Endogenous Testosterone and its Relationship to Preclinical and Clinical Measures of Cardiovascular Disease in the Atherosclerosis Risk in Communities Study
Endogenous Testosterone and its Relationship to Preclinical and Clinical Measures of Cardiovascular Disease in the Atherosclerosis Risk in Communities Study
复制标题
DOI：
10.1210/jc.2014-3934
复制
发表时间：
2015-04-01
影响因子：
5.8
通讯作者：
Dobs, Adrian
中科院分区：
文献类型：
--
作者：
Srinath, Reshmi;Golden, Sherita Hill;Dobs, Adrian
背景：流行病学研究表明，男性内源性睾酮 (T) 水平可能与心血管疾病 (CVD) 有关，但需要进一步澄清。目的：我们使用社区动脉粥样硬化风险 (ARIC) 中的男性参与者评估了内源性血浆 T 与平均颈动脉内膜中层厚度 (cIMT) 之间的横断面关系，以及与临床 CVD 事件、心脏死亡率和全因死亡率的纵向关系。研究设计：本研究涉及 ARIC 研究第 4 次访视的男性子集。背景：该研究在社区队列中进行。参与者：提供晨间血液样本的男性，不包括接受雄激素治疗的男性，患有流行的冠心病 (CHD)、中风或心力衰竭 (HF) (n = 1558)。干预：无。主要结果指标：通过液相色谱质谱法测定血浆 T 和使用高通量颈动脉 IMT 测定在第 4 次访视时获得分辨率 B 型超声检查。通过 2010 年（中位数 12.8 年）的监测确定了 CHD、心力衰竭、心脏死亡率和全因死亡率的发生率。结果：较低的 T 与较高的体重指数、较大的腰围、糖尿病、高血压、较低的 HDL 和从不吸烟显着相关（P = 0.01）。在未调整或调整的分析中，T 与平均 cIMT 无关。经过多变量调整后，T 的四分位数 (Q) 与 CHD 事件没有关联 [Q1 的风险比 (HR) = 0.87 (95% CI = 0.60-1.26)；第二季度为 0.97 (95% CI = 0.69-1.38)；与 Q4 的参考相比，Q3 为 0.97 (95% CI = 0.69-1.36)] 或事件 HF [Q1 的 HR = 0.77 (95% CI = 0.46-1.29)；第二季度为 0.72 (95% CI = 0.43-1.21)；与 Q4 的参考相比，Q3 为 0.87 (95% CI = 0.53-1.42)]。同样，T Q 值与死亡率或心脏相关死亡率也没有关联。结论：低男性血浆 T 与关键 CVD 危险因素存在横断面相关，但调整后与平均 cIMT、突发心脏事件或死亡率没有关联。我们的研究结果令人放心，高或低 T 水平都不能直接预测动脉粥样硬化，而是其他心血管危险因素的标志。
Context: Epidemiologic studies suggest that endogenous testosterone (T) levels in males may be implicated in cardiovascular disease (CVD), however further clarification is needed.Objective: We assessed the cross-sectional relationship between endogenous plasma T and mean carotid intima media thickness (cIMT), and the longitudinal relationship with incident clinical CVD events, cardiac mortality, and all-cause mortality using male participants in the Atherosclerosis Risk in Communities (ARIC) study.Design: This study involved a subset of men from visit 4 of the ARIC study.Setting: The study was conducted in a community based cohort.Participants: Males who provided a morning blood sample excluding those taking androgen therapy, with prevalent coronary heart disease (CHD), stroke, or heart failure (HF) (n = 1558).Intervention: None.Main Outcome Measures: Plasma T by liquid chromatography mass spectrometry and carotid IMT using high resolution B-mode ultrasound were obtained at visit 4. Incident CHD, HF, cardiac mortality, and all-cause mortality were identified by surveillance through 2010 (median 12.8 years).Results: Lower T was significantly associated with higher body mass index, greater waist circumference, diabetes, hypertension, lower HDL, and never smoking (P = 0.01). T was not associated with mean cIMT in unadjusted or adjusted analyses. Following multivariable adjustment, there was no association of quartile (Q) of T with incident CHD [hazard ratio (HR) = 0.87 (95% CI = 0.60-1.26) for Q1; 0.97 (95% CI = 0.69-1.38) for Q2; 0.97 (95% CI = 0.69-1.36) for Q3 compared to reference of Q4] or for incident HF [HR = 0.77 (95% CI = 0.46-1.29) for Q1; 0.72 (95% CI = 0.43-1.21) for Q2; 0.87 (95% CI = 0.53-1.42) for Q3 compared to reference of Q4]. Similarly there was no association of Q of T with mortality or cardiac-associated mortality.Conclusions: Low male plasma T is cross-sectionally associated with key CVD risk factors, but after adjustment there was no association with mean cIMT, incident cardiac events, or mortality. Our results are reassuring that neither high nor low T levels directly predict atherosclerosis, but are a marker for other cardiovascular risk factors.