1
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Bianchi VE, von Haehling S. The treatment of chronic anemia in heart failure: a global approach. Clin Res Cardiol 2024; 113:1117-1136. [PMID: 37660308 DOI: 10.1007/s00392-023-02275-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/24/2023] [Indexed: 09/05/2023]
Abstract
Chronic anemia is an independent risk factor for mortality in patients with heart failure (HF). Restoring physiological hemoglobin (Hb) levels is essential to increase oxygen transport capacity to tissues and improve cell metabolism as well as physical and cardiac performance. Nutritional deficits and iron deficiency are the major causes of chronic anemia, but other etiologies include chronic kidney disease, inflammatory processes, and unexplained anemia. Hormonal therapy, including erythropoietin (EPO) and anabolic treatment in chronic anemia HF patients, may contribute to improving Hb levels and clinical outcomes. Although preliminary studies showed a beneficial effect of EPO therapy on cardiac efficiency and in HF, more recent studies have not confirmed this positive impact of EPO, alluding to its side effect profile. Physical exercise significantly increases Hb levels and the response of anemia to treatment. In malnourished patients and chronic inflammatory processes, low levels of anabolic hormones, such as testosterone and insulin-like growth factor-1, contribute to the development of chronic anemia. This paper aims to review the effect of nutrition, EPO, anabolic hormones, standard HF treatments, and exercise as regulatory mechanisms of chronic anemia and their cardiovascular consequences in patients with HF.
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Affiliation(s)
- Vittorio Emanuele Bianchi
- Department of Endocrinology and Metabolism, Clinical Center Stella Maris, Strada Rovereta, 42, 47891, Falciano, San Marino.
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site, Göttingen, Germany
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2
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Iida T, Aoi S, Kunishige M, Kawane Y, Obata Y, Nishigaki M, Kodama M. A Cross-Sectional Study on Metabolic Syndrome Parameters, the Nutritional Index, and Physical Status Associated with or Without the Possible Diagnosed Sarcopenia in Older Women Using A Propensity Score Matching Method. J Frailty Sarcopenia Falls 2024; 9:142-150. [PMID: 38835622 PMCID: PMC11145093 DOI: 10.22540/jfsf-09-142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 06/06/2024] Open
Abstract
Objectives To develop strategies against sarcopenia, physiological and biochemical data in older women were analyzed using propensity score matching. Methods Fifty-six women aged ≥75 years with the AWGS calf circumference <33 cm were included in the sarcopenia risk group. Low muscle strength (handgrip strength <18kg) or low physical performance (five-times-sit-to-stand test ≥12s) were used the possible-sarcopenia group. Propensity score matching adjusted for age and BMI was performed between the possible-sarcopenia group with low muscle strength (or physical performance) and the sarcopenia risk group without low muscle strength (or physical performance). The comparison included nutritional index, metabolic syndrome parameters, BMD, and skeletal muscle mass index score between both groups. Results The possible-sarcopenia group with low muscle strength exhibited significantly lower BMD (p=0.014) and skeletal muscle mass index score (p=0.002) compared to the sarcopenia risk group without low muscle strength. The possible-sarcopenia group with low physical performance exhibited significantly lower AST (p=0.034) compared to the sarcopenia risk group without low physical performance. Conclusion These results suggest that older women with possible sarcopenia and low muscle strength may have reduced BMD and skeletal muscle mass index.
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Affiliation(s)
- Tadayuki Iida
- Faculty of Health and Welfare, Prefectural University of Hiroshima, Mihara, Japan
| | - Satomi Aoi
- Faculty of Health and Welfare, Prefectural University of Hiroshima, Mihara, Japan
| | - Masafumi Kunishige
- Faculty of Health Science Technology, Bunkyo Gakuin University, Saitama, Japan
| | - Yuka Kawane
- Health and Welfare Division, Health and Welfare Department, Mihara City Hall, Japan
| | - Yuto Obata
- Kurashiki Heisei Hospital Rehabilitation Center, Japan
| | - Masaya Nishigaki
- Seisenkai Medical Corporation Ichinose Hospital Rehabilitation department, Japan
| | - Miwako Kodama
- Health and Welfare Division, Health and Welfare Department, Mihara City Hall, Japan
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3
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Zhang X, Sanders JL, Boudreau RM, Arnold AM, Justice JN, Espeland MA, Kuchel GA, Barzilai N, Kuller LH, Lopez OL, Kritchevsky SB, Newman AB. Association of a Blood-Based Aging Biomarker Index With Death and Chronic Disease: Cardiovascular Health Study. J Gerontol A Biol Sci Med Sci 2024; 79:glad172. [PMID: 37464278 PMCID: PMC10799760 DOI: 10.1093/gerona/glad172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND A goal of gerontology is to discover phenotypes that reflect biological aging distinct from disease pathogenesis. Biomarkers that are strongly associated with mortality could be used to define such a phenotype. However, the relation of such an index with multiple chronic conditions warrants further exploration. METHODS A biomarker index (BI) was constructed in the Cardiovascular Health Study (N = 3 197), with a mean age of 74 years. The BI incorporated circulating levels of new biomarkers, including insulin-like growth factor-1, interleukin-6, amino-terminal pro-B-type natriuretic peptide, cystatin-C, C-reactive protein, tumor necrosis factor-alpha soluble receptor 1, fasting insulin, and fasting glucose, and was built based on their relationships with mortality. Cox proportional hazards models predicting a composite of death and chronic disease involving cardiovascular disease, dementia, and cancer were calculated with 6 years of follow-up. RESULTS The hazard ratio (HR, 95% CI) for the composite outcome of death or chronic disease per category of BI was 1.65 (1.52, 1.80) and 1.75 (1.58, 1.94) in women and men, respectively. The HR (95% CI) per 5 years of age was 1.57 (1.48, 1.67) and 1.55 (1.44, 1.67) in women and men, respectively. Moreover, BI could attenuate the effect of age on the composite outcome by 16.7% and 22.0% in women and men, respectively. CONCLUSIONS Biomarker index was significantly and independently associated with a composite outcome of death and chronic disease, and attenuated the effect of age. The BI that is composed of plasma biomarkers may be a practical intermediate phenotype for interventions aiming to modify the course of aging.
