title: Low concentrations of serum testosterone predict acute myocardial infarction in men with type 2 diabetes mellitus.
abstract: BACKGROUND
  The aim of the present study was to investigate the associations between endogenous testosterone concentrations and the incidence of acute myocardial infarction (AMI) in men and women with and without type 2 diabetes.
  
  
  METHODS
  The study comprised 1109 subjects ≥40 years of age (mean age 62 ± 12 years) participating in a baseline survey in Sweden in 1993-94. Information about smoking habits and physical activity was obtained using validated questionnaires. Serum concentrations of testosterone and sex hormone-binding globulin (SHBG) were obtained using radioimmunoassay. Diagnosis of type 2 diabetes was based on WHO's 1985 criteria. Individual patient information on incident AMI was ascertained by record linkage with national inpatient and mortality registers from baseline through 2011.
  
  
  RESULTS
  The prevalence of type 2 diabetes at baseline was 10.0% in men and 7.5% in women. During a mean follow-up of 14.1 years (±5.3), there were 74 events of AMI in men and 58 in women. In age-adjusted Cox models, a significant inverse association between concentrations of testosterone and AMI-morbidity was found in men with type 2 diabetes (HR = 0.86 CI (0.75-0.98)). In a final model also including waist-to-hip ratio, systolic blood pressure, total cholesterol and active smoking, the association still remained statistically significant (HR = 0.754 CI (0.61-0.92)).
  
  
  CONCLUSIONS
  Low concentrations of testosterone predicted AMI in men with type 2 diabetes independent of other risk factors. Trials with testosterone investigating the effect regarding cardiovascular outcome are still lacking. Future trials in this field should take into account a modification effect of diabetes.
authors.affiliation: Department of Public Health and Community Medicine/Primary Health Care, University of Gothenburg, Gothenburg, Sweden. bledar.daka@allmed.gu.se.
authors.forename: Bledar
authors.initials: B
authors.lastname: Daka
authors.affiliation: University of Nevada School of Medicine, Las Vegas, NV, USA. rlanger@medicine.nevada.edu.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Langer
authors.affiliation: Department of Clinical Sciences, Community Medicine, Lund, Sweden. charlotte_a.larsson@med.lu.se.
authors.forename: Charlotte A
authors.initials: CA
authors.lastname: Larsson
authors.affiliation: Department of Endocrinology, Medicine, Göteborg, Sweden. thord.rosen@medic.gu.se.
authors.forename: Thord
authors.initials: T
authors.lastname: Rosén
authors.affiliation: Department of Internal Medicine, Medicine, Göteborg, Sweden. per-anders.jansson@medic.gu.se.
authors.forename: Per Anders
authors.initials: PA
authors.lastname: Jansson
authors.affiliation: Department of Clinical Sciences, Community Medicine, Lund, Sweden. lennart.rastam@me.com.
authors.forename: Lennart
authors.initials: L
authors.lastname: Råstam
authors.affiliation: Department of Public Health and Community Medicine/Primary Health Care, University of Gothenburg, Gothenburg, Sweden. ulf.lindblad@gu.se.
authors.forename: Ulf
authors.initials: U
authors.lastname: Lindblad
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000453:epidemiology; D016016:Proportional Hazards Models; D011863:Radioimmunoassay; D012189:Retrospective Studies; D018570:Risk Assessment; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism; D013548:Sweden / Q000453:epidemiology; D013739:Testosterone / Q000097:blood*; D049629:Waist-Hip Ratio
chemical_list: D012738:Sex Hormone-Binding Globulin; D013739:Testosterone