Tuesday, August 29, 2017

An article appearing online on July 27, 2017 in the Journal of Sexual Medicine reports the finding of Baylor College of Medicine researchers of an association between lower levels of plasma testosterone and unfavorable levels of a number of markers of cardiovascular disease risk.

The study included 10,041 men whose median age was 58 years. The proportion of subjects with unfavorable levels of 9 out of 10 cardiovascular disease risk biomarkers, including cardiac troponin I, endothelin-1, interleukin-6, tumor necrosis factor-alpha, N-terminal pro-B-type natriuretic peptide, HDL cholesterol, high-sensitivity C-reactive protein, hemoglobin A1C and leptin, tended to increase in association with declining testosterone concentrations. Men with low testosterone levels, defined as less than 250 ng/dL, had a greater adjusted risk of high concentrations of interleukin-6, endothelin-1, N-terminal pro-B-type natriuretic peptide and leptin in comparison with higher testosterone levels.

The study is the first to examine the association between circulating testosterone levels and cardiovascular risk using a large panel of objective biomarkers. As potential mechanisms, studies suggest that testosterone can inhibit atherosclerotic plaque by lowering lipid lesions, preventing foam cell formation and endothelial injury, modulating coagulation and inhibiting inflammation.

“This association among testosterone level, cardiovascular disease, and diabetes implies that an initial presentation with symptoms of low testosterone might be an important entry point into the health care system, prompting screening for cardiovascular disease and diabetes,” Alexander W. Pastuszak, MD, PhD, and colleagues write. “Clinicians should be aware of the potential adverse cardiovascular risks associated with low testosterone levels in men and should further evaluate these men using validated screening calculators, such as the Framingham Coronary Heart Disease Risk Score, or refer men to a cardiologist for a more extensive workup.”