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Affiliation(s)
- Xiao Zhang
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | | | - Robert M Boudreau
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alice M Arnold
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Jamie N Justice
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Mark A Espeland
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - George A Kuchel
- UConn Center on Aging, UConn Health, Farmington, Connecticut, USA
| | - Nir Barzilai
- Department of Medicine, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York, USA
| | - Lewis H Kuller
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Oscar L Lopez
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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4
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Trumble BC, Negrey J, Koebele SV, Thompson RC, Samuel Wann L, Allam AH, Beheim B, Linda Sutherland M, Sutherland JD, Eid Rodriguez D, Michalik DE, Rowan CJ, Lombardi GP, Garcia AR, Cummings DK, Seabright E, Alami S, Kraft TS, Hooper P, Buetow K, Irimia A, Gatz M, Stieglitz J, Gurven MD, Kaplan H, Thomas GS. Testosterone is positively associated with coronary artery calcium in a low cardiovascular disease risk population. Evol Med Public Health 2023; 11:472-484. [PMID: 38145005 PMCID: PMC10746324 DOI: 10.1093/emph/eoad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 10/11/2023] [Indexed: 12/26/2023] Open
Abstract
Background In industrialized populations, low male testosterone is associated with higher rates of cardiovascular mortality. However, coronary risk factors like obesity impact both testosterone and cardiovascular outcomes. Here, we assess the role of endogenous testosterone on coronary artery calcium in an active subsistence population with relatively low testosterone levels, low cardiovascular risk and low coronary artery calcium scores. Methodology In this cross-sectional community-based study, 719 Tsimane forager-horticulturalists in the Bolivian Amazon aged 40+ years underwent computed tomography (49.8% male, mean age 57.6 years). Results Coronary artery calcium levels were low; 84.5% had no coronary artery calcium. Zero-inflated negative binomial models found testosterone was positively associated with coronary artery calcium for the full sample (Incidence Rate Ratio [IRR] = 1.477, 95% Confidence Interval [CI] 1.001-2.170, P = 0.031), and in a male-only subset (IRR = 1.532, 95% CI 0.993-2.360, P = 0.053). Testosterone was also positively associated with clinically relevant coronary atherosclerosis (calcium >100 Agatston units) in the full sample (Odds Ratio [OR] = 1.984, 95% CI 1.202-3.275, P = 0.007) and when limited to male-only sample (OR = 2.032, 95% CI 1.118-4.816, P = 0.024). Individuals with coronary artery calcium >100 had 20% higher levels of testosterone than those with calcium <100 (t = -3.201, P = 0.007). Conclusions and Implications Among Tsimane, testosterone is positively associated with coronary artery calcium despite generally low normal testosterone levels, minimal atherosclerosis and rare cardiovascular disease (CVD) events. Associations between low testosterone and CVD events in industrialized populations are likely confounded by obesity and other lifestyle factors.
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Affiliation(s)
- Benjamin C Trumble
- Arizona State University, School of Human Evolution and Social Change, Center for Evolution and Medicine, Institute of Human Origins, Tempe, AZ, USA
| | - Jacob Negrey
- Arizona State University, School of Human Evolution and Social Change, Center for Evolution and Medicine, Institute of Human Origins, Tempe, AZ, USA
| | - Stephanie V Koebele
- Arizona State University, School of Human Evolution and Social Change, Center for Evolution and Medicine, Institute of Human Origins, Tempe, AZ, USA
| | - Randall C Thompson
- Saint Luke’s Mid America Heart Institute, Department of Cardiology, Kansas City, MO, USA
| | - L Samuel Wann
- University of New Mexico, School of Medicine, Albuquerque, NM, USA
| | - Adel H Allam
- Al Azhar University, School of Medicine, Cairo, Egypt
| | - Bret Beheim
- Max Planck Institute for Evolutionary Anthropology, Department of Human Behavior, Ecology and Culture, Leipzig, Germany
| | | | | | | | - David E Michalik
- University of California Irvine, School of Medicine, Irvine, CA, USA
- Miller Women’s and Children’s Hospital Long Beach, CA, USA
| | | | - Guido P Lombardi
- Universidad Peruana Cayetano Heredia, Laboratorio de Paleopatología, Lima, Peru
| | - Angela R Garcia
- Arizona State University, School of Human Evolution and Social Change, Center for Evolution and Medicine, Institute of Human Origins, Tempe, AZ, USA
| | | | - Edmond Seabright
- Mohammed VI Polytechnic University, School of Collective Intelligence, Ben Guerir, Morocco
| | - Sarah Alami
- Mohammed VI Polytechnic University, School of Collective Intelligence, Ben Guerir, Morocco
| | - Thomas S Kraft
- University of Utah, Anthropology Department, Salt Lake City, UT, USA
| | - Paul Hooper
- Chapman University, Economic Science Institute, Orange, CA, USA
| | - Kenneth Buetow
- Arizona State University, School of Human Evolution and Social Change, Center for Evolution and Medicine, Institute of Human Origins, Tempe, AZ, USA
| | - Andrei Irimia
- University of Southern California, Psychology Department, Los Angeles, CA, USA
| | - Margaret Gatz
- University of Southern California, Psychology Department, Los Angeles, CA, USA
| | - Jonathan Stieglitz
- Toulouse Scool of Economics, Institute for Advanced Study Toulouse, Toulouse, France
| | - Michael D Gurven
- University of California Santa Barbara, Department of Anthropology, Santa Barbara, CA, USA
| | - Hillard Kaplan
- Chapman University, Economic Science Institute, Orange, CA, USA
| | - Gregory S Thomas
- MemorialCare Health System, Fountain Valley, CA, USA
- University of California Irvine, Division of Cardiology, Orange, CA, USA
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5
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Sakr HF, Sirasanagandla SR, Das S, Bima AI, Elsamanoudy AZ. Insulin Resistance and Hypertension: Mechanisms Involved and Modifying Factors for Effective Glucose Control. Biomedicines 2023; 11:2271. [PMID: 37626767 PMCID: PMC10452601 DOI: 10.3390/biomedicines11082271] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/18/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023] Open
Abstract
Factors such as aging, an unhealthy lifestyle with decreased physical activity, snacking, a standard Western diet, and smoking contribute to raising blood pressure to a dangerous level, increasing the risk of coronary artery disease and heart failure. Atherosclerosis, or aging of the blood vessels, is a physiological process that has accelerated in the last decades by the overconsumption of carbohydrates as the primary sources of caloric intake, resulting in increased triglycerides and VLDL-cholesterol and insulin spikes. Classically, medications ranging from beta blockers to angiotensin II blockers and even calcium channel blockers were used alone or in combination with lifestyle modifications as management tools in modern medicine to control arterial blood pressure. However, it is not easy to control blood pressure or the associated complications. A low-carbohydrate, high-fat (LCHF) diet can reduce glucose and insulin spikes, improve insulin sensitivity, and lessen atherosclerosis risk factors. We reviewed articles describing the etiology of insulin resistance (IR) and its impact on arterial blood pressure from databases including PubMed, PubMed Central, and Google Scholar. We discuss how the LCHF diet is beneficial to maintaining arterial blood pressure at normal levels, slowing down the progression of atherosclerosis, and reducing the use of antihypertensive medications. The mechanisms involved in IR associated with hypertension are also highlighted.
