P = 0.40; and HR, 0.60; 95% CI, 0.28 to 1.26; P = 0.18, respectively]. CONCLUSIONS Among all men and men >65 years, elevated SHBG and lower TT were independently associated with both a greater risk of CVD and an increased CVD mortality risk.
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Affiliation(s)
- Prabin Gyawali
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Sean A Martin
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Leonie K Heilbronn
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Andrew D Vincent
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Alicia J Jenkins
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Andrzej S Januszewski
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Robert J T Adams
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | | | - Gary A Wittert
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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23
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Yeap BB. Testosterone and its metabolites: differential associations with cardiovascular and cerebrovascular events in men. Asian J Androl 2019; 20:109-114. [PMID: 29199649 PMCID: PMC5858092 DOI: 10.4103/aja.aja_50_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
As men grow older, circulating testosterone declines while the incidence of cardiovascular disease increases. Thus, the role of sex hormones as biomarkers, and possibly contributing factors to clinical manifestations of cardiovascular disease in the increasing demographic of aging men, has attracted considerable interest. This review focuses on observational studies of endogenous androgens, namely circulating testosterone and dihydrotestosterone, which have examined their associations with cardiovascular events such as myocardial infarction and stroke. Studies which have examined the associations of endogenous estrogens, namely circulating estradiol, with these outcomes are also discussed. In large prospective cohort studies of predominantly middle-aged and older men, lower circulating testosterone consistently predicts higher incidence of cardiovascular events. Of note, both lower circulating testosterone and lower dihydrotestosterone are associated with higher incidence of stroke. These associations are less apparent when myocardial infarction is considered as the outcome. Results for estradiol are inconsistent. Lower circulating testosterone has been shown to predict higher cardiovascular disease-related mortality, as has lower circulating dihydrotestosterone. It is possible that the relationship of circulating androgens to cardiovascular events or mortality outcomes may be U-shaped rather than linear, with an optimal range defining men at lowest risk. Epidemiological studies are observational in nature and do not prove causality. Associations observed in studies of endogenous androgens need not necessarily translate into similar effects of exogenous androgens. Rigorous randomized controlled trials are needed to clarify the effects of testosterone treatment on cardiovascular risk in men.
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Affiliation(s)
- Bu B Yeap
- School of Medicine, University of Western Australia, Perth, Western Australia 6009, Australia.,Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia 6150, Australia
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24
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Laouali N, Brailly-Tabard S, Helmer C, Ancelin ML, Tzourio C, Elbaz A, Guiochon-Mantel A, Canonico M. Oestradiol level, oestrogen receptors, and mortality in elderly men: The three-city cohort study. Clin Endocrinol (Oxf) 2018; 89:514-525. [PMID: 29935032 DOI: 10.1111/cen.13797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/09/2018] [Accepted: 06/20/2018] [Indexed: 01/12/2023]
Abstract
CONTEXT Although endogenous oestradiol, generally considered as the female hormone, has been little investigated in men, it could play a role in men's health, mortality in particular. The influence of oestrogen receptors (ER) genetic polymorphisms on this relationship has never been studied. DESIGN AND PARTICIPANTS The Three-City cohort study included (1999-2001) 3650 men ≥65 years who were followed for mortality over 12 years. At baseline, total oestradiol (tE2) was measured and ER genotyped in a random subsample of 472 men without hormonal treatment. Free oestradiol (fE2) was estimated using Vermeulen and Södergard algorithms. MAIN OUTCOME Mortality data were obtained from death certificates. We used inverse probability weighted Cox models to examine the association of oestradiol with all-cause and cause-specific mortality and its interaction with ER genetic polymorphisms. RESULTS A total of 183 men died over the follow-up (cardiovascular disease (CVD), n = 44; cancer, n = 57; other causes, n = 82). After adjustment, there was a quadratic relationship of all-cause mortality with tE2 and fE2 (P-quadratic = 0.04 and 0.05, respectively), with higher mortality for the top and bottom tertiles compared to the middle one. These associations were stronger for CVD mortality (P-quadratic = 0.01 and 0.02 for tE2 and fE2, respectively) and disappeared for cancer mortality. There was no evidence of an interaction of oestradiol with any ER polymorphisms on all-cause mortality. CONCLUSION In elderly men, we showed a nonlinear association of tE2 and fE2 with all-cause mortality. These quadratic relationships were stronger for CVD mortality and did not exist for cancer mortality. ER genetic polymorphisms did not modify this association.
