Department for Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany.
Department of Cardiology, St. Adolf-Stift Hospital Reinbek, Reinbek, Germany.
ESC Heart Fail. 2021 Aug;8(4):2485-2491. doi: 10.1002/ehf2.13384. Epub 2021 May 2.
The increased incidence of heart failure in men suggests that endogenous sex hormones might play a role in the development of heart failure, but epidemiological data remain sparse. Here, we evaluated the predictive value of low testosterone levels on future heart failure in the large population-based FINRISK97 study.
Baseline serum testosterone concentrations were measured in 7855 subjects (3865 men and 3990 women) of the FINRISK97 study. During a median follow-up (FU) of 13.8 years, a total of 564 heart failure events were recorded. The age-adjusted baseline testosterone levels did not differ significantly between subjects developing incident heart failure during FU and those without incident events during FU (men: 16.6 vs. 17.1 nmol/L, P = 0.75; women: 1.15 vs. 1.17 nmol/L, P = 0.32). Relevant statistically significant correlations of testosterone levels were found with high-density lipoprotein cholesterol levels (R = 0.22; P < 0.001), body mass index (R = -0.23; P < 0.001), and waist-to-hip ratio (R = -0.21; P < 0.001) in men, while statistically significant correlations in women were negligible in effect size. In sex-stratified Cox regression analyses, taking age into account, a quite strong association between low testosterone and incident heart failure was found in men [hazard ratio (HR) 1.51 (95% confidence interval, CI: 1.09-2.10); P = 0.020 for lowest vs. highest quarter], but not in women [HR 0.70 (95% CI: 0.49-0.98); P = 0.086 for lowest vs. highest quarter]. Nevertheless, this association turned non-significant after full adjustment including body mass index and waist-to-hip ratio, and testosterone levels were no longer predictive for incident heart failure-neither in men [HR 0.99 (95% CI: 0.70-1.42); P = 0.77 for lowest vs. highest quarter] nor in women [HR 0.92 (95% CI: 0.64-1.33); P = 0.99 for lowest vs. highest quarter]. Accordingly, Kaplan-Meier analyses did not reveal significant association of testosterone levels with heart failure.
Low levels of testosterone do not independently predict future heart failure.
男性心力衰竭发病率的增加表明内源性性激素可能在心力衰竭的发展中起作用，但流行病学数据仍然很少。在这里，我们评估了大型基于人群的 FINRISK97 研究中低睾酮水平对未来心力衰竭的预测价值。
在 FINRISK97 研究的 7855 名受试者（3865 名男性和 3990 名女性）中测量了基线血清睾酮浓度。在中位随访（FU）13.8 年后，共记录了 564 例心力衰竭事件。在 FU 期间发生心力衰竭的受试者与 FU 期间未发生心力衰竭事件的受试者的基线睾酮水平无显著差异（男性：16.6 与 17.1 nmol/L，P=0.75；女性：1.15 与 1.17 nmol/L，P=0.32）。相关性分析显示，睾酮水平与高密度脂蛋白胆固醇水平（R=0.22；P<0.001）、体重指数（R=-0.23；P<0.001）和腰围-臀围比（R=-0.21；P<0.001）呈显著正相关，而女性的相关性较小。在按性别分层的 Cox 回归分析中，考虑到年龄因素，低睾酮与男性心力衰竭的发生存在较强的相关性[危险比（HR）1.51（95%置信区间，CI：1.09-2.10）；P=0.020 为最低与最高四分位值]，但在女性中则无相关性[HR 0.70（95%CI：0.49-0.98）；P=0.086 为最低与最高四分位值]。然而，这种相关性在包括体重指数和腰围-臀围比在内的完全调整后变得不显著，并且睾酮水平不再预测心力衰竭的发生——无论是男性[HR 0.99（95%CI：0.70-1.42）；P=0.77 为最低与最高四分位值]还是女性[HR 0.92（95%CI：0.64-1.33）；P=0.99 为最低与最高四分位值]。相应地，Kaplan-Meier 分析并未显示睾酮水平与心力衰竭之间存在显著相关性。
低水平的睾酮并不能独立预测未来的心力衰竭。