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Affiliation(s)
- Hussein F. Sakr
- Department of Physiology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman
| | - Srinivasa Rao Sirasanagandla
- Department of Human and Clinical Anatomy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (S.R.S.); (S.D.)
| | - Srijit Das
- Department of Human and Clinical Anatomy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (S.R.S.); (S.D.)
| | - Abdulhadi I. Bima
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah 21465, Saudi Arabia; (A.I.B.); (A.Z.E.)
| | - Ayman Z. Elsamanoudy
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah 21465, Saudi Arabia; (A.I.B.); (A.Z.E.)
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6
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Guler SA, Machahua C, Geiser TK, Kocher G, Marti TM, Tan B, Trappetti V, Ryerson CJ, Funke-Chambour M. Dehydroepiandrosterone in fibrotic interstitial lung disease: a translational study. Respir Res 2022; 23:149. [PMID: 35676709 PMCID: PMC9178848 DOI: 10.1186/s12931-022-02076-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dehydroepiandrosterone (DHEA) is a precursor sex hormone with antifibrotic properties. The aims of this study were to investigate antifibrotic mechanisms of DHEA, and to determine the relationship between DHEA-sulfate (DHEAS) plasma levels, disease severity and survival in patients with fibrotic interstitial lung diseases (ILDs). METHODS Human precision cut lung slices (PCLS) and normal human lung fibroblasts were treated with DHEA and/or transforming growth factor (TGF)-β1 before analysis of pro-fibrotic genes and signal proteins. Cell proliferation, cytotoxicity, cell cycle and glucose-6-phosphate dehydrogenase (G6PD) activity were assessed. DHEAS plasma levels were correlated with pulmonary function, the composite physiologic index (CPI), and time to death or lung transplantation in a derivation cohort of 31 men with idiopathic pulmonary fibrosis (IPF) and in an independent validation cohort of 238 men and women with fibrotic ILDs. RESULTS DHEA decreased the expression of pro-fibrotic markers in-vitro and ex-vivo. There was no cytotoxic effect for the applied concentrations, but DHEA interfered in proliferation by modulating the cell cycle through reduction of G6PD activity. In men with IPF (derivation cohort) DHEAS plasma levels in the lowest quartile were associated with poor lung function and higher CPI (adjusted OR 1.15 [95% CI 1.03-1.38], p = 0.04), which was confirmed in the fibrotic ILD validation cohort (adjusted OR 1.03 [95% CI 1.00-1.06], p = 0.01). In both cohorts the risk of early mortality was higher in patients with low DHEAS levels, after accounting for potential confounding by age in men with IPF (HR 3.84, 95% CI 1.25-11.7, p = 0.02), and for age, sex, IPF diagnosis and prednisone treatment in men and women with fibrotic ILDs (HR 3.17, 95% CI 1.35-7.44, p = 0.008). CONCLUSIONS DHEA reduces lung fibrosis and cell proliferation by inducing cell cycle arrest and inhibition of G6PD activity. The association between low DHEAS levels and disease severity suggests a potential prognostic and therapeutic role of DHEAS in fibrotic ILD.
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Affiliation(s)
- Sabina A Guler
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland. .,Department for BioMedical Research DBMR, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Carlos Machahua
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.,Department for BioMedical Research DBMR, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas K Geiser
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.,Department for BioMedical Research DBMR, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gregor Kocher
- Department for BioMedical Research DBMR, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Division of General Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas M Marti
- Department for BioMedical Research DBMR, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Division of General Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Benjamin Tan
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Manuela Funke-Chambour
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.,Department for BioMedical Research DBMR, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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7
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Mediterranean diet and other dietary patterns in association with biological aging in the moli-sani study cohort. Clin Nutr 2022; 41:1025-1033. [DOI: 10.1016/j.clnu.2022.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/17/2022] [Accepted: 02/28/2022] [Indexed: 02/07/2023]
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8
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Chatterton RT. Functions of dehydroepiandrosterone in relation to breast cancer. Steroids 2022; 179:108970. [PMID: 35122788 DOI: 10.1016/j.steroids.2022.108970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/17/2022] [Accepted: 01/31/2022] [Indexed: 11/20/2022]
Abstract
Although DHEA sulfate (DS) is the most abundant steroid in the circulation, breast fluid contains an approximately 80-fold greater concentration than serum. Transport of DS into cells requires organic anion transporting polypeptides (OATPs), which are specific for cell type, cell location, and substrate, but may have a broader specificity for housekeeping functions. Specific classes, which may be modified by soluble factors including neutral steroids, have been identified in the breast. After transport, DS may be cleaved to DHEA by ubiquitous sulfatases, which may be modified by the cell milieu, or DHEA may enter by diffusion. Synthesis from cholesterol does not occur because CYP17B12 and cytochrome b5 are lacking in breast tissues. Case-control studies reveal a positive association of serum DS with risk of breast cancer. The association is even greater with DHEA, particularly in postmenopausal women with HR + invasive tumors. Metabolites of DHEA, androstenedione and testosterone, are associated with breast cancer but DHEA is likely to have an independent role as well. Mechanisms by which DHEA may promote breast cancer relate to its effect in increasing circulating IGF-I, by inhibiting the suppressive effect of glucocorticoids, and by promoting retention of pre-adipocytes with aromatase activity. In addition, DHEA may interact with the G-protein coupled receptor GPER for stimulation of miR-21 and subsequent activation of the MAPK pathway. DHEA also has antitumor properties that relate to stimulation of immunity, suppression of inflammation, and elevation of adipose tissue adiponectin synthesis. The net effect may depend on the which factors predominate.
