Reduced testosterone levels in men linked to increased mortality over 7 year period

A report published in the November, 2010 issue of the British journal Heart reveals an increased risk of premature death from all causes and cardiovascular disease among men whose testosterone levels were deficient.

Researchers at Royal Hallamshire Hospital in Sheffield, England analyzed data from 930 men with cardiovascular disease who underwent elective coronary angiography in a cardiac referral center between June 2000 and June 2002. Serum total testosterone and bioavailable testosterone were measured on the day of the procedure.

The subjects were followed for an average of 6.9 years, during which 129 deaths occurred. Seventy-three of the deaths were due to cardiovascular causes. Twenty-four percent of the participants had either low total or bioavailable testosterone.

While the use of aspirin or beta-blockers was associated with a decrease in the adjusted risk of mortality, increased risk was associated with heart failure and reduced bioavailable testosterone. Twenty-one percent of those with deficient bioavailable testosterone levels died from all causes over follow-up, compared to 12 percent of those with normal levels. Low bioavailable testosterone levels were also associated with an increased risk of dying of cardiovascular causes. Additionally, borderline low levels of total testosterone were associated with an increased risk of dying over follow-up.

The current study's finding calls into question the belief of some physicians that testosterone replacement therapy contributes to an increased risk of heart disease. "In patients with coronary disease testosterone deficiency is common and impacts significantly negatively on survival," the authors conclude. "Prospective trials of testosterone replacement are needed to assess the effect of treatment on survival."

In an accompanying editorial, Dr Ronald C. W. Ma and Peter C. Y. Tong of Chinese University of Hong Kong and Prince of Wales Hospital note that "Clinical studies of testosterone supplementation in men with low testosterone are associated with reduced visceral adiposity, improved insulin sensitivity and an improved metabolic profile. Studies in subjects with cardiovascular diseases also suggested beneficial effects, with improved functional capacity in heart failure and improved symptoms in subjects with coronary artery disease."

"Compared with research on estrogens and cardiovascular disease, the role of androgens in the pathogenesis of metabolic and cardiovascular diseases has taken a backseat for many years," they note. "Recent data suggest that this important pathway warrants a lot more attention."

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