title: Sex hormone-binding globulin: a new marker of disease severity and prognosis in men with chronic heart failure.
abstract: OBJECTIVE
  Sex hormone-binding globulin (SHBG) is a key regulator of the actions of anabolic steroids. Chronic heart failure (HF) has been associated with anabolic steroid deficiency, but its relationship with SHBG is not known.
  
  
  METHODS
  The study involved 104 men (53+/-11 years) with HF (i.e. left ventricular ejection fraction [LVEF] <40%) attending a specialist clinic on optimum treatment and in a stable condition. At enrolment, the median and interquartile range (IQR) SHBG level was determined, associated hormone levels were measured, and known risk factors were recorded. The study end-point was cardiac death within 3 years.
  
  
  RESULTS
  At enrolment, the SHBG level (median 34.5 nmol/L, IQR 27-50 nmol/L) was correlated with the N-terminal probrain natriuretic peptide level (r=0.271, P=.005), LVEF (r=-0.263, P=.007), body mass index (r=-0.199, P=.020) and total testosterone level (r=0.332, P=.001). The median SHBG level was higher in the 16 patients (15.4%) who died, at 48.5 nmol/L (IQR 36-69.5 nmol/L) vs. 33 nmol/L (IQR 25.3-48.7 nmol/L; P=.001), and a high level was associated with an increased risk of death (hazard ratio [HR]=1.045, 95% confidence interval [CI] 1.021-1.069; P< .001). The association remained significant after adjustment in Cox multivariate regression modeling, at HR=1.049 (95% CI 1.020-1.079; P=.001). Analysis by SHBG tertiles showed mortality was 30% in the third tertile, 14% in the second, and 4% in the first (log rank 0.007; HR=3.25, 95% CI 1.43-7.34; P=.004).
  
  
  CONCLUSIONS
  The SHBG level correlated with measures of HF severity and was associated with a higher risk of cardiac death. Further studies are needed to clarify whether SHBG plays a role in HF pathophysiology.
authors.affiliation: Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Departamento de Medicina, Facultad de Medicina, Universidad de Murcia, El Palmar, 30120 Murcia, España. dapascual@servicam.com
authors.forename: Domingo A
authors.initials: DA
authors.lastname: Pascual-Figal
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Tornel
authors.forename: Francisco
authors.initials: F
authors.lastname: Nicolás
authors.forename: Jesús
authors.initials: J
authors.lastname: Sánchez-Más
authors.forename: María D
authors.initials: MD
authors.lastname: Martínez
authors.forename: María R
authors.initials: MR
authors.lastname: Gracia
authors.forename: Iris P
authors.initials: IP
authors.lastname: Garrido
authors.forename: Juan A
authors.initials: JA
authors.lastname: Ruipérez
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdés
mesh_terms: D015415:Biomarkers / Q000097:blood; D006333:Heart Failure / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D012738:Sex Hormone-Binding Globulin / Q000032:analysis*
chemical_list: D015415:Biomarkers; D012738:Sex Hormone-Binding Globulin