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Affiliation(s)
- Robert T Chatterton
- Department of Obstetrics and Gynecology and the Robert H Lurie Comprehensive Cancer Center of Northwestern, Northwestern University Feinberg Medical School. Chicago, IL 60911, USA.
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9
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Sahm A, Platzer M, Koch P, Henning Y, Bens M, Groth M, Burda H, Begall S, Ting S, Goetz M, Van Daele P, Staniszewska M, Klose JM, Costa PF, Hoffmann S, Szafranski K, Dammann P. Increased longevity due to sexual activity in mole-rats is associated with transcriptional changes in the HPA stress axis. eLife 2021; 10:57843. [PMID: 33724179 PMCID: PMC8012063 DOI: 10.7554/elife.57843] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 03/15/2021] [Indexed: 02/06/2023] Open
Abstract
Sexual activity and/or reproduction are associated with a doubling of life expectancy in the long-lived rodent genus Fukomys. To investigate the molecular mechanisms underlying this phenomenon, we analyzed 636 RNA-seq samples across 15 tissues. This analysis suggests that changes in the regulation of the hypothalamic–pituitary–adrenal stress axis play a key role regarding the extended life expectancy of reproductive vs. non-reproductive mole-rats. This is substantiated by a corpus of independent evidence. In accordance with previous studies, the up-regulation of the proteasome and so-called ‘anti-aging molecules’, for example, dehydroepiandrosterone, is linked with enhanced lifespan. On the other hand, several of our results are not consistent with knowledge about aging of short-lived model organisms. For example, we found the up-regulation of the insulin-like growth factor 1/growth hormone axis and several other anabolic processes to be compatible with a considerable lifespan prolongation. These contradictions question the extent to which findings from short-lived species can be transferred to longer-lived ones.
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Affiliation(s)
- Arne Sahm
- Computational Biology Group, Leibniz Institute on Aging - Fritz Lipmann Institute, Jena, Germany
| | - Matthias Platzer
- Computational Biology Group, Leibniz Institute on Aging - Fritz Lipmann Institute, Jena, Germany
| | - Philipp Koch
- Core Facility Life Science Computing, Leibniz Institute on Aging - Fritz Lipmann Institute, Jena, Germany
| | - Yoshiyuki Henning
- Institute of Physiology, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Martin Bens
- Core Facility Sequencing, Leibniz Institute on Aging - Fritz Lipmann Institute, Jena, Germany
| | - Marco Groth
- Core Facility Sequencing, Leibniz Institute on Aging - Fritz Lipmann Institute, Jena, Germany
| | - Hynek Burda
- Department of General Zoology, Faculty of Biology, University of Duisburg-Essen, Essen, Germany.,Department of Game Management and Wildlife Biology, Faculty of Forestry and Wood Sciences, Czech University of Life Sciences, Prague, Czech Republic
| | - Sabine Begall
- Department of General Zoology, Faculty of Biology, University of Duisburg-Essen, Essen, Germany
| | - Saskia Ting
- Institute of Pathology and Neuropathology, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Moritz Goetz
- Institute of Pathology and Neuropathology, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Paul Van Daele
- Department of Zoology, University of South Bohemia, České Budějovice, Czech Republic
| | - Magdalena Staniszewska
- Department of Nuclear Medicine, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Jasmin Mona Klose
- Department of Nuclear Medicine, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Pedro Fragoso Costa
- Department of Nuclear Medicine, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Steve Hoffmann
- Computational Biology Group, Leibniz Institute on Aging - Fritz Lipmann Institute, Jena, Germany
| | - Karol Szafranski
- Core Facility Life Science Computing, Leibniz Institute on Aging - Fritz Lipmann Institute, Jena, Germany
| | - Philip Dammann
- Department of General Zoology, Faculty of Biology, University of Duisburg-Essen, Essen, Germany.,Central Animal Laboratory, University Hospital, University of Duisburg-Essen, Essen, Germany
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10
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Kositsawat J, Kuo CL, Barry LC, Melzer D, Bandinelli S, Ferrucci L, Wu R, Kuchel GA. Interaction Between Vitamin D and Interleukin 6 on Slow Gait Speed: 6-Year Follow-up Data of Older Adults From InCHIANTI. J Gerontol A Biol Sci Med Sci 2021; 75:1161-1166. [PMID: 31282535 DOI: 10.1093/gerona/glz165] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Whereas the independent effects of biomarkers, including 25-hydroxy vitamin D (25(OH)D), insulin-like growth factor 1, C-reactive protein, and interleukin 6 (IL-6), on gait speed in older adults have been evaluated, their joint effects on gait speed are not well understood. METHODS Study subjects aged at least 65 at baseline (N = 970) were enrolled in the population-based Invecchiare in Chianti (InCHIANTI) study from 1998 to 2000 and were followed up at 3 and 6 years. All above biomarkers and gait speed data were measured at each of the three time points. Using a generalized estimating equation approach, we determined if slow gait speed (<0.8 m/s) was associated with the biomarkers. Further investigation was conducted for interactions between high IL-6 (≥.87 pg/mL) and other biomarkers focusing on low 25(OH)D (<20 ng/mL). RESULTS After controlling for other biomarkers and potential confounders, IL-6 emerged as the only biomarker independently associated with gait speed. The association between high IL-6 and slow gait speed was enhanced by low 25(OH)D, with significant interaction between high IL-6 and low 25(OH)D (p = .038). The odds ratio of slow gait speed for low 25(OH)D and high IL-6 was 1.63 (95% confidence interval [CI]: 1.15, 2.32) compared with the reference groups with both biomarker levels at the other ends. CONCLUSION The association of low vitamin D with slow gait speed statistically interacts with high IL-6. Coexisting vitamin D insufficiency and inflammation may provide a better biomarker for identifying those at risk of developing impairments in gait speed than either factor alone.
