Low Levels of Endogenous Androgens Increase the Risk of Atherosclerosis in Elderly Men: The Rotterdam Study
A. Elisabeth Hak,
Jacqueline C. M. Witteman,
Frank H. de Jong,
Mirjam I. Geerlings,
Albert Hofman and
Huibert A. P. Pols
Departments of Epidemiology & Biostatistics (A.E.H., J.C.M.W., M.I.G., A.H., H.A.P.P.) and Internal Medicine (A.E.H., F.H.d.J., H.A.P.P.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands
Address all correspondence and requests for reprints to: H. A. P. Pols, Department of Internal Medicine, Room D429, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail: . pols{at}inw3.azr.nl
Abstract
In both men and women, circulating androgen levels decline withadvancing age. Until now, results of several small studies onthe relationship between endogenous androgen levels and atherosclerosishave been inconsistent.
In the population-based Rotterdam Study, we investigated theassociation of levels of dehydroepiandrosterone sulfate (DHEAS)and total and bioavailable testosterone with aortic atherosclerosisamong 1,032 nonsmoking men and women aged 55 yr and over. Aorticatherosclerosis was assessed by radiographic detection of calcifieddeposits in the abdominal aorta, which have been shown to reflectintimal atherosclerosis.
Relative to men with levels of total and bioavailable testosteronein the lowest tertile, men with levels of these hormones inthe highest tertile had age-adjusted relative risks of 0.4 [95%confidence interval (CI), 0.2–0.9] and 0.2 (CI, 0.1–0.7),respectively, for the presence of severe aortic atherosclerosis.The corresponding relative risks for women were 3.7 (CI, 1.2–11.6)and 2.3 (CI, 0.7–7.8). Additional adjustment for cardiovasculardisease risk factors did not materially affect the results inmen, whereas in women the associations diluted. Men with levelsof total and bioavailable testosterone in subsequent tertileswere also protected against progression of aortic atherosclerosismeasured after 6.5 yr (SD ± 0.5 yr) of follow-up (P fortrend = 0.02). No clear association between levels of DHEASand presence of severe aortic atherosclerosis was found, eitherin men or in women. In men, a protective effect of higher levelsof DHEAS against progression of aortic atherosclerosis was suggested,but the corresponding test for trend did not reach statisticalsignificance.
In conclusion, we found an independent inverse association betweenlevels of testosterone and aortic atherosclerosis in men. Inwomen, positive associations between levels of testosteroneand aortic atherosclerosis were largely due to adverse cardiovasculardisease risk factors.
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A. E. Hak Author's Response: Low Levels of Endogenous Androgens Increase the Risk of Atherosclerosis in Elderly Men--Further Supportive Data
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R. D. Jones, C. J. Malkin, K. S. Channer, and T. H. Jones Low Levels of Endogenous Androgens Increase the Risk of Atherosclerosis in Elderly Men: Further Supportive Data
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