Endocrine Abstracts

Objective: Several studies report the association of low testosterone with ischaemic heart disease although the results are inconsistent. In our study we tried to evaluate the relationship between sex hormones and incidence of acute coronary syndrome (ACS).

Methods: This was a cross-sectional study. In 111 subjects (69 patients with ACS and 42 age-matched controls) we measured total testosterone, estradiol, SHBG, FSH, and LH by electrochemiluminiscence and calculate free androgen index (FAI). Patients with cancer, antiandrogen or testosterone treatment were excluded. In all patients we examined risk factors of myocardial infarction (hypertension, diabetes mellitus, dyslipidaemia, smoking, waist circumference, and BMI). Results were correlated by unpaired T-test and linear regression in SPCC system. In all subjects quartile analysis according to testosterone levels was performed.

Results: Patients with ACS have lower total testosterone levels comparing with controls (12.37 nmol/l vs 15.66 nmol/l, P=0.009). Patients had also lower levels of FAI and higher levels of FSH and LH but these were not significant. There was no difference in estradiol levels between the groups. In linear regression model testosterone correlated with waist circumference (R²=0.082, P=0.002) and weight (R²=0.076, P=0.002). In quartile testosterone analysis patients with testosterone levels in the lowest quartile had significantly higher incidence of ACS comparing with patients in the highest quartile (RR 1.72, CI 1.1; 2.6). Patients in the lowest testosterone quartile had also higher incidence of diabetes mellitus, dyslipidaemia, hypertension, and smoking.

Conclusions: Patients with ACS have significantly lower total testosterone levels and inversely, patients in the lowest testosterone quartile have higher incidence of ACS. Testosterone level correlates significantly with weight and waist circumference. Low testosterone is strongly associated with adiposity in patients with ACS and probably plays a role in metabolic syndrome.