Androgens and cardiovascular disease.
OBJECTIVE
There is increasing interest in age-related changes in sex hormone levels as a potentially treatable cause of ill-health in men. Relationships between androgens and cardiovascular disease will be discussed, with particular attention to more recently published research.


RESULTS
In middle-aged and older men, lower testosterone levels are associated with insulin resistance, metabolic syndrome and diabetes, interrelated conditions that predispose to cardiovascular disease. The relationship between androgens and preclinical atherosclerosis requires confirmation. Nevertheless, lower testosterone levels predict cardiovascular events, such as stroke and transient ischaemic attack, in older men and are associated with higher cardiovascular and overall mortality. Testosterone is aromatized to oestradiol, and both higher and lower oestradiol levels have been associated with cardiovascular risk. Randomized trials have shown that testosterone supplementation in men with existing coronary artery disease can be protective against myocardial ischaemia. However, additional interventional studies are needed with endpoints of cardiovascular events.


CONCLUSIONS
Observational studies continue to relate reduced circulating testosterone to cardiovascular risk, atherosclerosis and mortality in men. The role of oestradiol as a marker for cardiovascular disease requires clarification. Larger randomized trials are needed to establish whether hormonal therapy would reduce the burden of cardiovascular disease in ageing men.
Yeap
Bu B
BB
School of Medicine and Pharmacology, University of Western Australia, Perth, Australia. byeap@cyllene.uwa.edu.au
D000375:Aging / Q000502:physiology; D000728:Androgens / Q000172:deficiency / Q000502:physiology* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D020249:Hormone Replacement Therapy; D006801:Humans; D008297:Male; D012307:Risk Factors; D013739:Testosterone / Q000009:adverse effects / Q000627:therapeutic use
D000728:Androgens; D013739:Testosterone