title: Low testosterone concentrations in men contribute to the gender gap in cardiovascular morbidity and mortality.
abstract: BACKGROUND
  Across the industrialized world, men experience an earlier onset of cardiovascular disease (CVD) and a life expectancy 5 to 10 years shorter than women. Low total testosterone (TT) concentrations in men have been suggested as a novel CVD risk factor, but its contribution to this gender gap is less well studied.
  
  
  METHODS
  We used data of 4152 individuals (2113 women and 2039 men) aged 20 to 79 years from the longitudinal population-based cohort Study of Health in Pomerania, Germany. Multivariable Poisson and Cox proportional hazard regression models were used to investigate the risk of incident cardiovascular morbidity (5-year examination follow-up), as well as all-cause and CVD mortality (10-year follow-up) between men and women. Additionally, the added risk attributable to low TT in men (<10th percentile) was assessed.
  
  
  RESULTS
  Compared with women, men were uniformly at higher risk of incident cardiovascular morbidity, including overweight, hypertension, dyslipidemia, metabolic syndrome, and type 2 diabetes mellitus. Men were also at increased all-cause mortality (hazard ratio = 2.05; 95% CI, 1.61-2.60) and 10-year CVD risk compared with women. In subgroup analyses, men with low TT showed the highest 10-year CVD and mortality risk compared with both men with higher TT and women. TT was also negatively associated with cardiovascular risk as defined by the Framingham risk score (P < 0.001), after multivariable adjustment.
  
  
  CONCLUSIONS
  Analyzing a large population-based sample, we observed that men have a generally higher risk of incident cardiovascular morbidity and mortality. Furthermore, men with low TT concentrations were identified as high-risk individuals with regard to 10-year CVD and mortality risk.
authors.affiliation: Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany. robin.haring@uni-greifswald.de
authors.forename: Robin
authors.initials: R
authors.lastname: Haring
authors.forename: Ulrich
authors.initials: U
authors.lastname: John
authors.forename: Henry
authors.initials: H
authors.lastname: Völzke
authors.forename: Matthias
authors.initials: M
authors.lastname: Nauck
authors.forename: Marcus
authors.initials: M
authors.lastname: Dörr
authors.forename: Stephan B
authors.initials: SB
authors.lastname: Felix
authors.forename: Henri
authors.initials: H
authors.lastname: Wallaschofski
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood* / Q000453:epidemiology* / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D050177:Overweight / Q000453:epidemiology; D016012:Poisson Distribution; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D013739:Testosterone / Q000097:blood*; D055815:Young Adult
chemical_list: D013739:Testosterone