Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy.
J Sex Med. 2010 Apr;7(4 Pt 1):1557-64. doi: 10.1111/j.1743-6109.2009.01690.x. Epub 2010 Jan 25.
Although testosterone (T) has been suggested to play a protective role against the development of atherosclerosis, studies demonstrating an association between low T and incident major adverse cardiovascular events (MACE) are scanty in the general population and absent in subjects with erectile dysfunction (ED).
To investigate whether low T in subjects with ED predict incident fatal or nonfatal MACE.
This is an observational prospective cohort study evaluating a consecutive series of 1687 patients attending our andrological unit for ED. Patients were interviewed using the structured interview on erectile dysfunction (SIEDY) and ANDROTEST structured interviews measuring components relative to ED and hypogonadal-related symptoms, respectively.
Total T was evaluated at baseline. Information on MACE was obtained through the City of Florence Registry Office.
Among the patients studied, 5.2, 13.8, and 22.4% were hypogonadal according to different thresholds (T < 8, 10.4 and 12 nmol/L or 230, 300 and 350 ng/dL, respectively). During a mean follow-up of 4.3 + or - 2.6 years, 139 MACE, 15 of which were fatal, were observed. Unadjusted incidence of MACE was not associated with T levels. Conversely, the proportion of lethal events among MACE was significantly higher in hypogonadal patients, using either 10.4 nmol/L (300 ng/dL) or 8 nmol/L (230 ng/dL) thresholds. However, after adjustment for age and Chronic Diseases Score in a Cox regression model, only the association between incident fatal MACE and T < 8 nmol/L (230 ng/dL) was confirmed (HR = 7.1 [1.8-28.6]; P < 0.001). Interestingly, measuring hypogonadal-related symptoms and signs through ANDROTEST, only fatal MACE were also associated with a higher score (HR = 1.2 [1.0-1.5] for each ANDROTEST score increment; P = 0.05 after adjustment for age and Chronic Diseases Score).
T levels are associated with a higher mortality of MACE. The identification of low T levels should alert the clinician thus identifying subjects with an increased cardiovascular risk.
尽管有研究表明，睾丸酮（T）对动脉粥样硬化的发展具有保护作用，但在普通人群中，很少有研究表明低 T 与主要不良心血管事件（MACE）的发生有关，而在勃起功能障碍（ED）患者中则没有此类研究。
探讨 ED 患者的低 T 是否预测致命或非致命性 MACE 的发生。
这是一项观察性前瞻性队列研究，评估了 1687 名因 ED 就诊于我们男科门诊的连续患者系列。使用结构性勃起功能障碍访谈（SIEDY）和 ANDROTEST 结构化访谈对患者进行访谈，分别测量与 ED 和与低睾酮相关症状相关的成分。
在基线时评估总 T。通过佛罗伦萨市登记处获取 MACE 信息。
在所研究的患者中，根据不同的阈值（T < 8、10.4 和 12 nmol/L 或 230、300 和 350ng/dL），分别有 5.2%、13.8%和 22.4%的患者存在低 T。在平均 4.3 ± 2.6 年的随访期间，观察到 139 例 MACE，其中 15 例为致命性。未经调整的 MACE 发生率与 T 水平无关。相反，在使用 10.4 nmol/L（300ng/dL）或 8 nmol/L（230ng/dL）阈值时，低 T 患者中致命性事件的比例明显更高。然而，在 Cox 回归模型中，经年龄和慢性疾病评分调整后，仅证实了发生致命性 MACE 与 T < 8 nmol/L（230ng/dL）之间的关联（HR = 7.1[1.8-28.6]；P < 0.001）。有趣的是，通过 ANDROTEST 测量与低睾酮相关的症状和体征，只有致命性 MACE 与更高的评分相关（HR = 1.2[1.0-1.5]，每增加 1 分 ANDROTEST 评分；在调整年龄和慢性疾病评分后，P = 0.05）。
T 水平与 MACE 死亡率的升高有关。低 T 水平的识别应引起临床医生的警惕，从而识别出心血管风险增加的患者。
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