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Affiliation(s)
| | - Chia-Ling Kuo
- Connecticut Institute for Clinical and Translational Science, Farmington
| | - Lisa C Barry
- Center on Aging, University of Connecticut Health Center, Farmington
| | - David Melzer
- Center on Aging, University of Connecticut Health Center, Farmington.,Epidemiology and Public Health, University of Exeter Medical School, Devon, UK
| | | | | | - Rong Wu
- Connecticut Institute for Clinical and Translational Science, Farmington
| | - George A Kuchel
- Center on Aging, University of Connecticut Health Center, Farmington
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11
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Baldwin MR, Pollack LR, Friedman RA, Norris SP, Javaid A, O'Donnell MR, Cummings MJ, Needham DM, Colantuoni E, Maurer MS, Lederer DJ. Frailty subtypes and recovery in older survivors of acute respiratory failure: a pilot study. Thorax 2020; 76:350-359. [PMID: 33298583 DOI: 10.1136/thoraxjnl-2020-214998] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Identifying subtypes of acute respiratory failure survivors may facilitate patient selection for post-intensive care unit (ICU) follow-up clinics and trials. METHODS We conducted a single-centre prospective cohort study of 185 acute respiratory failure survivors, aged ≥ 65 years. We applied latent class modelling to identify frailty subtypes using frailty phenotype and cognitive impairment measurements made during the week before hospital discharge. We used Fine-Gray competing risks survival regression to test associations between frailty subtypes and recovery, defined as returning to a basic Activities of Daily Living disability count less than or equal to the pre-hospitalisation count within 6 months. We characterised subtypes by pre-ICU frailty (Clinical Frailty Scale score ≥ 5), the post-ICU frailty phenotype, and serum inflammatory cytokines, hormones and exosome proteomics during the week before hospital discharge. RESULTS We identified five frailty subtypes. The recovery rate decreased 49% across each subtype independent of age, sex, pre-existing disability, comorbidity and Acute Physiology and Chronic Health Evaluation II score (recovery rate ratio: 0.51, 95% CI 0.41 to 0.63). Post-ICU frailty phenotype prevalence increased across subtypes, but pre-ICU frailty prevalence did not. In the subtype with the slowest recovery, all had cognitive impairment. The three subtypes with the slowest recovery had higher interleukin-6 levels (p=0.03) and a higher prevalence of ≥ 2 deficiencies in insulin growth factor-1, dehydroepiandrostersone-sulfate, or free-testosterone (p=0.02). Exosome proteomics revealed impaired innate immunity in subtypes with slower recovery. CONCLUSIONS Frailty subtypes varied by prehospitalisation frailty and cognitive impairment at hospital discharge. Subtypes with the slowest recovery were similarly characterised by greater systemic inflammation and more anabolic hormone deficiencies at hospital discharge.
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Affiliation(s)
- Matthew R Baldwin
- Pulmonary, Allergy, and Critical Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Lauren R Pollack
- Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Richard A Friedman
- Bioinformatics, Columbia University Irving Medical Center, New York, New York, USA
| | - Simone P Norris
- Pulmonary, Allergy, and Critical Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Azka Javaid
- Pulmonary, Allergy, and Critical Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Max R O'Donnell
- Pulmonary, Allergy, and Critical Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Matthew J Cummings
- Pulmonary, Allergy, and Critical Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth Colantuoni
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Biostatistics, Johns Hopkins University-Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mathew S Maurer
- Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - David J Lederer
- Pulmonary, Allergy, and Critical Care, Columbia University Irving Medical Center, New York, New York, USA.,Regeneron Pharmaceuticals, Tarrytown, New York, USA
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12
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Kim K, Ho JH. Handgrip Strength and Mortality in Elderly Koreans: Evidence From the Korea Longitudinal Study of Ageing. Asia Pac J Public Health 2020; 32:302-309. [PMID: 32608248 DOI: 10.1177/1010539520937100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite substantial research on numerous aspects of health in the elderly, past studies that examined the association between handgrip strength and mortality have been conducted with samples drawn mostly from Caucasian populations, and little is known about whether similar trends are found in non-Western contexts such as Korea. The present study drew data from KLoSA (Korean Longitudinal Study of Aging), a nationally representative sample of middle-aged adults, and followed up for a decade. Results from discrete-time event history analysis of mortality indicated that higher handgrip strength significantly reduces the likelihood of death in both men and women. Men in the highest third of handgrip strength were 53.9% less likely to experience death than those in the lowest third. Women followed a similar pattern: middle and high handgrip strength reduced the odds by 26.4% and 48.3%, respectively. These findings suggest that handgrip strength has a significant impact on elderly mortality and does so in a negatively gradient manner.
