Nettleship J, Jones R, Channer K, Jones T
Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, UK.
Front Horm Res. 2009;37:91-107. doi: 10.1159/000176047.
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.
冠状动脉疾病（CAD）最强的独立危险因素是年龄增长和男性性别。虽然各国CAD死亡率存在很大差异，但始终观察到男女比例约为2:1。这些观察结果导致人们认为睾酮可能对心血管系统产生有害影响。尽管如此，冠状动脉粥样硬化会随着年龄增长而增加，同时观察到血清生物可利用睾酮水平显著下降。同样，低睾酮水平也与其他心血管危险因素以及动脉粥样硬化过程介质的表达增加有关。这本身就表明睾酮不会促进动脉粥样硬化的形成。此外，流行病学研究表明睾酮水平与动脉粥样硬化替代标志物之间存在负相关关系，这表明可能是睾酮缺乏状态，而非男性性别与CAD相关。在喂食胆固醇的动物模型中，去势会加速动脉粥样硬化，而睾酮替代治疗后则会减轻。睾酮还被证明可改善心绞痛男性的心肌缺血。因此，越来越多的证据表明，睾酮对动脉粥样硬化过程具有有益的调节作用。这些研究是本章的重点。
