Low serum testosterone and increased mortality in men with coronary heart disease.
BACKGROUND
To examine the effect of serum testosterone levels on survival in a consecutive series of men with confirmed coronary disease and calculate the prevalence of testosterone deficiency.


METHODS
Longitudinal follow-up study.


METHODS
Tertiary referral cardiothoracic centre. Patients 930 consecutive men with coronary disease referred for diagnostic angiography recruited between June 2000 and June 2002 and followed up for a mean of 6.9±2.1 years.


RESULTS
All-cause mortality and vascular mortality. Prevalence of testosterone deficiency.


RESULTS
The overall prevalence of biochemical testosterone deficiency in the coronary disease cohort using bio-available testosterone (bio-T) <2.6 nmol/l was 20.9%, using total testosterone <8.1 nmol/l was 16.9% and using either was 24%. Excess mortality was noted in the androgen-deficient group compared with normal (41 (21%) vs 88 (12%), p=0.002). The only parameters found to influence time to all-cause and vascular mortality (HR ± 95% CI) in multivariate analyses were the presence of left ventricular dysfunction (3.85; 1.72 to 8.33), aspirin therapy (0.63; 0.38 to 1.0), β-blocker therapy (0.45; 0.31 to 0.67) and low serum bio-T (2.27; 1.45 to 3.6).


CONCLUSIONS
In patients with coronary disease testosterone deficiency is common and impacts significantly negatively on survival. Prospective trials of testosterone replacement are needed to assess the effect of treatment on survival.
Department of Cardiology, Royal Hallamshire Hospital, Sheffield, UK
Chris J
CJ
Malkin
Peter J
PJ
Pugh
Paul D
PD
Morris
Sonia
S
Asif
T Hugh
TH
Jones
Kevin S
KS
Channer
D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000097:blood* / Q000209:etiology / Q000401:mortality; D004739:England / Q000453:epidemiology; D004812:Epidemiologic Methods; D006801:Humans; D007006:Hypogonadism / Q000150:complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D013739:Testosterone / Q000097:blood* / Q000172:deficiency
D013739:Testosterone