Neutral associations of testosterone, dihydrotestosterone and estradiol with fatal and non-fatal cardiovascular events, and mortality in men aged 17–97 years

Yi Xian Chan, Matthew Knuiman, Joe Hung, Mark Divitini, John Beilby, D.J. Handelsman, J. Beilin, Brendan Mcquillan, Bu Yeap

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Abstract

© 2016 John Wiley & Sons Ltd ContextLower testosterone (T) is associated with poorer health outcomes in older men, however, the relationship between T, dihydrotestosterone (DHT) and estradiol (E2) with cardiovascular disease (CVD) in younger to middle-aged men remains unclear.
ObjectivesWe assessed associations between endogenous sex hormones with mortality (all-cause and CVD) and CVD events, in a cohort of men aged 17–97 years.
Participants and methodsSex hormones were assayed using mass spectrometry in 2143 men from the 1994/5 Busselton Health Survey. Outcomes to December 2010 were analysed.
ResultsOf the 1804 men included in the analysis, mean age was 50·3 ± 16·8 years and 68·9% of men were aged <60. Mean follow-up period was 14·9 years. There were 319 deaths, 141 CVD deaths and 399 CVD events. Compared to the full cohort, men who died had lower baseline T (12·0 ± 4·4 vs 13·6 ± 4·9 nmol/l), free T (181·9 ± 52·9 vs 218·3 ± 63·8 pmol/l) and DHT (1·65 ± 0·64 vs 1·70 ± 0·72 nmol/l), but higher E2 (64·0 ± 32 vs 60·1 ± 30·2 pmol/l). After adjustment for risk factors, T was not associated with mortality (adjusted HR = 0·90, 95% CI 0·79–1·04; P = 0·164 for every increase in 1 SD of T), CVD deaths (adjusted HR = 1·04, 95% CI 0·84–1·29; P = 0·708) or CVD events (adjusted HR = 1·03, 95% CI 0·92–1·15, P = 0·661). No associations were found for free T, DHT or E2. Results were similar for men older and younger than 60 years.
ConclusionsIn predominantly middle-aged men, T, DHT and E2 do not influence mortality or CVD outcomes. This neutral association of hormones with CVD contrasts with prior studies of older men.
Original languageEnglish
Pages (from-to)575-582
Number of pages8
JournalClinical Endocrinology
Volume85
Issue number4
Early online date26 Sep 2016
DOIs
Publication statusPublished - Oct 2016

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