Testosterone concentrations and risk of cardiovascular events in androgen-deficient men with atherosclerotic cardiovascular disease.

Autor: Boden WE; VA Boston Healthcare System, Boston University School of Medicine, Boston, MA. Electronic address: william.boden@va.gov., Miller MG; AbbVie, Chicago, IL., McBride R; Axio Research, LLC, Seattle, WA., Harvey C; Axio Research, LLC, Seattle, WA., Snabes MC; AbbVie, Chicago, IL., Schmidt J; AbbVie, Chicago, IL., McGovern ME; VA Boston Healthcare System, Boston University School of Medicine, Boston, MA., Fleg JL; National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD., Desvigne-Nickens P; Axio Research, LLC, Seattle, WA., Anderson T; Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta., Kashyap M; Long Beach VA Healthcare System, Los Angeles, CA., Probstfield JL; University of Washington, Seattle, WA.
Jazyk: angličtina
Zdroj: American heart journal [Am Heart J] 2020 Jun; Vol. 224, pp. 65-76. Date of Electronic Publication: 2020 Mar 20.
DOI: 10.1016/j.ahj.2020.03.016
Abstrakt: Background: Whether androgen deficiency among men increases the risk of cardiovascular (CV) events or is merely a disease marker remains a subject of intense scientific interest.
Objectives: Among male subjects in the AIM-HIGH Trial with metabolic syndrome and low baseline levels of high-density lipoprotein (HDL)-cholesterol who were randomized to niacin or placebo plus simvastatin, we examined the relationship between low baseline testosterone (T) concentrations and subsequent CV outcomes during a mean 3-year follow-up.
Methods: In this post hoc analysis of men with available baseline plasma T concentrations, we examined the relationship between clinical/demographic characteristics and T concentrations both as a continuous and dichotomous variable (<300 ng/dL ["low T"] vs. ≥300 ng/dL ["normal T"]) on rates of pre-specified CV outcomes, using Cox proportional hazards models.
Results: Among 2118 male participants in whom T concentrations were measured, 643 (30%) had low T and 1475 had normal T concentrations at baseline. The low T group had higher rates of diabetes mellitus, hypertension, elevated body mass index, metabolic syndrome, higher blood glucose, hemoglobin A1c, and triglyceride levels, but lower levels of both low-density lipoprotein and HDL-cholesterol, and a lower rate of prior myocardial infarction (MI). Men with low T had a higher risk of the primary composite outcome of coronary heart disease (CHD) death, MI, stroke, hospitalization for acute coronary syndrome, or coronary or cerebral revascularization (20.1%) compared with the normal T group (15.2%); final adjusted HR 1.23, P = .07, and a higher risk of the CHD death, MI, and stroke composite endpoint (11.8% vs. 8.2%; final adjusted HR 1.37, P = .04), respectively.
Conclusions: In this post hoc analysis, there was an association between low baseline testosterone concentrations and increased risk of subsequent CV events in androgen-deficient men with established CV disease and metabolic syndrome, particularly for the composite secondary endpoint of CHD death, MI, and stroke.
Condensed Abstract: In this AIM-HIGH Trial post hoc analysis of 2118 men with metabolic syndrome and low HDL-cholesterol with available baseline plasma testosterone (T) samples, 643 males (30%) had low T (mean: 229 ng/dL) and 1475 (70%) had normal T (mean: 444 ng/dL) concentrations. The "low T" group had a 24% higher risk of the primary 5-component endpoint (20.1%) compared with the normal T group (15.2%); final adjusted HR 1.23, P = .07). There was also a 31% higher risk of the secondary composite endpoint: coronary heart disease death, myocardial infarction, and stroke (11.8% vs. 8.2%, final adjusted HR 1.37, P = .04) in the low vs. normal T group, respectively.
(Copyright © 2020. Published by Elsevier Inc.)
Databáze: MEDLINE
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