Deparment of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA.
Department of Preventive Medicine and Population Health, UTMB Health School of Medicine, 301 University Blvd, Galveston, TX, 77555-1153, USA.
Hormones (Athens). 2022 Sep;21(3):399-411. doi: 10.1007/s42000-022-00360-3. Epub 2022 Mar 25.
The role of testosterone (T) deficiency (T ≤ 300 ng/dL) and hypercholesterolemia (total cholesterol ≥ 240 mg/dL) in the risk of all-cause cardiovascular diseases (CVD) and cancer mortality among a nationally representative sample of non-Hispanic White (NHW), non-Hispanic Black (NHB) and Hispanic men remains poorly understood.
Data included a full sample (NHANES 1988-1991, 1999-2004, 2011-2014) and subset sample (excluding 2011-2012, no estradiol and SHBG levels available) of 5379 and 3740 men, respectively. Participants were aged ≥ 20 y with serum T and cholesterol data (median follow-up 7.6 years). Weighted multivariable-adjusted Cox proportional hazards models were used in this study.
In the overall population of full and subset samples, hypercholesterolemia was inversely associated with all-cause (HR = 0.76, 95% CI, 0.63-0.91) and cancer mortality (HR = 0.56, 95% CI, 0.34-0.90). Similar findings were observed among NHW men, but higher T levels increased the risk of CVD mortality in the subset sample (T vs T P = 0.02). Among NHB men in the full and subset samples, T deficiency increased the risk of CVD mortality, but T vs. T decreased it (P = 0.03), and hypercholesterolemia decreased cancer mortality. Among Hispanic men in the full and subset samples, T deficiency increased, and hypercholesterolemia decreased the risk of CVD mortality.
Hypercholesterolemia was inversely associated with cancer mortality. However, higher levels of T were positively associated with CVD mortality among NHW and were inversely associated with CVD mortality among NHB and Hispanic men. Larger prospective studies are warranted to clarify the underlying relationship between T and cholesterol with mortality among racial and ethnic groups.
睾酮（T）缺乏症（T≤300ng/dL）和高胆固醇血症（总胆固醇≥240mg/dL）在非西班牙裔白人（NHW）、非西班牙裔黑人（NHB）和西班牙裔男性的全因心血管疾病（CVD）和癌症死亡率风险中的作用仍知之甚少。
数据包括一个完整的样本（NHANES 1988-1991、1999-2004、2011-2014）和一个亚组样本（排除 2011-2012 年，无雌二醇和 SHBG 水平），分别有 5379 名和 3740 名男性。参与者年龄≥20 岁，有血清 T 和胆固醇数据（中位随访 7.6 年）。本研究采用加权多变量调整 Cox 比例风险模型。
在全样本和亚组样本的总体人群中，高胆固醇血症与全因死亡率（HR=0.76，95%CI，0.63-0.91）和癌症死亡率（HR=0.56，95%CI，0.34-0.90）呈负相关。在 NHW 男性中也观察到了类似的发现，但在亚组样本中，较高的 T 水平增加了 CVD 死亡率的风险（T 与 T 的 P=0.02）。在全样本和亚组样本的 NHB 男性中，T 缺乏症增加了 CVD 死亡率的风险，但 T 与 T 降低了风险（P=0.03），高胆固醇血症降低了癌症死亡率。在全样本和亚组样本的西班牙裔男性中，T 缺乏症增加了 CVD 死亡率的风险，高胆固醇血症降低了 CVD 死亡率的风险。
高胆固醇血症与癌症死亡率呈负相关。然而，在 NHW 男性中，较高的 T 水平与 CVD 死亡率呈正相关，而在 NHB 和西班牙裔男性中，与 CVD 死亡率呈负相关。需要更大规模的前瞻性研究来阐明 T 和胆固醇与不同种族和族裔群体死亡率之间的潜在关系。
