RT Journal Article
SR Electronic
T1 Low serum testosterone and increased mortality in men with coronary heart disease
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1821
OP 1825
DO 10.1136/hrt.2010.195412
VO 96
IS 22
A1 Chris J Malkin
A1 Peter J Pugh
A1 Paul D Morris
A1 Sonia Asif
A1 T Hugh Jones
A1 Kevin S Channer
YR 2010
UL http://heart.bmj.com/content/96/22/1821.abstract
AB 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.