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Testosterone levels and cardiovascular disease
  1. Ronald C W Ma,
  2. Peter C Y Tong
  1. Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
  1. Correspondence to Dr Ronald C W Ma, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong; rcwma{at}cuhk.edu.hk

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The marked gender differences in prevalence of coronary heart disease between men and premenopausal women have previously been attributed to potentially beneficial effects of oestrogen, but interventional studies did not support a protective role of oestrogen against development of coronary heart disease. Emerging data suggest that reduced testosterone levels in men may be associated with increased cardiovascular risk. Previous mainly cross-sectional studies have suggested an association between low testosterone concentrations and a more adverse metabolic profile,1 and thus increased risk of cardiovascular disease. Nevertheless, several earlier small prospective studies did not detect any association between testosterone concentrations and cardiovascular disease.1 In the more recent European Prospective Investigation into Cancer in Norfolk Study, endogenous testosterone concentrations at baseline were found to be inversely associated with all-cause mortality and cardiovascular mortality among men aged 40–79 without cardiovascular disease or cancer at baseline.2 Furthermore, this risk association persisted, despite correction for traditional cardiovascular risk factors, suggesting that the benefit may involve additional pathways. Several other studies have linked low testosterone with cardiovascular disease and increased mortality3 and, along with the increasing research on the clinical impact of age-related physiological decline in androgens, have led to rekindled interest in the potentially cardioprotective role of testosterone.

Although abuse of testosterone is linked with increased risk of cardiovascular disease and sudden death, higher testosterone levels …

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