A new Swedish study has shown that elderly ment with higher serum testosterone levels have around a 30% lower risk of cardiovascular events over five years compared with men with lower levels.
Testosterone levels are highest in men around age 25, and decline about 1.5% every year after that. While women experience a sudden loss of estrogen during menopause, men gradually lose their testosterone levels, and the condition has therefore been largely ignored until recently, when it was labeled “andropause”.
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excerpts from the paper by Lisa Nainggolan
And the association remains even after adjustment for traditional cardiovascular risk factors and excluding those with CVD at baseline, say Dr Claes Ohlsson (University of Gothenburg, Sweden) and colleagues in their paper in the October 11, 2011 issue of the Journal of the American College of Cardiology.
Senior author Dr Asa Tivesten (University of Gothenburg) told heartwire : “This paper is an important start, because previously data have been inconsistent about whether there is an association between serum testosterone and CVD events or not. We now know there is an association, but we don’t know what is causing it.”
Study Looked at Community-Dwelling Elderly Men
Ohlsson and colleagues analyzed baseline levels of testosterone in 2416 men aged 69 to 81 years who were participating in the prospective, population-based Osteoporotic Fractures in Men Study (MrOS). They also measured sex-hormone-binding globulin (SHBG) and obtained cardiovascular clinical outcomes from central Swedish registries.
This paper is an important start, because previously data have been inconsistent about whether there is an association between serum testosterone and CVD events or not.
Over a median of five years of follow-up, there were 485 fatal and nonfatal cardiovascular events, and both total testosterone and SHBG levels were inversely associated with risk of CV events (trend over quartiles p=0.009 and p=0.012, respectively).
Tivesten said initially they used quartile 1 (ie, the lowest levels of serum testosterone) as a reference and compared events in this group with those in quartiles 2, 3, and 4. However, they saw no significant difference in the number of CV events between the first three quartiles.
But men in the highest quartile of testosterone (>550 ng/dL) had a lower risk of CV events compared with men in the lower three quartiles (hazard ratio 0.70; p=0.002). This association remained when the first 2.6 years of follow-up were excluded–in order to rule out any effect of baseline (subacute) disease–and was only slightly attenuated after adjustment for confounding factors (HR 0.77; p=0.032).
In models that included testosterone and SHBG, testosterone, but not SHBG, predicted risk.
More Research to Assess Risk/Benefit of Testosterone Supplements
Tivesten says the research does not suggest that testosterone supplements should be used to try to prevent cardiovascular disease and that more work is required to investigate this, because one trial using high doses of exogenous testosterone in older men has actually shown an increase in cardiovascular events.
However, what is established, she says, is that men with testosterone deficiency should receive testosterone supplementation.
And in older men, she adds, the issue is confounded by the fact that testosterone levels decline naturally with age: “So should we regard all elderly men as testosterone deficient? Or just look at subgroups?”
This study was supported by the Swedish Research Council, the Swedish Foundation for Strategic Research, the Avtal om Läkarutbildning och Forskning research grant in Gothenburg, the Swedish Heart-Lung Foundation, the Marianne and Marcus Wallenberg Foundation, the Lundberg Foundation, the Torsten and Ragnar Söderberg Foundation, the Åke Wiberg Foundation, and the Novo Nordisk Foundation. Ohlsson and Tivesten report that they have no disclosures. Disclosures for the coauthors are listed in the paper.
- Ohlsson C, Barrett-Connor E, Bhasin S, et al. High serum testosterone is associated with reduced risk of cardiovascular events in elderly men. The MrOS (osteoporotic fractures in men) Study in Sweden. J Am Coll Cardiol 2011; 58:1674-1681.