title: Low testosterone is associated with an increased risk of MACE lethality in subjects with erectile dysfunction.
abstract: BACKGROUND
  Although testosterone (T) has been suggested to play a protective role against the development of atherosclerosis, studies demonstrating an association between low T and incident major adverse cardiovascular events (MACE) are scanty in the general population and absent in subjects with erectile dysfunction (ED).
  
  
  OBJECTIVE
  To investigate whether low T in subjects with ED predict incident fatal or nonfatal MACE.
  
  
  METHODS
  This is an observational prospective cohort study evaluating a consecutive series of 1687 patients attending our andrological unit for ED. Patients were interviewed using the structured interview on erectile dysfunction (SIEDY) and ANDROTEST structured interviews measuring components relative to ED and hypogonadal-related symptoms, respectively.
  
  
  METHODS
  Total T was evaluated at baseline. Information on MACE was obtained through the City of Florence Registry Office.
  
  
  RESULTS
  Among the patients studied, 5.2, 13.8, and 22.4% were hypogonadal according to different thresholds (T < 8, 10.4 and 12 nmol/L or 230, 300 and 350 ng/dL, respectively). During a mean follow-up of 4.3 + or - 2.6 years, 139 MACE, 15 of which were fatal, were observed. Unadjusted incidence of MACE was not associated with T levels. Conversely, the proportion of lethal events among MACE was significantly higher in hypogonadal patients, using either 10.4 nmol/L (300 ng/dL) or 8 nmol/L (230 ng/dL) thresholds. However, after adjustment for age and Chronic Diseases Score in a Cox regression model, only the association between incident fatal MACE and T < 8 nmol/L (230 ng/dL) was confirmed (HR = 7.1 [1.8-28.6]; P < 0.001). Interestingly, measuring hypogonadal-related symptoms and signs through ANDROTEST, only fatal MACE were also associated with a higher score (HR = 1.2 [1.0-1.5] for each ANDROTEST score increment; P = 0.05 after adjustment for age and Chronic Diseases Score).
  
  
  CONCLUSIONS
  T levels are associated with a higher mortality of MACE. The identification of low T levels should alert the clinician thus identifying subjects with an increased cardiovascular risk.
authors.affiliation: Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corona
authors.forename: Matteo
authors.initials: M
authors.lastname: Monami
authors.forename: Valentina
authors.initials: V
authors.lastname: Boddi
authors.forename: Michela
authors.initials: M
authors.lastname: Cameron-Smith
authors.forename: Alessandra D
authors.initials: AD
authors.lastname: Fisher
authors.forename: Giulia
authors.initials: G
authors.lastname: de Vita
authors.forename: Cecilia
authors.initials: C
authors.lastname: Melani
authors.forename: Daniela
authors.initials: D
authors.lastname: Balzi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Sforza
authors.forename: Gianni
authors.initials: G
authors.lastname: Forti
authors.forename: Edoardo
authors.initials: E
authors.lastname: Mannucci
authors.forename: Mario
authors.initials: M
authors.lastname: Maggi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality*; D002423:Cause of Death; D015897:Comorbidity; D006801:Humans; D007006:Hypogonadism / Q000097:blood* / Q000401:mortality*; D018783:Impotence, Vasculogenic / Q000097:blood* / Q000401:mortality*; D007558:Italy; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D013739:Testosterone / Q000097:blood*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D013739:Testosterone