Low Testosterone, ED Linked to Cardiac Death Risk

[Michael Scally MD]

Low Testosterone, ED Linked to Cardiac Death Risk
http://www.medpagetoday.com/Cardiolo...Syndrome/19800


PRAGUE -- Men with erectile dysfunction and low testosterone have an increased risk of dying from cardiovascular disease, an Italian researcher reported.

In a prospective cohort study of men with erectile dysfunction, those whose serum testosterone was below a threshold of 230 nanograms per deciliter and who suffered a major adverse cardiovascular event were seven times more likely to die as a result than those with the highest testosterone levels, according to Giovanni Corona, MD, PhD, of the University of Florence.

But low testosterone itself did not increase the risk of any cardiac event, Corona said in a poster presentation at the 2010 European Congress of Endocrinology in Prague.

It's the first time that low testosterone has been associated with higher death rates from heart disease in men with erectile dysfunction, Corona said in a statement.

The finding "shows that screening for testosterone deficiency in men with erectile dysfunction may help clinicians identify those at higher risk from cardiovascular events," he said.

It might be that testosterone replacement therapy could prevent some unnecessary deaths, Corona said, but it's still not clear whether low testosterone levels are the cause or the consequence of the higher cardiac risk. The work needs to be confirmed in larger studies, he said.

Corona and colleagues studied testosterone levels of 1,687 patients with erectile dysfunction who attended the andrology clinic at the University of Florence.

Patients were interviewed using the structured interview on erectile dysfunction (SIEDY) as well as the ANDROTEST structured interview to measure aspects of erectile dysfunction and hypogonadal symptoms.

Total testosterone was evaluated at baseline and information on major adverse cardiovascular events came from the City of Florence Registry Office. On average, patients were followed for 4.3 years, Corona reported.

The baseline analysis showed that 5.2%, 13.8%, and 22.4% were hypogonadal according to different thresholds: meaning serum testosterone less than 230, 300, and 350 nanograms per deciliter, respectively.

During follow-up, the researchers observed 139 major adverse cardiovascular events, 15 of which were fatal, but the unadjusted incidence of those events was not associated with testosterone levels.

After adjusting for age and chronic diseases score, using a Cox regression model, fatal events were significantly associated with a testosterone level below 230 nanograms per deciliter. The hazard ratio was 7.1, with a 95% confidence interval from 1.8 to 28.6, which was significant at P<0.001.

The researchers also analyzed links between obesity, blood flow to the penis, and the risk of a fatal cardiac event, using the same cohort of patients.

The researchers found that 39.8% were of normal weight -- defined as a body mass index of between 18.5 and 24.9 kg/m2. Another 44.1% were overweight (BMI 25 through 29.9) while 16.1% were obese (BMI 30 or more).

Cox regression analysis, adjusted for age and chronic disease, showed that obesity classes and the presence of arteriogenic erectile dysfunction were significantly and independently associated with incident major adverse cardiovascular events, at P<0.05 and P<0.001, respectively.

Within obesity classes, arteriogenic erectile dysfunction -- defined as peak systolic velocity of less than 25 centimeters per second on a penile flow at color Doppler ultrasound -- was associated with increased risk of a cardiac event only among the obese, Corona and colleagues found.


Primary source: European Congress of Endocrinology
Source reference:
Corona G, et al "Low testosterone is associated with an increased risk of MACE lethality in subjects with erectile dysfunction" ECE 2010; Poster 149.

Additional source: European Congress of Endocrinology
Source reference:
Corona G, et al "Is obesity a further cardiovascular risk factor in patients with erectile dysfunction?"ECE 2010; Poster 151.