Sexual Medicine and Andrology Unit, Department of Clinical Physiopathology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy.
Eur J Endocrinol. 2011 Nov;165(5):687-701. doi: 10.1530/EJE-11-0447. Epub 2011 Aug 18.
To verify whether hypogonadism represents a risk factor for cardiovascular (CV) morbidity and mortality and to verify whether testosterone replacement therapy (TRT) improves CV parameters in subjects with known CV diseases (CVDs).
Meta-analysis.
An extensive Medline search was performed using the following words 'testosterone, CVD, and males'. The search was restricted to data from January 1, 1969, up to January 1, 2011.
Of the 1178 retrieved articles, 70 were included in the study. Among cross-sectional studies, patients with CVD have significantly lower testosterone and higher 17-β estradiol (E(2)) levels. Conversely, no difference was observed for DHEAS. The association between low testosterone and high E(2) levels with CVD was confirmed in a logistic regression model, after adjusting for age and body mass index (hazard ratio (HR)=0.763 (0.744-0.783) and HR=1.015 (1.014-1.017), respectively, for each increment of total testosterone and E(2) levels; both P<0.0001). Longitudinal studies showed that baseline testosterone level was significantly lower among patients with incident overall- and CV-related mortality, in comparison with controls. Conversely, we did not observe any difference in the baseline testosterone and E(2) levels between case and controls for incident CVD. Finally, TRT was positively associated with a significant increase in treadmill test duration and time to 1 mm ST segment depression.
Lower testosterone and higher E(2) levels correlate with increased risk of CVD and CV mortality. TRT in hypogonadism moderates metabolic components associated with CV risk. Whether low testosterone is just an association with CV risk, or an actual cause-effect relationship, awaits further studies.
验证性腺功能减退是否是心血管（CV）发病率和死亡率的一个危险因素，并验证睾酮替代疗法（TRT）是否能改善已知心血管疾病（CVD）患者的 CV 参数。
荟萃分析。
使用以下关键词“testosterone、CVD 和 males”对 Medline 进行广泛搜索。搜索范围限制为 1969 年 1 月 1 日至 2011 年 1 月 1 日的数据。
从检索到的 1178 篇文章中，有 70 篇被纳入研究。在横断面研究中，CVD 患者的睾酮水平明显较低，而 17-β 雌二醇（E(2)）水平较高。相反，DHEAS 则没有差异。在调整年龄和体重指数（HR=0.763（0.744-0.783）和 HR=1.015（1.014-1.017）后，在逻辑回归模型中证实了低睾酮和高 E(2)水平与 CVD 的相关性，每个睾酮和 E(2)水平的增量；两者均 P<0.0001）。纵向研究显示，与对照组相比，发生全因和心血管相关死亡率的患者的基线睾酮水平明显较低。相反，我们没有观察到病例组和对照组之间基线睾酮和 E(2)水平在发生 CVD 方面有任何差异。最后，TRT 与跑步机测试持续时间和 1mm ST 段压低的时间显著增加呈正相关。
较低的睾酮和较高的 E(2)水平与 CVD 风险增加和 CV 死亡率增加相关。在性腺功能减退症中，TRT 可调节与 CV 风险相关的代谢成分。低睾酮是否只是与 CV 风险相关，还是与 CV 风险有实际的因果关系，还需要进一步研究。