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Affiliation(s)
- Keuntae Kim
- Korea University Sejong Campus, Sejong City, South Korea
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13
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Paul JA, Whittington RA, Baldwin MR. Critical Illness and the Frailty Syndrome: Mechanisms and Potential Therapeutic Targets. Anesth Analg 2020; 130:1545-1555. [PMID: 32384344 DOI: 10.1213/ane.0000000000004792] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Frailty is a syndrome characterized by decreased reserves across multiple physiologic systems resulting in functional limitations and vulnerability to new stressors. Physical frailty develops over years in community-dwelling older adults but presents or worsens within days in the intensive care unit (ICU) because common mechanisms governing age-related physical frailty are often exacerbated by critical illness. The hallmark of physical frailty is a combined loss of muscle mass, force, and endurance. About one-third of ICU patients have frailty before hospitalization, which increases their risk for both short- and long-term disability and mortality. While there are several valid ways to measure clinical frailty in patients before or after an ICU admission, the mechanistic underpinnings of frailty in critically ill patients and ICU survivors have not been thoroughly investigated. Furthermore, therapeutic interventions to treat frailty during and after time in the ICU are lacking. In this narrative review, we examine studies that identify potential biological mechanisms underlying the development and propagation of physical frailty in both aging and critical illness (eg, inflammation, mitochondrial myopathy, and neuroendocrinopathy). We discuss specific aspects of these frailty mechanisms in older adults, critically ill patients, and ICU survivors that may represent therapeutic targets. Consistent with complexity underlying frailty, this syndrome is unlikely to result from an excess of a single harmful mediator or deficit of a single protective mediator. Rather, frailty occurs in the presence of an incompletely understood state of multisystem dysregulation. We further describe knowledge gaps that warrant clinical and translational research in frailty and critical care with an overall goal of developing effective frailty treatments in critically ill patients and ICU survivors.
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Affiliation(s)
- Jonathan A Paul
- From the Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York
| | - Robert A Whittington
- From the Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York
| | - Matthew R Baldwin
- Division of Pulmonary, Allergy, and Critical Care, Department of Internal Medicine, Columbia University Irving Medical Center, New York, New York
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14
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Abstract
PURPOSE We explored the Medicare database (1999 to 2014) to provide a comprehensive assessment of testosterone therapy patterns in the older U.S. male population. MATERIALS AND METHODS We estimated annual age-standardized incidence (new users) and prevalence (existing users) of testosterone therapy according to demographic characteristics, comorbidities and potential indications. RESULTS There were 392,698 incident testosterone therapy users during 88 million person-years. Testosterone therapy users were predominantly younger, white nonHispanic, and located in South and West U.S. Census regions. On average testosterone therapy use increased dramatically during 2007 to 2014 (average annual percent change 15.5%), despite a decrease in 2014. In 2014 the most common recorded potential indications for any testosterone therapy were hypogonadism (48%), fatigue (18%), erectile dysfunction (15%), depression (4%) and psychosexual dysfunction (1%). Laboratory tests to measure circulating testosterone concentrations for testosterone therapy were infrequent with 35% having had at least 1 testosterone test in the 120 days preceding testosterone therapy, 4% the recommended 2 pre-testosterone therapy tests, and 16% at least 1 pre-testosterone therapy test and at least 1 post-testosterone therapy test. CONCLUSIONS Testosterone therapy remains common in the older U.S. male population, despite a recent decrease. Although testosterone therapy prescriptions are predominantly for hypogonadism, a substantial proportion appear to be for less specific conditions. Testosterone tests among men prescribed testosterone therapy appear to be infrequent.
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15
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Barrientos G, Llanos P, Basualto-Alarcón C, Estrada M. Androgen-Regulated Cardiac Metabolism in Aging Men. Front Endocrinol (Lausanne) 2020; 11:316. [PMID: 32499759 PMCID: PMC7243157 DOI: 10.3389/fendo.2020.00316] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/24/2020] [Indexed: 12/21/2022] Open
Abstract
The prevalence of cardiovascular mortality is higher in men than in age-matched premenopausal women. Gender differences are linked to circulating sex-related steroid hormone levels and their cardio-specific actions, which are critical factors involved in the prevalence and features of age-associated cardiovascular disease. In women, estrogens have been described as cardioprotective agents, while in men, testosterone is the main sex steroid hormone. The effects of testosterone as a metabolic regulator and cardioprotective agent in aging men are poorly understood. With advancing age, testosterone levels gradually decrease in men, an effect associated with increasing fat mass, decrease in lean body mass, dyslipidemia, insulin resistance and adjustment in energy substrate metabolism. Aging is associated with a decline in metabolism, characterized by modifications in cardiac function, excitation-contraction coupling, and lower efficacy to generate energy. Testosterone deficiency -as found in elderly men- rapidly becomes an epidemic condition, associated with prominent cardiometabolic disorders. Therefore, it is highly probable that senior men showing low testosterone levels will display symptoms of androgen deficiency, presenting an unfavorable metabolic profile and increased cardiovascular risk. Moreover, recent reports establish that testosterone replacement improves cardiomyocyte bioenergetics, increases glucose metabolism and reduces insulin resistance in elderly men. Thus, testosterone-related metabolic signaling and gene expression may constitute relevant therapeutic target for preventing, or treating, age- and gender-related cardiometabolic diseases in men. Here, we will discuss the impact of current evidence showing how cardiac metabolism is regulated by androgen levels in aging men.
