Low serum testosterone and increased mortality in men with coronary heart disease
- 1Department of Cardiology, Royal Hallamshire Hospital, Sheffield, UK
- 2Academic Unit of Diabetes Endocrinology and Metabolism, University of Sheffield Medical School, Sheffield, UK
- 3Centre for Diabetes and Endocrinology, Barnsley Hospital, Barnsley, UK
- Correspondence to Professor Kevin S Channer, Department of Cardiology, M131, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK; kevin.channer{at}sth.nhs.uk
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Contributors CJM collected the mortality data, analysed the final results and wrote the first draft of the paper. PJP designed the initial study, processed the ethics approval and collected baseline data. PDM helped design the initial study and collected the baseline data. SA helped design the initial study and collected the baseline data. THJ and KSC developed the original concept for the study, obtained funding and supervised ethics submission, data collection and writing of the final paper.
- Accepted 3 June 2010
- Published Online First 19 October 2010
Abstract
Background To examine the effect of serum testosterone levels on survival in a consecutive series of men with confirmed coronary disease and calculate the prevalence of testosterone deficiency.
Design Longitudinal follow-up study.
Setting Tertiary referral cardiothoracic centre.
Patients 930 consecutive men with coronary disease referred for diagnostic angiography recruited between June 2000 and June 2002 and followed up for a mean of 6.9±2.1 years.
Outcome All-cause mortality and vascular mortality. Prevalence of testosterone deficiency.
Results The overall prevalence of biochemical testosterone deficiency in the coronary disease cohort using bio-available testosterone (bio-T) <2.6 nmol/l was 20.9%, using total testosterone <8.1 nmol/l was 16.9% and using either was 24%. Excess mortality was noted in the androgen-deficient group compared with normal (41 (21%) vs 88 (12%), p=0.002). The only parameters found to influence time to all-cause and vascular mortality (HR ± 95% CI) in multivariate analyses were the presence of left ventricular dysfunction (3.85; 1.72 to 8.33), aspirin therapy (0.63; 0.38 to 1.0), β-blocker therapy (0.45; 0.31 to 0.67) and low serum bio-T (2.27; 1.45 to 3.6).
Conclusions In patients with coronary disease testosterone deficiency is common and impacts significantly negatively on survival. Prospective trials of testosterone replacement are needed to assess the effect of treatment on survival.
Footnotes
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Funding This study was funded by the South Sheffield Charitable Trust.
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Competing interests None.
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Patient consent Obtained.
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Ethics approval This study was conducted with the approval of the South Yorkshire local research and ethics committee.
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Provenance and peer review Not commissioned; externally peer reviewed.
