While ageing should be seen as a thing of pride, consultant cardiologists say for men, old age-induced testosterone deficiency has an unfavourable effect on their cardiovascular health, noting it can be considered a risk factor for heart-related diseases and mortality. They were speaking against the background of a new study released and published in the Annals of Internal Medicine on May 14, 2024, which associated low testosterone in men with cardiovascular disease mortality.
The study carried out with the sole aim of clarifying the controversial position that circulating sex hormones modulate mortality and cardiovascular disease risk in ageing men, was carried out by Bu Yeap and his team. Tilted, ‘Associations of Testosterone and Related Hormones With All-Cause and Cardiovascular Mortality and Incident Cardiovascular Disease in Men: Individual Participant Data Meta-analyses,’ the authors said men with low testosterone, high luteinising hormone, or very low estradiol concentrations have increased all-cause mortality.
On the data extraction, the independent variables in the study were testosterone, Sex Hormone–Binding Globulin, LH, dihydrotestosterone, and estradiol concentrations. The study recorded primary outcomes including all-cause mortality, CVD death, and incident CVD events indicating that variables that may affect the result of the research included age, body mass index, marital status, alcohol consumption, and smoking. Others are physical activity, hypertension, diabetes, creatinine concentration, ratio of total to high-density lipoprotein cholesterol, and lipid medication use.
The authors found, “The association of lower testosterone concentrations with higher all-cause mortality was present irrespective of luteinising hormone concentrations, indicating that low testosterone was the main factor.” The Lead researcher, Bu Yeap, said men with lower testosterone concentrations and normal or high SHBG had increased mortality risk, but those with lower testosterone concentrations and low SHBG had lower mortality risk. “This is consistent with the fact that men can have lower testosterone concentrations in the presence of low SHBG, without being hypogonadal,” he added.
At the Houston Methodist, U.S., Dr Khurram Nasir confirmed the study, stating, “Testosterone deficiency has an unfavourable effect on cardiovascular health. It can even be considered a risk factor for heart disease.” He noted that such is not good news for the one in three men aged 40 to 80 who suffer from low testosterone, a condition affected by certain lifestyle factors and health conditions, including being overweight and having type 2 diabetes. He noted that after age 30, there is a steady decline in testosterone levels, about one to two per cent per year, saying that it is a natural phenomenon, but some men experience a more exacerbated decline, resulting in early-onset testosterone deficiency Preventive Cardiologist.
According to Nasir, some of the best-known symptoms of low testosterone such as reduced libido, general fatigue and loss of muscle, are relatively straightforward, saying that the link between the heart and low testosterone is more complex. He said, “Based on what we know about the association between testosterone deficiency and metabolic issues, impaired glucose metabolism, poor cholesterol levels, and inflammation, all of which are linked to heart disease, we can infer that testosterone deficiency is also associated with poor heart health.”
The Preventive Cardiologist noted that one of the most noticeable examples of this is erectile dysfunction, the most common sexual problem men of 40 and older report to their doctor. “ED is often the result of poor blood circulation caused by atherosclerosis when the arteries that supply the body with blood become narrowed due to plaque buildup leading to High Blood Pressure. This link might be indirect, but it’s why ED can be a warning sign of heart disease,” Nasir added.
Speaking further, a Professor of Cardiovascular Medicine with the University of Abuja, Augustine Odili, said there is an urgent need for every Nigerian to know their Blood Pressure status to reduce cardiovascular deaths among Nigerians. Odili, who is also the National President of the Nigerian Cardiac Society, said, “If every Nigerian knows their blood pressure status and does something about it if necessary, Nigeria will be raising the life expectancy of its citizens. “If Nigerians get to know their blood pressure conditions, we are going to reduce deaths in this country by 50 per cent. Blood pressure is a simple condition that anybody can diagnose, but when neglected, may lead to irreversible outcomes. “Sometimes, talking about high and low cholesterol amounts to a waste of energy because that is not the issue. People’s blood pressure will be elevated because of one thing or the other. But by nature of the illness, it doesn’t have symptoms and that is its major undoing. “Even when you see a person with an elevated blood pressure, it is difficult to convince such a person that he has a problem because it doesn’t show symptoms. For me, if we use the same energy we dissipate in talking about cholesterol to make the masses know their status and take medications, lives would have been saved. “At least, 80 to 90 per cent of these deaths are cardiovascular-related. It is a major source of stroke and the major cause of heart failure, kidney failure, and erectile dysfunction, among others.”
A study published in the National Library of Medicine by Dr Hargun Kaura and Geoff Werstuck titled, ‘The Effect of Testosterone on Cardiovascular Disease and Cardiovascular Risk Factors in Men: A Review of Clinical and Preclinical Data,’ affirmed the new study. The researchers said that the effects of testosterone on cardiovascular risk have been of special interest due to the increased risk of CVD in men. They noted that various factors increase the risk of CVD, including diabetes, obesity, hypertension, dyslipidemia, and increasing age.
According to the study, though it is well established that testosterone levels decline and cardiovascular mortality increases with age, the association between testosterone and CVD remains unclear. “An increased risk of premature cardiovascular events in men initially led to the belief that testosterone had detrimental effects on cardiovascular health. Some large observational and randomized studies have supported this conclusion, whereas others have suggested a cardio protective role for testosterone. “With testosterone therapies being used in the treatment of conditions that affect millions of men worldwide, the relationship of testosterone to cardiovascular risk and disease must be better understood to inform guidelines for use of these therapies.”
