Western Australian Centre for Health and Ageing (M570), Centre for Medical Research, Western Australian Institute for Medical Research School of Medicine and Pharmacology School of Surgery, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia.
Eur J Endocrinol. 2011 Apr;164(4):569-77. doi: 10.1530/EJE-10-1063. Epub 2011 Feb 1.
Hypogonadism in men is associated with insulin resistance, elevations in pro-inflammatory cytokines and fibrinogen, and an atherogenic lipid profile. However, it is uncertain whether the age-related decline in testosterone is associated with ischaemic heart disease (IHD) events.
To determine whether testosterone and its associated hormones, sex hormone-binding globulin (SHBG) and LH, predict IHD events in older men.
Prospective cohort study.
Between 2001 and 2004, 3637 community-dwelling men aged 70-88 years underwent a clinical assessment of cardiovascular risk factors and biochemical assessment of testosterone, SHBG and LH. Free testosterone was calculated using mass action equations. Participants were followed until December 2008 using electronic record linkage to capture IHD events (hospital admission or death).
Mean follow-up was 5.1 years. During this period, 618 men (17.0%; 95% confidence interval (CI) 15.8, 18.3%) experienced an event, of which 160 were fatal. Men with higher baseline total or free testosterone levels experienced fewer IHD events (hazard ratio (HR)=0.89; 95% CI 0.82, 0.97 and HR=0.86; 95% CI 0.79, 0.94 for each one s.d. increase in total and free testosterone respectively). These associations were maintained after adjustment for age and waist:hip ratio but did not persist after adjustment for prevalent IHD or other cardiovascular risk factors. SHBG was not associated with IHD events. In contrast, higher LH levels were associated with reduced event-free survival in both univariate (HR=1.15; 95% CI 1.08, 1.22) and adjusted analyses (HR=1.08; 95% CI 1.01, 1.15).
Dysregulation of the hypothalamic-pituitary-gonadal axis may be a risk factor for IHD. Further studies of men with either elevated LH or low testosterone are warranted.
男性的性腺功能减退与胰岛素抵抗、促炎细胞因子和纤维蛋白原升高以及动脉粥样硬化脂质谱有关。然而，尚不确定与年龄相关的睾丸激素下降是否与缺血性心脏病 (IHD) 事件有关。
确定睾丸激素及其相关激素，即性激素结合球蛋白 (SHBG) 和 LH，是否可预测老年男性的 IHD 事件。
前瞻性队列研究。
在 2001 年至 2004 年间，对 3637 名年龄在 70-88 岁的社区居民进行了心血管危险因素的临床评估和睾丸激素、SHBG 和 LH 的生化评估。使用质量作用方程计算游离睾丸激素。使用电子记录链接对参与者进行随访，以捕捉 IHD 事件（住院或死亡），随访时间截至 2008 年 12 月。
平均随访时间为 5.1 年。在此期间，618 名男性（17.0%；95%置信区间 [CI] 为 15.8%，18.3%）发生了 IHD 事件，其中 160 人死亡。基线总睾丸激素或游离睾丸激素水平较高的男性发生 IHD 事件的次数较少（风险比 [HR]=0.89；95%CI 0.82，0.97 和 HR=0.86；95%CI 0.79，0.94，每增加一个标准差）。这些关联在调整年龄和腰臀比后仍然存在，但在调整已有 IHD 或其他心血管危险因素后则不存在。SHBG 与 IHD 事件无关。相比之下，LH 水平较高与单变量（HR=1.15；95%CI 1.08，1.22）和调整后的分析（HR=1.08；95%CI 1.01，1.15）中无事件生存率降低有关。
下丘脑-垂体-性腺轴的失调可能是 IHD 的一个危险因素。需要进一步研究 LH 升高或睾丸激素水平低的男性。
