Elevated LH predicts ischaemic heart disease events in older men: the Health in Men Study

Abstract

Context: Hypogonadism in men is associated with insulin resistance, elevations in pro-inflammatory cytokines and fibrinogen, and an atherogenic lipid profile. However, it is uncertain whether the age-related decline in testosterone is associated with ischaemic heart disease (IHD) events. Objective: To determine whether testosterone and its associated hormones, sex hormone-binding globulin (SHBG) and LH, predict IHD events in older men. Design: Prospective cohort study. Methods: Between 2001 and 2004, 3637 community-dwelling men aged 70-88 years underwent a clinical assessment of cardiovascular risk factors and biochemical assessment of testosterone, SHBG and LH. Free testosterone was calculated using mass action equations. Participants were followed until December 2008 using electronic record linkage to capture IHD events (hospital admission or death). Results: Mean follow-up was 5.1 years. During this period, 618 men (17.0%; 95% confidence interval (CI) 15.8, 18.3%) experienced an event, of which 160 were fatal. Men with higher baseline total or free testosterone levels experienced fewer IHD events (hazard ratio (HR)Z0.89; 95% CI 0.82, 0.97 and HRZ0.86; 95% CI 0.79, 0.94 for each one S.D. increase in total and free testosterone respectively). These associations were maintained after adjustment for age and waist:hip ratio but did not persist after adjustment for prevalent IHD or other cardiovascular risk factors. SHBG was not associated with IHD events. In contrast, higher LH levels were associated with reduced event-free survival in both univariate (HRZ1.15; 95% CI 1.08, 1.22) and adjusted analyses (HRZ1.08; 95% CI 1.01, 1.15). Conclusions: Dysregulation of the hypothalamic-pituitary-gonadal axis may be a risk factor for IHD. Further studies of men with either elevated LH or low testosterone are warranted.

The relationship between endogenous testosterone and lipid profile in middle-aged and elderly Chinese men

“…From a clinical perspective, we should ponder whether low TT might be related to cardiovascular disease via effects on serum lipid levels. In addition, evidence has shown that high luteinizing hormone (LH) level is related to the CHD risk or is involved in arterial dilatation as well as occlusive vascular disease in older men (46,47,48,49). LH might have an independent effect on the cardiovascular system via the LH receptor or rather be an epiphenomenon of another disease process.…”

Low Free Testosterone Predicts Mortality from Cardiovascular Disease But Not Other Causes: The Health in Men Study

“…We recently reported that men with elevated LH were more likely to experience ischemic heart disease (IHD) events (21). To explore whether this association was also present with regard to CVD mortality, we stratified men by gonadal status using established Australian consensus guidelines (29).…”

“…The ability to draw conclusions from the data is further limited by differences in age range, definition of endpoints, and in the few studies examining causespecific mortality, failure to control for the problem of competing risks. Additionally, as far as we are aware, no previous study has examined the relationship between mortality and gonadotropins, which together with testosterone, may provide better risk stratification than testosterone levels alone (21).…”

Off-label use of hormones as an antiaging strategy: a review

“…Contrary to the widespread belief that T is related to a higher cardiovascular risk, studies show that atherosclerosis is mostly related to low T levels 71–77. Moreover, direct antianginal effects have been described with T administration 78,79.…”