VA Boston Healthcare System, Boston University School of Medicine, Boston, MA.
AbbVie, Chicago, IL.
Am Heart J. 2020 Jun;224:65-76. doi: 10.1016/j.ahj.2020.03.016. Epub 2020 Mar 20.
Whether androgen deficiency among men increases the risk of cardiovascular (CV) events or is merely a disease marker remains a subject of intense scientific interest.
Among male subjects in the AIM-HIGH Trial with metabolic syndrome and low baseline levels of high-density lipoprotein (HDL)-cholesterol who were randomized to niacin or placebo plus simvastatin, we examined the relationship between low baseline testosterone (T) concentrations and subsequent CV outcomes during a mean 3-year follow-up.
In this post hoc analysis of men with available baseline plasma T concentrations, we examined the relationship between clinical/demographic characteristics and T concentrations both as a continuous and dichotomous variable (<300 ng/dL ["low T"] vs. ≥300 ng/dL ["normal T"]) on rates of pre-specified CV outcomes, using Cox proportional hazards models.
Among 2118 male participants in whom T concentrations were measured, 643 (30%) had low T and 1475 had normal T concentrations at baseline. The low T group had higher rates of diabetes mellitus, hypertension, elevated body mass index, metabolic syndrome, higher blood glucose, hemoglobin A1c, and triglyceride levels, but lower levels of both low-density lipoprotein and HDL-cholesterol, and a lower rate of prior myocardial infarction (MI). Men with low T had a higher risk of the primary composite outcome of coronary heart disease (CHD) death, MI, stroke, hospitalization for acute coronary syndrome, or coronary or cerebral revascularization (20.1%) compared with the normal T group (15.2%); final adjusted HR 1.23, P = .07, and a higher risk of the CHD death, MI, and stroke composite endpoint (11.8% vs. 8.2%; final adjusted HR 1.37, P = .04), respectively.
In this post hoc analysis, there was an association between low baseline testosterone concentrations and increased risk of subsequent CV events in androgen-deficient men with established CV disease and metabolic syndrome, particularly for the composite secondary endpoint of CHD death, MI, and stroke.
In this AIM-HIGH Trial post hoc analysis of 2118 men with metabolic syndrome and low HDL-cholesterol with available baseline plasma testosterone (T) samples, 643 males (30%) had low T (mean: 229 ng/dL) and 1475 (70%) had normal T (mean: 444 ng/dL) concentrations. The "low T" group had a 24% higher risk of the primary 5-component endpoint (20.1%) compared with the normal T group (15.2%); final adjusted HR 1.23, P = .07). There was also a 31% higher risk of the secondary composite endpoint: coronary heart disease death, myocardial infarction, and stroke (11.8% vs. 8.2%, final adjusted HR 1.37, P = .04) in the low vs. normal T group, respectively.
男性雄激素缺乏是否会增加心血管（CV）事件的风险，或者仅仅是一种疾病标志物，这仍然是一个科学研究的热点。
在 AIM-HIGH 试验中，患有代谢综合征且基线高密度脂蛋白（HDL）-胆固醇水平低的男性中，随机分为烟酸或安慰剂加辛伐他汀治疗，我们研究了基线睾丸酮（T）浓度低与随后的 CV 结局之间的关系在平均 3 年的随访期间。
在这项事后分析中，我们检查了基线血浆 T 浓度可获得的男性中，临床/人口统计学特征与 T 浓度之间的关系，包括连续和二分变量（<300ng/dL[低 T]与≥300ng/dL[正常 T]）与预先指定的 CV 结局的发生率，使用 Cox 比例风险模型。
在 2118 名测量了 T 浓度的男性参与者中，643 名（30%）有低 T，1475 名有正常 T 浓度。低 T 组糖尿病、高血压、体重指数升高、代谢综合征、血糖、糖化血红蛋白和甘油三酯水平较高，而低 LDL 和 HDL-胆固醇水平较低，且既往心肌梗死（MI）发生率较低。低 T 组的主要复合结局（冠心病死亡、MI、中风、急性冠脉综合征住院或冠脉或脑血运重建）的风险高于正常 T 组（20.1% vs. 15.2%；最终调整后的 HR 1.23，P=0.07），而冠心病死亡、MI 和中风复合终点的风险也较高（11.8% vs. 8.2%；最终调整后的 HR 1.37，P=0.04）。
在这项事后分析中，在患有心血管疾病和代谢综合征的雄激素缺乏男性中，基线睾丸酮浓度较低与随后的 CV 事件风险增加之间存在关联，特别是对于冠心病死亡、MI 和中风的复合次要终点。
