Prevalence of hypogonadism in men with coronary artery disease

Pugh, Peter J.; Malkin, Chris J.; Morris, Paul; Asif, Sonia; Jones, Richard D.; Jones, Tim; Channer, Kevin S.

doi:10.1016/s0735-1097(03)82060-0

Cited by 6 publications

(7 citation statements)

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“…9 There may be a considerable number of men for whom testosterone therapy may be indicated, since men with coronary heart disease have lower testosterone concentrations than men with normal coronary angiograms and nearly a quarter of men with coronary disease are biochemically androgen deficient. Although a positive effect on inducible myocardial ischaemia was recorded we could not confirm a beneficial effect on the symptom of angina.…”

Section: Limitationsmentioning

confidence: 99%

“…5 Two large studies have recently found low testosterone to be associated with increased burden of aortic and carotid atheroma. 6 7 Furthermore, our research group has found in cross sectional investigations that men with coronary disease have lower androgen concentrations than men with normal angiograms 8 and that the overall prevalence of overt biochemical hypogonadism in 830 men with proven coronary artery disease at angiography was 23.4%, 9 which is approximately three times higher than the background healthy community prevalence. 10 In vitro and in vivo studies have found testosterone to be a coronary vasodilator.…”

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confidence: 97%

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Testosterone replacement in hypogonadal men with angina improves ischaemic threshold and quality of life

Malkin

2004

Heart

228

155

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Background: Low serum testosterone is associated with several cardiovascular risk factors including dyslipidaemia, adverse clotting profiles, obesity, and insulin resistance. Testosterone has been reported to improve symptoms of angina and delay time to ischaemic threshold in unselected men with coronary disease. Objective: This randomised single blind placebo controlled crossover study compared testosterone replacement therapy (Sustanon 100) with placebo in 10 men with ischaemic heart disease and hypogonadism. Results: Baseline total testosterone and bioavailable testosterone were respectively 4.2 (0.5) nmol/l and 1.7 (0.4) nmol/l. After a month of testosterone, delta value analysis between testosterone and placebo phase showed that mean (SD) trough testosterone concentrations increased significantly by 4.8 (6.6) nmol/l (total testosterone) (p = 0.05) and 3.8 (4.5) nmol/l (bioavailable testosterone) (p = 0.025), time to 1 mm ST segment depression assessed by Bruce protocol exercise treadmill testing increased by 74 (54) seconds (p = 0.002), and mood scores assessed with validated questionnaires all improved. Compared with placebo, testosterone therapy was also associated with a significant reduction of total cholesterol and serum tumour necrosis factor a with delta values of 20.41 (0.54) mmol/l (p = 0.04) and 21.8 (2.4) pg/ml (p = 0.05) respectively. Conclusion: Testosterone replacement therapy in hypogonadal men delays time to ischaemia, improves mood, and is associated with potentially beneficial reductions of total cholesterol and serum tumour necrosis factor a.

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Section: Limitationsmentioning

confidence: 99%

mentioning

confidence: 97%

Testosterone replacement in hypogonadal men with angina improves ischaemic threshold and quality of life

Malkin

2004

Heart

228

155

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“…Recent evidence suggests that this may be a population as large as 1 in 4 of all men afflicted with the condition [86], constituting a considerable population worldwide. Large, long-term clinical trials are clearly warranted, since testosterone replacement may represent an overlooked therapeutic opportunity for this patient population.…”

