The Association between Premature Coronary Artery Disease and Level of Testosterone in Young Adult Males


OBJECTIVE: Low testosterone levels in men have been associated with an increased risk of cardiovascular disease. We aimed to identify the association between serum testosterone level and premature coronary artery disease (CAD) and its predictors in young adult males.

METHODS: In this cross sectional study, consecutive male candidates for coronary angiography with unstable angina, no previous CAD and age ≤45 years were included. Serum levels of free (FT) and total testosterone (TT) as well as demographic and cardiovascular characteristics were compared between the CAD-positive and normal coronary subjects. The cutoff point for low TT was 2.5 ng/L. Additionally, the relationships between all the variables and the number of affected vessels and FT and TT and predictors of CAD were assessed.

RESULTS: In this study, 191 patients with premature CAD were compared with 94 normal coronary subjects. Patients in the CAD group were significantly older (41.59 ± 3.79 versus 39.27 ± 4.97 years; P-value < 0.01), and had higher rates of diabetes mellitus (P-value = 0.04) and dyslipidemia (P-value = 0.01). Serum levels of FT and TT were significantly lower in the CAD group than the normal coronary subjects (P-value < 0.01 for both). The rate of subjects with low TT increased by the number of the affected vessels (p-value for trend <0.01) and there was a significant correlation between the Gensini score and FT and TT (r = -0.37, P-value < 0.01 and r = -0.34, P-value < 0.01, respectively). After adjustment for confounders, the association between low TT and CAD remained significant (Odds ratio = 4.30, 95% confidence interval: 1.99-9.32; P-value ≤ 0.001) CONCLUSION: Low levels of testosterone were associated with premature CAD and its severity in young adults.


Alex’s Notes: I’m going to make this short. Testosterone has a lot of “gray” surrounding its connection to cardiovascular disease (CVD) risk. Much started with the Framingham study that showed a positive correlation between testosterone and CVD. Yet, it is also known that testosterone increases muscle mass, reduces fat mass, and provides a greater sense of wellbeing – all things that are protective against CVD. Moreover, common sense says that if testosterone is problematic, then all the teenage boys of the world would be having heart attacks. Contrary to this, it has also been shown that low levels of circulating free testosterone and total testosterone are related to the development of premature CVD (before 45-years of age).

All the above said, the present study aimed to evaluate the connection between serum testosterone levels and CVD in males less than 45 years of age. Confirming some earlier studies, there was a significant correlation between low free testosterone and low total testosterone levels and premature CVD. Even after adjustment for other well-known cardiovascular risk factors such as age, diabetes, and dyslipidemia, the association remained significant. Of course, it must be said that this is a correlation only and also that this only applies to men. Regardless, the results clearly demonstrate that low testosterone may be bad for your heart.


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