Original Article

Low Circulating Androgens and Mortality Risk in Heart Failure

Gülmisal Güder¹, Stefan Frantz², Johann Bauersachs¹, Bruno Allolio², Georg Ertl¹, Christiane E. Angermann¹, Stefan Störk^1,*

¹ University of Würzburg, Germany;
² Universitätsklinik Würzburg, Germany

Correspondence to: S Störk, Medicine I, University of Würzburg, Klinikstrasse 6-8, Würzburg, 97070, Germany; stoerk_s{at}klinik.uni-wuerzburg.de

Accepted 20 October 2009

Objective: Deficiency of anabolic sex steroids is common in HF. The pathophysiological implications of this phenomenon, however, have not been fully elucidated. This clinical study investigated the significance of low serum androgens levels in heart failure (HF).

Design: Prospective cohort study.

Patients and methods: In 191 consecutively recruited males with HF (mean age, 64 years; New York Heart Association [NYHA] class I-IV 24/35/35/6%) and reduced (ejection fraction [EF] 40%, n=96) or preserved left ventricular function (EF>40%, n=95) total and free serum testosterone, dehydroepiandrosterone sulfate (DHEAS), and sex hormone binding globulin (SHBG) were measured. The median observation period was 859 days.

Results: During follow-up 53 patients (28%) died. While total serum testosterone was normal in most patients (91%), free testosterone and DHEAS were reduced in 79% and 23%, respectively. DHEAS and free testosterone, but not total testosterone, were inversely associated with NYHA class (both P<0.01). Lower free testosterone and DHEAS and higher SHBG predicted all-cause mortality risk (hazard ratio[HR] 0.89, 95% confidence interval[CI] 0.82-0.96 per 1 ng/dl free testosterone, P=0.004, HR 0.95, 95% CI 0.89-1.00, per 10 µg/dl DHEAS, P=0.058, and HR 1.18, 95% CI 1.05-1.33 per 10 nmol/l SHBG, P=0.006, respectively [adjusted for age and NYHA class]). However, further adjustment for carefully selected confounding factors abolished these associations.

Conclusion: In male HF patients, low serum levels of androgens are associated with adverse prognosis, but this relation is confounded by indicators of a poor health state. Our results suggest that low serum androgens develop as a sequel of this progressive multi-faceted systemic disorder.

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