title: Combination of low free testosterone and low vitamin D predicts mortality in older men referred for coronary angiography.
abstract: BACKGROUND
  Low levels of 25-hydroxyvitamin D [25(OH)D] and free testosterone (FT) are both associated with increased mortality. Experimental studies show a complex interplay of vitamin D and androgen metabolism suggesting that a deficiency of both hormones may be associated with a particularly adverse clinical outcome.
  
  
  OBJECTIVE
  To evaluate the impact of parallel FT and 25(OH)D deficiency in a large cohort of older men.
  
  
  METHODS
  We measured total testosterone (TT), sex hormone-binding globulin and 25(OH)D levels in 2069 men who were routinely referred for coronary angiography (1997-2000).
  
  
  METHODS
  Cox proportional hazard ratios (HRs) (with 95% confidence intervals) for mortality from all causes, cardiovascular and noncardiovascular causes according to combined deficiency of FT and 25(OH)D.
  
  
  RESULTS
  In multivariate-adjusted analyses, we found an increased risk for all-cause mortality, cardiovascular and noncardiovascular mortality for men in the lowest FT [HR 1·26 (1·03-1·54), 1·24 (0·96-1·60) and 1·39 (1·00-1·93), respectively] and 25(OH)D quartile [HR 1·77 (1·47-2·13), 1·65 (1·29-2·10) and 1·89 (1·38-2·60) respectively] compared with men in higher FT and 25(OH)D quartiles. There was no independent association of TT levels with mortality. Multivariate-adjusted HRs progressively increased with the number of hormones (FT and 25(OH)D) in the lowest quartile [0 vs 2 hormone deficiencies: 2·11 (1·60-2·79) for all cause, 1·77 (1·23-2·55) for cardiovascular and 2·33 (1·45-3·47) for noncardiovascular mortality, respectively].
  
  
  CONCLUSIONS
  A combined deficiency of FT and 25(OH)D is significantly associated with fatal events in a large cohort of men referred for coronary angiography.
authors.affiliation: Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria. elisabeth.lerchbaum@medunigraz.at
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Lerchbaum
authors.forename: Stefan
authors.initials: S
authors.lastname: Pilz
authors.forename: Bernhard O
authors.initials: BO
authors.lastname: Boehm
authors.forename: Tanja B
authors.initials: TB
authors.lastname: Grammer
authors.forename: Barbara
authors.initials: B
authors.lastname: Obermayer-Pietsch
authors.forename: Winfried
authors.initials: W
authors.lastname: März
mesh_terms: D000368:Aged; D000375:Aging / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000209:etiology / Q000401:mortality*; D015331:Cohort Studies; D017023:Coronary Angiography; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013739:Testosterone / Q000097:blood* / Q000172:deficiency; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood* / Q000150:complications / Q000401:mortality*
chemical_list: D014807:Vitamin D; D013739:Testosterone; C104450:25-hydroxyvitamin D