title: Low testosterone levels predict all-cause mortality and cardiovascular events in women: a prospective cohort study in German primary care patients.
abstract: OBJECTIVE
  Although associations between testosterone and cardiovascular (CV) morbidity in women have been proposed, no large prospective study has evaluated potential associations between testosterone and mortality in women. The objective was to determine whether baseline testosterone levels in women are associated with future overall or CV morbidity and mortality.
  
  
  METHODS
  Prospective cohort study with a 4.5-year follow-up period.
  
  
  METHODS
  From a representative sample of German primary care practices, 2914 female patients between 18 and 75 years were analyzed for the main outcome measures: CV risk factors, CV diseases, and all-cause mortality.
  
  
  RESULTS
  At baseline, the study population was aged 57.96±14.37 years with a mean body mass index of 26.71±5.17 kg/m(2). No predictive value of total testosterone for incident CV risk factors or CV diseases was observed in logistic regressions. Patients with total testosterone levels in the lowest quintile Q1, however, had a higher risk to die of any cause or to develop a CV event within the follow-up period compared to patients in the collapsed quintiles Q2-Q5 in crude and adjusted Cox regression models (all-cause mortality: Q2-Q5 versus Q1: crude hazard ratios (HR) 0.49, 95% confidence interval (CI) 0.33-0.74; adjusted HR 0.62, 95% CI 0.42-0.939; CV events: Q2-Q5 versus Q1: crude HR 0.54, 95% CI 0.38-0.77; adjusted HR 0.68, 95% CI 0.48-0.97). Kaplan-Meier curves revealed similar data.
  
  
  CONCLUSIONS
  Low baseline testosterone in women is associated with increased all-cause mortality and incident CV events independent of traditional risk factors.
authors.affiliation: Department of Endocrinology, Max Planck Institute of Psychiatry, Kraepelinstrasse 2-10, Munich, Germany. csievers@mpipsykl.mpg.de
authors.forename: Caroline
authors.initials: C
authors.lastname: Sievers
authors.forename: Jens
authors.initials: J
authors.lastname: Klotsche
authors.forename: Lars
authors.initials: L
authors.lastname: Pieper
authors.forename: Harald J
authors.initials: HJ
authors.lastname: Schneider
authors.forename: Winfried
authors.initials: W
authors.lastname: März
authors.forename: Hans Ulrich
authors.initials: HU
authors.lastname: Wittchen
authors.forename: Günter K
authors.initials: GK
authors.lastname: Stalla
authors.forename: Christos
authors.initials: C
authors.lastname: Mantzoros
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality*; D002853:Chromatography, Liquid; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D053719:Tandem Mass Spectrometry; D013739:Testosterone / Q000097:blood*; D055815:Young Adult
chemical_list: D013739:Testosterone