Tran Cammie, Yeap Bu B, Ball Jocasta, Clayton-Chubb Daniel, Hussain Sultana Monira, Brodtmann Amy, Tonkin Andrew M, Neumann Johannes T, Schneider Hans G, Fitzgerald Sharyn, Woods Robyn L, McNeil John J
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Medical School, University of Western Australia, Perth, Western Australia, Australia.
EClinicalMedicine. 2024 Apr 29;72:102611. doi: 10.1016/j.eclinm.2024.102611. eCollection 2024 Jun.
A cardiovascular safety trial of testosterone in men with cardiovascular risk factors or disease found no difference in rates of major adverse cardiovascular events (MACE) or death but noted more atrial fibrillation (AF) events in testosterone-treated men. We investigated the relationship between endogenous testosterone concentrations with risk of developing AF in healthy older men.
Post-hoc analysis of 4570 male participants in the ASPirin in Reducing Events in the Elderly (ASPREE) study. Men were aged ≥ 70 years, had no history of cardiovascular disease (including AF), thyroid disease, prostate cancer, dementia, or life-threatening illnesses. Risk of AF was modelled using Cox proportional hazards regression.
Median (IQR) age was 73.7 (71.6-77.1) years and median (IQR) follow-up 4.4 (3.3-5.5) years, during which 286 men developed AF (15.3 per 1000 participant-years). Baseline testosterone was higher in men who developed incident AF compared men who did not [17.0 (12.4-21.2) vs 15.7 (12.2-20.0) nmol/L]. There was a non-linear association of baseline testosterone with incident AF. The risk for AF was higher in men with testosterone in quintiles (Q) 4&5 (Q4:Q3, HR = 1.91; 95%CI = 1.29-2.83 and Q5:Q3HR = 1.98; 95%CI = 1.33-2.94). Results were similar after excluding men who experienced MACE or heart failure during follow-up.
Circulating testosterone concentrations within the high-normal range are independently associated with an increased risk of incident AF amongst healthy older men. This suggests that AF may be an adverse consequence of high-normal total testosterone concentrations.
National Institute on Aging and National Cancer Institute at the National Institutes of Health; Australian Government (NHMRC, CSIRO); Monash University; and AlfredHealth.
一项针对有心血管危险因素或疾病的男性进行的睾酮心血管安全性试验发现，主要不良心血管事件（MACE）发生率或死亡率无差异，但注意到接受睾酮治疗的男性心房颤动（AF）事件更多。我们研究了健康老年男性内源性睾酮浓度与发生AF风险之间的关系。
对阿司匹林减少老年人事件（ASPREE）研究中的4570名男性参与者进行事后分析。男性年龄≥70岁，无心血管疾病（包括AF）、甲状腺疾病、前列腺癌、痴呆或危及生命疾病史。使用Cox比例风险回归对AF风险进行建模。
中位（IQR）年龄为73.7（71.6 - 77.1）岁，中位（IQR）随访时间为4.4（3.3 - 5.5）年，在此期间286名男性发生AF（每1000参与者年15.3例）。发生新发AF的男性基线睾酮水平高于未发生AF的男性[17.0（12.4 - 21.2）对15.7（12.2 - 20.0）nmol/L]。基线睾酮与新发AF之间存在非线性关联。睾酮处于第4和第5五分位数（Q）的男性发生AF的风险更高（Q4:Q3，HR = 1.91；95%CI = 1.29 - 2.83；Q5:Q3，HR = 1.98；95%CI = 1.33 - 2.94）。排除随访期间发生MACE或心力衰竭的男性后结果相似。
健康老年男性中，高正常范围内的循环睾酮浓度与新发AF风险增加独立相关。这表明AF可能是总睾酮浓度高正常的不良后果。
美国国立卫生研究院国家衰老研究所和国家癌症研究所；澳大利亚政府（NHMRC、CSIRO）；莫纳什大学；以及阿尔弗雷德医院。
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