title: Endogenous testosterone and its relationship to preclinical and clinical measures of cardiovascular disease in the atherosclerosis risk in communities study.
abstract: BACKGROUND
  Epidemiologic studies suggest that endogenous testosterone (T) levels in males may be implicated in cardiovascular disease (CVD), however further clarification is needed.
  
  
  OBJECTIVE
  We assessed the cross-sectional relationship between endogenous plasma T and mean carotid intima media thickness (cIMT), and the longitudinal relationship with incident clinical CVD events, cardiac mortality, and all-cause mortality using male participants in the Atherosclerosis Risk in Communities (ARIC) study.
  
  
  METHODS
  This study involved a subset of men from visit 4 of the ARIC study.
  
  
  METHODS
  The study was conducted in a community based cohort.
  
  
  METHODS
  Males who provided a morning blood sample excluding those taking androgen therapy, with prevalent coronary heart disease (CHD), stroke, or heart failure (HF) (n = 1558).
  
  
  METHODS
  None.
  
  
  METHODS
  Plasma T by liquid chromatography mass spectrometry and carotid IMT using high resolution B-mode ultrasound were obtained at visit 4. Incident CHD, HF, cardiac mortality, and all-cause mortality were identified by surveillance through 2010 (median 12.8 years).
  
  
  RESULTS
  Lower T was significantly associated with higher body mass index, greater waist circumference, diabetes, hypertension, lower HDL, and never smoking (P = 0.01). T was not associated with mean cIMT in unadjusted or adjusted analyses. Following multivariable adjustment, there was no association of quartile (Q) of T with incident CHD [hazard ratio (HR) = 0.87 (95% CI = 0.60-1.26) for Q1; 0.97 (95% CI = 0.69-1.38) for Q2; 0.97 (95% CI = 0.69-1.36) for Q3 compared to reference of Q4] or for incident HF [HR = 0.77 (95% CI = 0.46-1.29) for Q1; 0.72 (95% CI = 0.43-1.21) for Q2; 0.87 (95% CI = 0.53-1.42) for Q3 compared to reference of Q4]. Similarly there was no association of Q of T with mortality or cardiac-associated mortality.
  
  
  CONCLUSIONS
  Low male plasma T is cross-sectionally associated with key CVD risk factors, but after adjustment there was no association with mean cIMT, incident cardiac events, or mortality. Our results are reassuring that neither high nor low T levels directly predict atherosclerosis, but are a marker for other cardiovascular risk factors.
authors.affiliation: Johns Hopkins University School of Medicine (R.S., S.H.G., A.D.), Division of Endocrinology, Diabetes and Metabolism, Baltimore, Maryland 21287; Department of Epidemiology (K.A.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21287.
authors.forename: Reshmi
authors.initials: R
authors.lastname: Srinath
authors.forename: Sherita
authors.initials: S
authors.lastname: Hill Golden
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Carson
authors.forename: Adrian
authors.initials: A
authors.lastname: Dobs
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D059168:Carotid Intima-Media Thickness; D002423:Cause of Death; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012307:Risk Factors; D013739:Testosterone / Q000097:blood*
chemical_list: D015415:Biomarkers; D013739:Testosterone