Department of Medicine, Creighton University Medical Center, Omaha, NE 68131, USA.
Int J Cardiol. 2010 Jun 25;142(1):8-14. doi: 10.1016/j.ijcard.2009.10.033. Epub 2009 Nov 17.
Globally, cardiovascular disease is the single largest cause of mortality. The differences in pattern of cardiovascular disease between the two genders have not been explained properly. The spotlight has largely been focused on estrogens but no conclusive evidence has proven its role in reducing the incidence of cardiovascular disease. Consequently, androgens have attracted significant interest in explaining the gender difference in cardiovascular disease. More studies in last two decades have increased our knowledge about the effects of androgens on cardiovascular disease progression. Evidence for age related fall in testosterone levels in males and increasing cardiovascular events with age had lead to the postulation of idea of 'andropause or male menopause'. Unfortunately, for the last few decades the androgens have been highlighted as agents of abuse among athletes all over the world. There have been multiple reports of their association with sudden cardiac death and adverse cardiovascular outcomes when abused. Contrastingly, there has been an increasing prescription use of testosterone supplementation in various conditions related to androgen deficiency state and for many other off-label indications. Human observational studies have mostly concluded that men with lower testosterone levels tend to have higher incidence of coronary artery disease. Emerging evidence supports that lower androgen levels predict poor cardiovascular risk profile. Role with supplementation of testosterone for cardiovascular disease is being studied in both primary and secondary prevention stages and its safety being evaluated. This is an appropriate time to review the role of androgens specifically from a cardiovascular standpoint.
在全球范围内，心血管疾病是导致死亡的首要原因。男女之间心血管疾病模式的差异尚未得到妥善解释。研究的重点主要集中在雌激素上，但没有确凿的证据证明它在降低心血管疾病发病率方面的作用。因此，雄激素在解释心血管疾病性别差异方面引起了广泛关注。在过去的二十年中，更多的研究增加了我们对雄激素对心血管疾病进展影响的认识。男性睾丸激素水平随年龄下降的证据以及随着年龄的增长心血管事件的增加，导致了“男性更年期或雄激素缺乏症”这一概念的提出。不幸的是，在过去几十年中，雄激素一直被强调为全世界运动员滥用的物质。有多项报告称，滥用雄激素与心源性猝死和不良心血管结局有关。相比之下，在与雄激素缺乏状态相关的各种情况下，以及许多其他非适应证情况下，睾酮补充剂的处方使用正在增加。人类观察性研究大多得出结论，睾丸激素水平较低的男性患冠状动脉疾病的发病率较高。新出现的证据支持较低的雄激素水平预示着较差的心血管风险状况。目前正在对原发性和继发性预防阶段补充睾酮对心血管疾病的作用进行研究，并评估其安全性。现在是从心血管角度专门审查雄激素作用的适当时机。
