Low concentrations of serum testosterone predict acute myocardial infarction in men with type 2 diabetes mellitus

Abstract

BackgroundThe aim of the present study was to investigate the associations between endogenous testosterone concentrations and the incidence of acute myocardial infarction (AMI) in men and women with and without type 2 diabetes.MethodsThe study comprised 1109 subjects ≥40 years of age (mean age 62 ± 12 years) participating in a baseline survey in Sweden in 1993–94. Information about smoking habits and physical activity was obtained using validated questionnaires. Serum concentrations of testosterone and sex hormone-binding globulin (SHBG) were obtained using radioimmunoassay. Diagnosis of type 2 diabetes was based on WHO’s 1985 criteria. Individual patient information on incident AMI was ascertained by record linkage with national inpatient and mortality registers from baseline through 2011.ResultsThe prevalence of type 2 diabetes at baseline was 10.0 % in men and 7.5 % in women. During a mean follow-up of 14.1 years (±5.3), there were 74 events of AMI in men and 58 in women. In age-adjusted Cox models, a significant inverse association between concentrations of testosterone and AMI-morbidity was found in men with type 2 diabetes (HR = 0.86 CI (0.75–0.98)). In a final model also including waist-to-hip ratio, systolic blood pressure, total cholesterol and active smoking, the association still remained statistically significant (HR = 0.754 CI (0.61–0.92)).ConclusionLow concentrations of testosterone predicted AMI in men with type 2 diabetes independent of other risk factors. Trials with testosterone investigating the effect regarding cardiovascular outcome are still lacking. Future trials in this field should take into account a modification effect of diabetes.

Serum Sortilin Associates With Aortic Calcification and Cardiovascular Risk in Men

“…In our cohort, high serum sortilin was associated with MACCE independently of hypertension, diabetes mellitus, or decreased testosterone levels - all cardiovascular risk factors. 29–31 Thus, sortilin seems to be associated to MACCE risk even in individuals without these cardiovascular risk factors, suggesting that it may act through independent mechanisms.…”

Lower circulating kisspeptin and primary hypogonadism in men with type 2 diabetes

“…It has been observed that low circulating T leads to lack of negative feedback inhibition on LH and FSH secretion, leading to primary hypogonadism. 13,16,32,33 Further to this, kisspeptin has been suggested to have the ability to increase LH pulsatility and T concentrations in T2DM males with reproductive disorders such as hypogonadism. 14,28 Dhillo and friends, 27 initially reported that the administration of exogenous kisspeptin stimulated the hypothalamic-pituitary-gonadal axis in human males causing a rise in LH, FSH and T concentrations.…”

“…Interestingly, however, in the case group, LH and FSH concentrations were relatively high, although kisspeptin and T levels were low. It has been observed that low circulating T leads to lack of negative feedback inhibition on LH and FSH secretion, leading to primary hypogonadism . Further to this, kisspeptin has been suggested to have the ability to increase LH pulsatility and T concentrations in T2DM males with reproductive disorders such as hypogonadism .…”

Erectile dysfunction and testosterone deficiency as cardiovascular risk factors?

“…Evidence has emerged over the last 20 years that ED and TD are important predictors of increased cardiovascular risk but while ED is widely accepted as a “marker”, the position of TD remains controversial . Recent evidence demonstrates that ED and TD may be useful and relevant in terms of early diagnosis of CVD and effective management to target risk reduction …”