Kelly Daniel M, Jones T Hugh
Department of Human Metabolism, Medical School, The University of Sheffield, Sheffield, UK.
Front Horm Res. 2014;43:1-20. doi: 10.1159/000360553. Epub 2014 Jun 10.
Testosterone deficiency is highly prevalent in men with cardiovascular disease (CVD) and is associated with an increased mortality. Low testosterone also has an adverse effect on several cardiovascular risk factors, which include insulin resistance, diabetes, dyslipidaemia, central adiposity and endothelial dysfunction. Male gender is a well-recognised risk factor for premature CVD and mortality. The question of whether or not testosterone deficiency is a contributory factor to atherogenesis or merely a biomarker of ill health arises. Animal studies and experiments on isolated cells indicate that many of the mechanisms intimate to the atherosclerotic process are beneficially modulated by testosterone. Epidemiological studies have shown that men with endogenous testosterone levels in the mid-upper normal range have reduced cardiovascular events and mortality compared to those with low or lower range, and with high range testosterone. Testosterone replacement in men diagnosed with hypogonadism where mid-normal range levels are achieved have shown a beneficial effect on several cardiovascular risk factors, cardiac ischaemia, functional exercise capacity and improved mortality. Yet studies where patients were either undertreated or given high-dose testosterone have been associated with an increased risk of cardiovascular-related events. Clinical monitoring and titration of testosterone dose is therefore of paramount importance.
睾酮缺乏在心血管疾病（CVD）男性患者中极为普遍，且与死亡率增加相关。低睾酮水平还对多种心血管危险因素产生不利影响，这些因素包括胰岛素抵抗、糖尿病、血脂异常、中心性肥胖和内皮功能障碍。男性性别是公认的早发性CVD和死亡的危险因素。于是出现了一个问题，即睾酮缺乏究竟是动脉粥样硬化发生的一个促成因素，还是仅仅是健康状况不佳的一个生物标志物。动物研究和对分离细胞的实验表明，许多与动脉粥样硬化过程密切相关的机制都受到睾酮的有益调节。流行病学研究表明，与睾酮水平处于低范围或高范围的男性相比，内源性睾酮水平处于中高正常范围的男性心血管事件和死亡率更低。对被诊断为性腺功能减退的男性进行睾酮替代治疗，使睾酮水平达到正常范围时，已显示出对多种心血管危险因素、心肌缺血、功能运动能力及死亡率改善都有有益影响。然而，那些患者治疗不足或给予高剂量睾酮的研究与心血管相关事件风险增加有关。因此，睾酮剂量的临床监测和滴定至关重要。
