Relationship between Serum Testosterone and Cardiovascular Disease Risk Determined Using the Framingham Risk Score in Male Patients with Sexual Dysfunction

Abstract

PurposeThe aim of the present study aimed to evaluate the effect of testosterone on cardiovascular disease by using the Framingham Risk Score (FRS) in patients with sexual dysfunction.Materials and MethodsA total of 308 men with sexual dysfunction were enrolled in this study. Clinical assessments included the 15-item International Index of Erectile Function (IIEF), blood pressure measurement, and clinical laboratory indexes. The FRS, which predicts the incidence rate of cardiovascular diseases in the next 10 years, was calculated on the basis of age, gender, total cholesterol, smoking status, high density lipoprotein cholesterol, and systolic blood pressure.ResultsThe mean age of the 308 enrolled patients was 49.42±10.73 years, and the patients' mean body mass index (kg/m2) was 25.07±3.14. The mean total IIEF score was 28.44±18.06. The median total testosterone concentration was 3.2 ng/mL (interquartile range [IQR]: 2.3~3.2 ng/mL). The median calculated free and bioavailable testosterone concentrations were 0.052 ng/mL (IQR 0.039~0.070 ng/mL) and 1.30 ng/mL (IQR: 1.00~1.76 ng/mL), respectively. The mean FRS was 10.47±6.45. The FRS tended to show a negative correlation with the total and calculated free testosterone levels, but this was not significant (p=0.064 and p=0.074, respectively). In the multiple linear regression analysis, a significant negative correlation was observed between the total testosterone level and the FRS (p=0.048).ConclusionsThe results suggest that the testosterone level is related to the FRS and that a high testosterone level may decrease the risk of cardiovascular disease.

Long-Term Testosterone Therapy Improves Cardiometabolic Function and Reduces Risk of Cardiovascular Disease in Men with Hypogonadism

“…It should be noted that pulse pressure is considered a marker of vascular stiffness and any reduction in this parameter is considered favorable for reducing CVD risk. 97 , 98 This observation is congruent with data from a recent placebo-controlled study in which reduction in arterial stiffness was reported following TTh. 99 The reduction in rate pressure product in the T-group reflects a decrease in the myocardial workload.…”

Sex Hormones and Sex Chromosomes Cause Sex Differences in the Development of Cardiovascular Diseases

“…49 Conversely, testosterone has been suggested to protect males from atherosclerosis. 50–53 Males with higher circulating testosterone concentrations had higher HDL cholesterol levels. 54,55 In studies tracking serum lipids and lipoproteins from childhood to adulthood, levels of HDL cholesterol dropped in boys, but were not changed in girls after puberty.…”

Vascular Pathways of Testosterone: Clinical Implications

“…Men who had low T levels also had more atherosclerotic plaques, endothelial dysfunction and higher levels of high-sensitivity CRP [94]. Moreover, Lee et al (2014), in a study with 50-year-old men with sexual dysfunction (308) observed a significant negative correlation between total T levels and the Framingham Risk Score (FRS) [95]. This is a scoring system derived from the Framingham heart study conducted in the United States and is an instrument that uses a simple past medical history and genderspecific cholesterol levels in asymptomatic patients to predict the incidence rate of CVD in the next 10 years [96,97].…”

“…This is a scoring system derived from the Framingham heart study conducted in the United States and is an instrument that uses a simple past medical history and genderspecific cholesterol levels in asymptomatic patients to predict the incidence rate of CVD in the next 10 years [96,97]. In this sense, Lee et al (2014) suggested that a higher T level may decrease the 10-year risk of CVD, and the occurrence of atherosclerosis, coronary artery disease and coronary events [95]. In contrast to these studies, Lee et al (2016), using a large cohort of 3164 men from 4 ethnic origins (Caucasian, African American, Hispanic American and Asian American), aged 45 to 84 years, and without known CVD, observed that lower free T was associated with a higher relative risk of coronary artery Ca 2+ score > 0 and lower total T was associated with higher log coronary artery Ca 2+ score.…”