Yeap Bu B
School of Medicine, University of Western Australia, Perth, Western Australia 6009, Australia.
Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia 6150, Australia.
Asian J Androl. 2018 Mar-Apr;20(2):109-114. doi: 10.4103/aja.aja_50_17.
As men grow older, circulating testosterone declines while the incidence of cardiovascular disease increases. Thus, the role of sex hormones as biomarkers, and possibly contributing factors to clinical manifestations of cardiovascular disease in the increasing demographic of aging men, has attracted considerable interest. This review focuses on observational studies of endogenous androgens, namely circulating testosterone and dihydrotestosterone, which have examined their associations with cardiovascular events such as myocardial infarction and stroke. Studies which have examined the associations of endogenous estrogens, namely circulating estradiol, with these outcomes are also discussed. In large prospective cohort studies of predominantly middle-aged and older men, lower circulating testosterone consistently predicts higher incidence of cardiovascular events. Of note, both lower circulating testosterone and lower dihydrotestosterone are associated with higher incidence of stroke. These associations are less apparent when myocardial infarction is considered as the outcome. Results for estradiol are inconsistent. Lower circulating testosterone has been shown to predict higher cardiovascular disease-related mortality, as has lower circulating dihydrotestosterone. It is possible that the relationship of circulating androgens to cardiovascular events or mortality outcomes may be U-shaped rather than linear, with an optimal range defining men at lowest risk. Epidemiological studies are observational in nature and do not prove causality. Associations observed in studies of endogenous androgens need not necessarily translate into similar effects of exogenous androgens. Rigorous randomized controlled trials are needed to clarify the effects of testosterone treatment on cardiovascular risk in men.
随着男性年龄的增长，循环睾酮水平下降，而心血管疾病的发病率上升。因此，性激素作为生物标志物的作用，以及在日益增加的老年男性人群中可能成为心血管疾病临床表现的促成因素，已引起了相当大的关注。本综述聚焦于内源性雄激素的观察性研究，即循环睾酮和双氢睾酮，这些研究探讨了它们与心肌梗死和中风等心血管事件的关联。同时也讨论了研究内源性雌激素，即循环雌二醇，与这些结果之间关联的研究。在以中老年男性为主的大型前瞻性队列研究中，较低的循环睾酮水平始终预示着心血管事件的更高发病率。值得注意的是，较低的循环睾酮水平和较低的双氢睾酮水平均与中风的较高发病率相关。当以心肌梗死作为结果时，这些关联不太明显。关于雌二醇的结果并不一致。较低的循环睾酮水平已被证明可预测更高的心血管疾病相关死亡率，较低的循环双氢睾酮水平也是如此。循环雄激素与心血管事件或死亡率结果之间的关系可能呈U形而非线性，存在一个定义最低风险男性的最佳范围。流行病学研究本质上是观察性的，不能证明因果关系。在内源性雄激素研究中观察到的关联不一定能转化为外源性雄激素的类似效果。需要严格的随机对照试验来阐明睾酮治疗对男性心血管风险的影响。