Section: Resultsmentioning

confidence: 99%

Testosterone and Coronary Artery Disease

Nettleship¹,

Jones²,

Ks³

et al. 2008

Frontiers of Hormone Research

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The strongest independent risk factors for coronary artery disease (CAD) are increasing age and male gender. Whilst a wide variation in CAD mortality exists between countries, a male to female ratio of approximately 2:1 is consistently observed. These observations have led to the assumption that testosterone may exert a detrimental influence on the cardiovascular system. Despite this, coronary atherosclerosis increases with age, whilst a marked fall in serum bioavailable testosterone levels is observed. Similarly, low testosterone levels are also associated with other cardiovascular risk factors and increased expression of mediators of the atherosclerotic process. This in itself suggests that testosterone does not promote atheroma formation. Moreover, epidemiological studies show an inverse relationship between testosterone levels and surrogate markers of atherosclerosis, which suggests that it may be a testosterone deficient state, rather than male sex which is associated with CAD. In cholesterol-fed animal models, atherosclerosis is accelerated by castration and reduced after testosterone replacement therapy. Testosterone has also been shown to improve myocardial ischemia in men with angina pectoris. Consequently, increasing evidence suggests that the process of atherosclerosis is beneficially modulated by testosterone. These studies are the focus of this chapter.

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“…[150] Furtherterol and a reduction in plaque size in male animal models of more, we have recently reported that, in a cohort of 831 male atherosclerosis. [157] However, previous studies have used less-strict definiweekly intramuscular injection. Animals received supplemental testostertestosterone <2.5 nmol/L and/or total testosterone <7.5 nmol/L), is one enantate (100μL of 250 mg/mL), for 17 weeks via twice 23.4%.…”

Section: Testosterone Therapy In Animal Modelsmentioning

confidence: 99%

“…[157] However, previous studies have used less-strict definiweekly intramuscular injection. This study [157] provides atherogenic diet for 12 weeks. [168] Comparable to these findings, Bruck et al [169] demontestosterone <11.0 nmol/L.…”

Section: Testosterone Therapy In Animal Modelsmentioning

confidence: 99%

Testosterone and Atherosclerosis in Aging Men

Jones

Nettleship

Kapoor

et al. 2005

American Journal of Cardiovascular Drugs

107

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Two of the strongest independent risk factors for coronary heart disease (CHD) are increasing age and male sex. Despite a wide variance in CHD mortality between countries, men are consistently twice as likely to die from CHD than their female counterparts. This sex difference has been attributed to a protective effect of female sex hormones, and a deleterious effect of male sex hormones, upon the cardiovascular system. However, little evidence suggests that testosterone exerts cardiovascular harm. In fact, serum levels of testosterone decline with age, and low testosterone is positively associated with other cardiovascular risk factors. Furthermore, testosterone exhibits a number of potential cardioprotective actions. For example, testosterone treatment is reported to reduce serum levels of the pro-inflammatory cytokines interleukin (IL)-1beta and tumor necrosis factor (TNF)-alpha, and to increase levels of the anti-inflammatory cytokine IL-10; to reduce vascular cell adhesion molecule (VCAM)-1 expression in aortic endothelial cells; to promote vascular smooth muscle and endothelial cell proliferation; to induce vasodilatation and to improve vascular reactivity, to reduce serum levels of the pro-thrombotic factors plasminogen activator inhibitor (PAI)-1 and fibrinogen; to reduce low-density lipoprotein-cholesterol (LDL-C); to improve insulin sensitivity; and to reduce body mass index and visceral fat mass. These actions of testosterone may confer cardiovascular benefit since testosterone therapy reduces atheroma formation in cholesterol-fed animal models, and reduces myocardial ischemia in men with CHD. Consequently, an alternative hypothesis is that an age-related decline in testosterone contributes to the atherosclerotic process. This is supported by recent findings, which suggest that as many as one in four men with CHD have serum levels of testosterone within the clinically hypogonadal range. Consequently, restoration of serum levels of testosterone via testosterone replacement therapy could offer cardiovascular, as well as other, clinical advantages to these individuals.

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Prevalence of hypogonadism in men with coronary artery disease

Cited by 6 publications

References 0 publications

Testosterone replacement in hypogonadal men with angina improves ischaemic threshold and quality of life

Testosterone replacement in hypogonadal men with angina improves ischaemic threshold and quality of life

Testosterone and Coronary Artery Disease

Testosterone and Atherosclerosis in Aging Men

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