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Affiliation(s)
- Genaro Barrientos
- Programa de Fisiología y Biofísica, Facultad de Medicina, Instituto de Ciencias Biomédicas, Universidad de Chile, Santiago, Chile
- Centro de Estudios en Ejercicio, Metabolismo y Cáncer (CEMC), Universidad de Chile, Santiago, Chile
| | - Paola Llanos
- Centro de Estudios en Ejercicio, Metabolismo y Cáncer (CEMC), Universidad de Chile, Santiago, Chile
- Facultad de Odontología, Instituto de Investigación en Ciencias Odontológicas (ICOD), Universidad de Chile, Santiago, Chile
| | - Carla Basualto-Alarcón
- Departamento de Ciencias de la Salud, Universidad de Aysén, Coyhaique, Chile
- Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Manuel Estrada
- Programa de Fisiología y Biofísica, Facultad de Medicina, Instituto de Ciencias Biomédicas, Universidad de Chile, Santiago, Chile
- *Correspondence: Manuel Estrada
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16
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Biomarkers in the path from cellular senescence to frailty. Exp Gerontol 2019; 129:110750. [PMID: 31678465 DOI: 10.1016/j.exger.2019.110750] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/26/2019] [Accepted: 10/09/2019] [Indexed: 02/06/2023]
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17
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Sanders JL, Arnold AM, Boudreau RM, Hirsch CH, Kizer JR, Kaplan RC, Cappola AR, Cushman M, Jacob ME, Kritchevsky SB, Newman AB. Association of Biomarker and Physiologic Indices With Mortality in Older Adults: Cardiovascular Health Study. J Gerontol A Biol Sci Med Sci 2019; 74:114-120. [PMID: 29659743 DOI: 10.1093/gerona/gly075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/09/2018] [Indexed: 12/11/2022] Open
Abstract
Background A goal of gerontology is discovering aging phenotypes that reflect biological aging distinct from disease pathogenesis. Biomarkers that strongly and independently associated with mortality and that statistically attenuated chronologic age could be used to define such a phenotype. We determined the association of a Biomarker Index (BI) with mortality and compared it with a validated Physiologic Index (PI) in older adults. Methods The indices were constructed in the Cardiovascular Health Study, mean (SD) age 74.5 (5.1) years. The BI incorporated circulating levels of new biomarkers, including insulin-like growth factor-1, insulin-like growth factor-binding protein 3, amino-terminal pro-B-type natriuretic peptide, dehydroepiandrosterone sulfate, and interleukin-6, and was built in test (N = 2,197) and validation (N = 1,124) samples. The PI included carotid intima-media thickness, pulmonary capacity, brain white matter grade, cystatin-C, and fasting glucose. Multivariable Cox proportional hazards models predicting death were calculated with 10 years of follow-up. Results In separate age-adjusted models, the hazard ratio for mortality per point of the BI was 1.30 (95% confidence interval 1.25, 1.34) and the BI attenuated age by 25%. The hazard ratio for the PI was 1.28 (1.24, 1.33; 29% age attenuation). In the same model, the hazard ratio for the BI was 1.23 (1.18, 1.28) and for the PI was 1.22 (1.17, 1.26), and age was attenuated 42.5%. Associations persisted after further adjustment. Conclusions The BI and PI were significantly and independently associated with mortality. Both attenuated the age effect on mortality substantially. The indices may be feasible phenotypes for developing interventions hoping to alter the trajectory of aging.
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Affiliation(s)
- Jason L Sanders
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Alice M Arnold
- Department of Biostatistics, University of Washington, Seattle
| | | | - Calvin H Hirsch
- Department of Medicine, University of California-Davis, Sacramento
| | - Jorge R Kizer
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Anne R Cappola
- Department of Medicine, University of Pennsylvania, Philadelphia
| | - Mary Cushman
- Departments of Medicine and Pathology, University of Vermont, Burlington
| | - Mini E Jacob
- New England GRECC, VA Boston Healthcare System, Boston, Massachusetts.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Stephen B Kritchevsky
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
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18
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Platz EA, Barber JR, Chadid S, Lu J, Dobs AS, Kanarek NF, Nelson WG, Bradwin G, McGlynn KA, Rohrmann S. Nationally Representative Estimates of Serum Testosterone Concentration in Never-Smoking, Lean Men Without Aging-Associated Comorbidities. J Endocr Soc 2019; 3:1759-1770. [PMID: 31528824 PMCID: PMC6735742 DOI: 10.1210/js.2019-00151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 06/26/2019] [Indexed: 12/27/2022] Open
Abstract
CONTEXT Testosterone deficiency prevalence increases with age, comorbidities, and obesity. OBJECTIVE To inform clinical guidelines for testosterone deficiency management and development of targets for nonpharmacologic intervention trials for these men, we determined serum testosterone in never-smoking, lean men without select comorbidities in nationally representative surveys. DESIGN SETTING PARTICIPANTS We used cross-sectional data for never-smoking, lean men ≥20 years without diabetes, myocardial infarction, congestive heart failure, stroke, or cancer, without use of hormone-influencing medications, and participated in morning sessions of National Health and Nutrition Examination Survey (NHANES) III (phase I 1988-1991) or continuous NHANES (1999-2004). By age, we determined median total testosterone (ng/mL) measured previously by a Food and Drug Administration-approved immunoassay and median estimated free testosterone concentration. RESULTS In NHANES III, in never-smoking, lean men without comorbidities, median (25th, 75th percentile) testosterone was 4% to 9% higher than all men-20 to 39 years: 6.24 (5.16, 7.51), 40 to 59: 5.37 (3.83, 6.49), and ≥60: 4.61 (4.01, 5.18). In continuous NHANES, in never-smoking, lean men without comorbidities, levels were 13% to 24% higher than all men-20 to 39 years: 6.26 (5.32, 7.27), 40 to 59: 5.86 (4.91, 6.55), and ≥60: 4.22 (3.74, 5.73). In never-smoking, lean men without comorbidities, median estimated free testosterone was similar to (NHANES III) or slightly higher than (continuous NHANES) in all men. CONCLUSIONS These nationally representative data document testosterone levels (immunoassay) in never-smoking, lean men without select comorbidities 30 and 15 to 20 years ago. This information can be incorporated into guidelines for testosterone deficiency management and used to develop targets for nonpharmacologic intervention trials for testosterone deficiency.
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Affiliation(s)
- Elizabeth A Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
- Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John R Barber
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Susan Chadid
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jiayun Lu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Adrian S Dobs
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Norma F Kanarek
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - William G Nelson
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
- Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gary Bradwin
- Department of Laboratory Medicine, Harvard Medical School and Children's Hospital, Boston, Massachusetts
| | - Katherine A McGlynn
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology; Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
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19
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Abstract
Over the past decade, there has been a substantial increase in the number of men who are treated with testosterone. Despite this increase in the use of testosterone, the risks of adverse cardiovascular events are unclear as meta-analyses have reported conflicting findings and no clinical studies have been large enough or long enough to adequately assess for cardiovascular risks. The goal of this paper is to review large prescription database studies of testosterone treatment and adverse cardiovascular events and mortality with the aim of providing some guidance for clinicians and researchers in this controversial area.