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Affiliation(s)
- Nasser Laouali
- Paris-Saclay University, Paris-South University, UVSQ, Center for Research in Epidemiology and Population Health, INSERM, Villejuif, France
| | - Sylvie Brailly-Tabard
- Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Hôpitaux Universitaires Paris Sud, AH-HP, CHU Bicêtre, France
- INSERM UMR_S U1185, Fac Med Paris Sud, Univ. Paris Sud, Université Paris-Saclay, Le Kremlin Bicêtre, France
| | - Catherine Helmer
- University Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR 1219, CHU Bordeaux, Bordeaux, France
| | - Marie-Laure Ancelin
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Christophe Tzourio
- University Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR 1219, CHU Bordeaux, Bordeaux, France
| | - Alexis Elbaz
- Paris-Saclay University, Paris-South University, UVSQ, Center for Research in Epidemiology and Population Health, INSERM, Villejuif, France
| | - Anne Guiochon-Mantel
- Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Hôpitaux Universitaires Paris Sud, AH-HP, CHU Bicêtre, France
- INSERM UMR_S U1185, Fac Med Paris Sud, Univ. Paris Sud, Université Paris-Saclay, Le Kremlin Bicêtre, France
| | - Marianne Canonico
- Paris-Saclay University, Paris-South University, UVSQ, Center for Research in Epidemiology and Population Health, INSERM, Villejuif, France
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25
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Holmboe SA, Skakkebæk NE, Juul A, Scheike T, Jensen TK, Linneberg A, Thuesen BH, Andersson AM. Individual testosterone decline and future mortality risk in men. Eur J Endocrinol 2018; 178:123-130. [PMID: 29066571 DOI: 10.1530/eje-17-0280] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 10/16/2017] [Accepted: 10/23/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Male aging is characterized by a decline in testosterone (TS) levels with a substantial variability between subjects. However, it is unclear whether differences in age-related changes in TS are associated with general health. We investigated associations between mortality and intra-individual changes in serum levels of total TS, SHBG, free TS and LH during a ten-year period with up to 18 years of registry follow-up. DESIGN 1167 men aged 30-60 years participating in the Danish Monitoring Trends and Determinants of Cardiovascular Disease (MONICA1) study and who had a follow-up examination ten years later (MONICA10) were included. From MONICA10, the men were followed up to 18 years (mean: 15.2 years) based on the information from national mortality registries via their unique personal ID numbers. METHODS Cox proportional hazard models were used to investigate the association between intra-individual hormone changes and all-cause, CVD and cancer mortalities. RESULTS A total of 421 men (36.1%) died during the follow-up period. Men with most pronounced decline in total TS (<10th percentile) had a higher all-cause mortality risk compared to men within the 10th to 90th percentile (hazard ratio (HR): 1.60; 95% confidence interval (CI): 1.08-2.36). No consistent associations were seen in cause-specific mortality analyses. CONCLUSION Our study showed that higher mortality rates were seen among the men who had the most pronounced age-related decline in TS, independent of their baseline TS levels.
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Affiliation(s)
- Stine A Holmboe
- Department of Growth and Reproduction
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC)Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Niels E Skakkebæk
- Department of Growth and Reproduction
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC)Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anders Juul
- Department of Growth and Reproduction
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC)Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Departments of Clinical MedicineFaculty of Health and Medical Sciences
| | - Thomas Scheike
- Departments of BiostatisticsUniversity of Copenhagen, Copenhagen, Denmark
| | - Tina K Jensen
- Department of Growth and Reproduction
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC)Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Allan Linneberg
- Departments of Clinical MedicineFaculty of Health and Medical Sciences
- Research Centre for Prevention and HealthThe Capital Region, Denmark
- Department of Clinical Experimental ResearchRigshospitalet, Copenhagen, Denmark
| | - Betina H Thuesen
- Research Centre for Prevention and HealthThe Capital Region, Denmark
| | - Anna-Maria Andersson
- Department of Growth and Reproduction
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC)Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Chasland LC, Knuiman MW, Divitini ML, Chan YX, Handelsman DJ, Naylor LH, Green DJ, Yeap BB. Greater physical activity and higher androgen concentrations are independently associated with lower cardiometabolic risk in men. Clin Endocrinol (Oxf) 2017; 87:466-474. [PMID: 28656662 DOI: 10.1111/cen.13407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/21/2017] [Accepted: 06/21/2017] [Indexed: 11/27/2022]
Abstract
CONTEXT Male ageing is associated with lower circulating testosterone (T) and increased incidence of cardiovascular disease (CVD). Whether physical activity (PA) interacts with hormones to modify CVD risk is unclear. OBJECTIVE We assessed whether PA and sex hormone concentrations were independently associated with measures of CVD risk. PARTICIPANTS A total of 1649 men. METHODS Leisure, home, work and total PA were ascertained. At baseline, serum T, dihydrotestosterone (DHT) and oestradiol (E2) were assayed. Men were stratified into high PA+high hormone (H/H); low PA+high hormone (L/H); high PA+low hormone (H/L); and low PA+low hormone (L/L). RESULTS Mean age was 49.8 years at outset with 415 CVD events and 127 CVD deaths occurring during 20-year follow-up. Men with higher PA and higher T or DHT had lower odds of metabolic syndrome (eg leisure H/H vs L/L odds ratio [OR] 0.17 P<.001 for T, 0.26 P<.001 for DHT). Men with higher PA and E2 had lower risk of metabolic syndrome (eg leisure PA H/H vs L/L OR 0.51, P=.001). Men with higher leisure, work or total PA and higher DHT had the lowest risk of CVD death (eg leisure H/H hazard ratio [HR] 0.55 vs L/L, P=.033). Men with lower leisure, home or work PA and higher E2 were at greater risk of CVD death (eg leisure L/H HR 1.60 vs L/L, P=.039). CONCLUSIONS Considering T, DHT and E2 in the context of PA better informs consideration of cardiovascular risk. A 2×2 factorial RCT assessing PA and androgens would illuminate the scope for preventing CVD in men.
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Affiliation(s)
- Lauren C Chasland
- School of Sport Science, Exercise and Health, University of Western Australia, Perth, WA, Australia
| | - Matthew W Knuiman
- School of Population Health, University of Western Australia, Perth, WA, Australia
| | - Mark L Divitini
- School of Population Health, University of Western Australia, Perth, WA, Australia
| | - Yi X Chan
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia
| | | | - Louise H Naylor
- School of Sport Science, Exercise and Health, University of Western Australia, Perth, WA, Australia
| | - Daniel J Green
- School of Sport Science, Exercise and Health, University of Western Australia, Perth, WA, Australia
| | - Bu B Yeap
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia
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27
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Gan EH, Quinton R. Have the Testosterone Trials demonstrated the effectiveness of testosterone therapy in older men without classical hypogonadism? J R Coll Physicians Edinb 2016; 46:168-171. [DOI: 10.4997/jrcpe.2016.307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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