Cardiology Division, Geneva University Hospitals, Switzerland.
TIMI Study Group, Brigham and Women's Hospitals, Harvard Medical School, Boston, USA.
Eur J Prev Cardiol. 2021 Apr 10;28(2):235–242. doi: 10.1177/2047487319853343.
Endogenous testosterone levels decrease in men with aging. Controversies persist regarding the screening and treatment of low testosterone levels in patients with acute coronary syndromes (ACS).
Total serum testosterone levels were measured in 1054 men hospitalized for ACS that were part of a Swiss prospective cohort. Total testosterone levels were classified first in tertiles and using the cut-off of 300 ng/dL. Primary endpoint was all-cause mortality at one year. Cox regression models adjusting for the GRACE score (composite of age, heart rate systolic blood pressure, creatinine, cardiac arrest at admission, ST segment deviation, abnormal troponin enzyme and Killip classification), preexisting diabetes and inflammation (high-sensitivity C-reactive protein). A total of 430 men (40.8%) had total testosterone levels ≤300 ng/dL. Low total testosterone levels were correlated with lower high-density lipoprotein cholesterol and higher triglycerides, high-sensitivity C-reactive protein, high-sensitivity troponin T, N-terminal-pro B-type natriuretic peptide and glucose levels (all p < 0.01). Patients in the lowest testosterone tertile had a mortality rate at one-year of 5.4% compared with 2.9% in the highest tertile with an unadjusted hazard ratio of 1.92 (95% confidence interval 0.96-1.90, p = 0.095) and adjusted hazard ratio of 1.26 (95% confidence interval 0.57-2.78, p = 0.565). In an exploratory analysis, the highest mortality rate (10.3%) was observed in men aged >65 years old belonging to the lowest testosterone tertile.
In this large population of men with ACS, we found a prevalence of low total endogenous testosterone levels of almost 40%. However, low testosterone levels were not significantly associated with mortality after adjustment for high-risk confounders.
随着男性年龄的增长，其体内的内源性睾酮水平会下降。对于患有急性冠状动脉综合征（ACS）的患者，睾酮水平降低的筛查和治疗仍存在争议。
在瑞士前瞻性队列研究中，共纳入了 1054 名因 ACS 住院的男性患者，检测了他们的总血清睾酮水平。首先根据三分位法和 300ng/dL 的截断值对总睾酮水平进行分类。主要终点为一年时的全因死亡率。Cox 回归模型调整了 GRACE 评分（年龄、心率、收缩压、入院时心搏骤停、ST 段偏移、异常肌钙蛋白酶和 Killip 分级的综合评分）、既往糖尿病和炎症（高敏 C 反应蛋白）。共有 430 名男性（40.8%）的总睾酮水平≤300ng/dL。总睾酮水平较低与较低的高密度脂蛋白胆固醇和较高的甘油三酯、高敏 C 反应蛋白、高敏肌钙蛋白 T、N 端 pro B 型利钠肽和葡萄糖水平相关（均 p<0.01）。在最低睾酮三分位的患者中，一年时的死亡率为 5.4%，而在最高三分位的患者中死亡率为 2.9%，未调整的危险比为 1.92（95%置信区间 0.96-1.90，p=0.095），调整后的危险比为 1.26（95%置信区间 0.57-2.78，p=0.565）。在一项探索性分析中，年龄>65 岁且属于最低睾酮三分位的男性死亡率最高（10.3%）。
在这项 ACS 男性的大型人群研究中，我们发现总内源性睾酮水平较低的患病率几乎为 40%。然而，在调整了高危混杂因素后，低睾酮水平与死亡率之间无显著相关性。
