Association between serum testosterone level and cardiovascular health in US male adults: results from the 2013-2016 NHANES.

BACKGROUND

There have been many studies of the association between testosterone and cardiovascular disease (CVD). However, limited research has examined the association between testosterone and Life's Essential 8 (LE8), a recently updated algorithm for assessing cardiovascular health (CVH).

OBJECTIVES

This study aims to investigate the association between serum total testosterone (TT) levels and LE8 scores-where higher LE8 scores indicate better CVH-among adult males in the United States.

METHOD

Data from 3308 adult males were extracted from the National Health and Nutrition Examination Survey conducted between 2013 and 2016. Weighted univariate and multivariate linear regression models [β and 95% confidence intervals (CIs)] and logistic regression models [odds ratios (ORs) and 95% CIs] were used to explore the association between testosterone and LE8 and high CVH risk. Additionally, a smoothed curve fit (penalized spline method) and generalized additive model regression were applied to further explore these relationships.

OUTCOMES

LE8 includes 4 health behaviors (nicotine exposure, diet, physical activity, and sleep duration) and 4 health factors (body mass index, non-high-density lipoprotein cholesterol, blood pressure, and blood glucose).

RESULTS

Serum TT levels were strongly associated with LE8 scores after adjusting for all confounders (continuous: β = 2.75, 95% CI: 1.92, 3.57, P < .0001; quartiles: Q4 vs Q1: β = 3.89, 95% CI: 2.78, 5.01, P < .0001). Similarly, high levels of TT were associated with a significantly lower CVH risk (OR = 0.59, 95% CI: 0.49, 0.73, P < .001). Compared to low TT levels, normal TT levels significantly reduced the risk of CVH (OR = 0.51, 95% CI: 0.38, 0.69, P < .001). Smoothed curve fitting showed a positive linear correlation between TT levels and LE8 scores, as well as a consistent linear negative correlation with CVH risk.

CLINICAL IMPLICATIONS

These findings highlight the importance of endogenous TT levels in promoting CVH and provide new insights into factors influencing CVH.

STRENGTHS AND LIMITATIONS

This study is the first to investigate the association between serum TT level and LE8 scores as well as LE8-assessed CVH among adult males. However, the observational nature of this study precludes any assessment of causality.

CONCLUSIONS

This study demonstrates a robust positive association between serum TT levels and LE8 scores in a nationally representative sample of adult men in the United States.