Rosenberg Michael A, Shores Molly M, Matsumoto Alvin M, Bůžková Petra, Lange Leslie A, Kronmal Richard A, Heckbert Susan R, Mukamal Kenneth J
Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado.
Division of Biomedical Informatics and Personalized Medicine, University of Colorado School of Medicine, Aurora, Colorado.
Clin Cardiol. 2018 Jun;41(6):830-836. doi: 10.1002/clc.22965. Epub 2018 Jun 8.
Decline in serum androgens is common among older men and has been associated with cardiovascular disease, although its role in risk of atrial fibrillation (AF) has not been well defined.
Low serum androgens are associated with an increased risk of AF.
We examined the prospective associations between testosterone, its more active metabolite dihydrotestosterone (DHT), and sex hormone-binding globulin (SHBG) with risk of AF among 1019 otherwise healthy men with average age 76.3 ±4.9 years in the Cardiovascular Health Study.
After median follow-up of 9.5 years, 304 (30%) men developed AF. We detected a nonlinear association with risk of incident AF in both free and total DHT, in which subjects with the lowest levels had a higher risk of incident AF. After adjustment for demographics, clinical risk factors, left atrial diameter, and serum NT-proBNP levels, men with free DHT <0.16 ng/dL were at increased risk compared with men with higher levels (hazard ratio: 1.48, 95% confidence interval: 1.01-2.17, P <0.05). Sensitivity analyses confirmed that the increased risk was not cutpoint-specific, with a significant association noted up to cutpoints <~0.2 ng/dL. We also detected a complex nonlinear association between SHBG and incident AF, in which subjects in the middle quintile (52.9-65.3 nmol/L) had increased risk.
Among older men, low free DHT is associated with an increased risk of incident AF. Further studies are needed to explore mechanisms for this association.
血清雄激素水平下降在老年男性中很常见，并且与心血管疾病有关，尽管其在心房颤动（AF）风险中的作用尚未明确界定。
低血清雄激素与AF风险增加有关。
在心血管健康研究中，我们研究了1019名平均年龄为76.3±4.9岁的健康男性中，睾酮、其活性更高的代谢产物双氢睾酮（DHT）和性激素结合球蛋白（SHBG）与AF风险之间的前瞻性关联。
中位随访9.5年后，304名（30%）男性发生AF。我们在游离和总DHT中均检测到与新发AF风险的非线性关联，其中水平最低的受试者发生新发AF的风险更高。在调整了人口统计学、临床风险因素、左心房直径和血清NT-proBNP水平后，游离DHT<0.16 ng/dL的男性与水平较高的男性相比，风险增加（风险比：1.48，95%置信区间：1.01-2.17，P<0.05）。敏感性分析证实，风险增加并非特定于切点，在切点<~0.2 ng/dL时均观察到显著关联。我们还检测到SHBG与新发AF之间存在复杂的非线性关联，其中处于中间五分位数（52.9-65.3 nmol/L）的受试者风险增加。
在老年男性中，低游离DHT与新发AF风险增加有关。需要进一步研究来探索这种关联的机制。
