Pastuszak AW, Kohn TP, Estis J, Lipshultz LI. Low Plasma Testosterone Is Associated With Elevated Cardiovascular Disease Biomarkers. J Sex Med. http://www.jsm.jsexmed.org/article/S1743-6095(17)31314-0/abstract
BACKGROUND: The relation between testosterone (T) plasma concentration and cardiovascular (CV) risk is unclear, with evidence supporting increased risk in men with low and high T levels. Few studies have assessed CV risk as a function of plasma T levels using objective biomarkers.
AIM: To determine the relation between T levels and high-sensitivity CV risk biomarkers.
METHODS: Ten thousand forty-one male patients were identified in the database of a commercial clinical laboratory performing biomarker testing. Patients were grouped by total T concentration and associations with the following biomarkers were determined:
· cardiac troponin I (cTnI),
· endothelin-1 (ET-1),
· interleukin-6 (IL-6),
· tumor necrosis factor-alpha (TNF-alpha),
· interleukin-17A,
· N-terminal pro-B-type natriuretic peptide (NTproBNP),
· high-density lipoprotein (HDL) cholesterol,
· high-sensitivity C-reactive protein (hs-CRP),
· hemoglobin A1c (HbA1c), and
· leptin.
OUTCOMES: Association of CV risk markers with levels of T in men.
RESULTS: The median age of the cohort was 58 years (interquartile range = 48-68), and the median plasma T level was 420 ng/dL (interquartile range = 304-565); T levels did not vary with patient age.
An inverse relation between plasma T levels and CV risk was observed for 9 of 10 CV markers:
· cTnI,
· ET-1,
· IL-6,
· TNF-alpha,
· NTproBNP,
· HDL cholesterol,
· hs-CRP,
· HbA1c, and
· leptin.
Even after adjusting for age, body mass index, HbA1c, hs-CRP, and HDL cholesterol levels, the CV markers IL-6, ET-1, NTproBNP, and leptin were significantly associated with a T level lower than 250 ng/dL.
CLINICAL IMPLICATIONS: Men with low T levels could be at increased risk for increased CV disease as seen by increased CV risk markers.
STRENGTH AND LIMITATIONS: This study was performed in a group of 10,041 men and is the first study to examine CV risk associated with circulating T levels using a large panel of 10 objective biomarkers. This study is limited by an absence of clinical data indicating whether men had pre-existing CV disease or other CV risk factors.
CONCLUSION: Men with low plasma T levels exhibit increases in CV risk markers, consistent with a potential increased risk of CV disease.
BACKGROUND: The relation between testosterone (T) plasma concentration and cardiovascular (CV) risk is unclear, with evidence supporting increased risk in men with low and high T levels. Few studies have assessed CV risk as a function of plasma T levels using objective biomarkers.
AIM: To determine the relation between T levels and high-sensitivity CV risk biomarkers.
METHODS: Ten thousand forty-one male patients were identified in the database of a commercial clinical laboratory performing biomarker testing. Patients were grouped by total T concentration and associations with the following biomarkers were determined:
· cardiac troponin I (cTnI),
· endothelin-1 (ET-1),
· interleukin-6 (IL-6),
· tumor necrosis factor-alpha (TNF-alpha),
· interleukin-17A,
· N-terminal pro-B-type natriuretic peptide (NTproBNP),
· high-density lipoprotein (HDL) cholesterol,
· high-sensitivity C-reactive protein (hs-CRP),
· hemoglobin A1c (HbA1c), and
· leptin.
OUTCOMES: Association of CV risk markers with levels of T in men.
RESULTS: The median age of the cohort was 58 years (interquartile range = 48-68), and the median plasma T level was 420 ng/dL (interquartile range = 304-565); T levels did not vary with patient age.
An inverse relation between plasma T levels and CV risk was observed for 9 of 10 CV markers:
· cTnI,
· ET-1,
· IL-6,
· TNF-alpha,
· NTproBNP,
· HDL cholesterol,
· hs-CRP,
· HbA1c, and
· leptin.
Even after adjusting for age, body mass index, HbA1c, hs-CRP, and HDL cholesterol levels, the CV markers IL-6, ET-1, NTproBNP, and leptin were significantly associated with a T level lower than 250 ng/dL.
CLINICAL IMPLICATIONS: Men with low T levels could be at increased risk for increased CV disease as seen by increased CV risk markers.
STRENGTH AND LIMITATIONS: This study was performed in a group of 10,041 men and is the first study to examine CV risk associated with circulating T levels using a large panel of 10 objective biomarkers. This study is limited by an absence of clinical data indicating whether men had pre-existing CV disease or other CV risk factors.
CONCLUSION: Men with low plasma T levels exhibit increases in CV risk markers, consistent with a potential increased risk of CV disease.