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Affiliation(s)
- Molly M Shores
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, VA Puget Sound Health Care System, 1660 South Columbian Way Seattle, WA 98108, USA
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20
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Abstract
The cardiovascular system is particularly sensitive to androgens, but some controversies exist regarding the effect of testosterone on the heart. While among anabolic abusers, cases of sudden cardiac death have been described, recently it was reported that low serum level of testosterone was correlated with increased risk of cardiovascular diseases (CVD) and mortality rate. This review aims to evaluate the effect of testosterone on myocardial tissue function, coronary artery disease (CAD), and death. Low testosterone level is associated with increased incidence of CAD and mortality. Testosterone administration in hypogonadal elderly men and women has a positive effect on cardiovascular function and improved clinical outcomes and survival time. Although at supraphysiologic doses, androgen may have a toxic effect, and at physiological levels, testosterone is safe and exerts a beneficial effect on myocardial function including mechanisms at cellular and mitochondrial level. The interaction with free testosterone and estradiol should be considered. Further studies are necessary to better understand the interaction mechanisms for an optimal androgen therapy in CVD.
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Affiliation(s)
- Vittorio Emanuele Bianchi
- Clinical Center Stella Maris, Laboratory of Physiology of Exercise, Strada Rovereta 42, 47891, Falciano, Republic of San Marino.
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21
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Bisset ES, Howlett SE. The biology of frailty in humans and animals: Understanding frailty and promoting translation. Aging Med (Milton) 2019; 2:27-34. [PMID: 31942510 PMCID: PMC6880675 DOI: 10.1002/agm2.12058] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/28/2019] [Indexed: 12/14/2022] Open
Abstract
Frailty is a state of high vulnerability to adverse health outcomes. This concept is used to explain the heterogeneity in rates of aging in people of the same age. Frailty has important clinical implications, because even minor stressors can lead to adverse outcomes, including death, in frail individuals. Although frailty mechanisms are not well understood, advances in our ability to qualify frailty have encouraged efforts in this area. Quantification of frailty with both "frailty phenotype" and "frailty index" approaches has begun to highlight putative frailty mechanisms and new animal models of frailty are inspiring preclinical research. These models either adapt frailty phenotype and frailty index tools for use in animals or they use genetically manipulated mice that mimic conditions seen in frailty (eg, inflammation, sarcopenia, weakness). This review: describes commonly used tools to quantify frailty clinically, discusses potential frailty mechanisms, and describes animal models of frailty. It also highlights how these models have been used to explore frailty mechanisms and potential frailty interventions, including pharmacological treatments, diet, and exercise. These exciting new developments in the field have the potential to facilitate translational research, improve our understanding of mechanisms of frailty, and help develop new interventions to mitigate frailty in our aging population.
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Affiliation(s)
- Elise S. Bisset
- Department of PharmacologyDalhousie UniversityHalifaxNova ScotiaCanada
| | - Susan E. Howlett
- Department of PharmacologyDalhousie UniversityHalifaxNova ScotiaCanada
- Department of Medicine (Geriatric Medicine)Dalhousie UniversityHalifaxNova ScotiaCanada
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22
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Zurfluh S, Nickler M, Ottiger M, Steuer C, Kutz A, Christ-Crain M, Zimmerli W, Thomann R, Hoess C, Henzen C, Bernasconi L, Huber A, Mueller B, Schuetz P. Dihydrotestosterone is a predictor for mortality in males with community-acquired pneumonia: results of a 6-year follow-up study. Respir Res 2018; 19:240. [PMID: 30514319 PMCID: PMC6280517 DOI: 10.1186/s12931-018-0947-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/21/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Adrenal hormone metabolite levels are altered in acute illnesses such as community-acquired pneumonia (CAP). Our aim was to investigate associations of sex and mineralocorticoid hormone metabolites with short- and long-term mortality and severity of CAP in male and female patients. METHODS We prospectively followed 285 patients (60.4% male, mean age 71 years) with CAP from a previous multicenter trial. At baseline, levels of different metabolites of sex hormones and mineralocorticoids were measured by liquid chromatography coupled to tandem mass spectrometry. We calculated Cox regression models adjusted for age and comorbidities. RESULTS All-cause mortality was 5.3% after 30 days and increased to 47.4% after 6 years. In males, high levels of dihydrotestosterone were associated with higher 6-year mortality (adjusted HR 2.84, 95%CI 1.15-6.99, p = 0.023), whereas high levels of 17-OH-progesterone were associated with lower 6-year mortality (adjusted HR 0.72, 95%CI 0.54-0.97, p = 0.029). Testosterone levels in males correlated inversely with inflammatory markers (CRP rho = - 0.39, p < 0.001; PCT rho = - 0.34, p < 0.001) and disease severity as assessed by the Pneumonia severity index (PSI) (rho = - 0.23, p = 0.003). No similar association was found for female patients. CONCLUSION Whereas in males with CAP, sex and mineralocorticoid hormone metabolite levels correlated with inflammation, disease severity and long-term survival, no similar association was found for females. Further study of sex and mineralocorticoid hormones in acute illness could generate predictive signatures with implementation in clinical practice.
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Affiliation(s)
- Seline Zurfluh
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.
| | - Manuela Nickler
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Manuel Ottiger
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Alexander Kutz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Mirjam Christ-Crain
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Basel, Basel, Switzerland
| | - Werner Zimmerli
- Basel University Medical Clinic Liestal, Liestal, Switzerland
| | - Robert Thomann
- Department of Internal Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Claus Hoess
- Department of Internal Medicine, Kantonsspital Münsterlingen, Münsterlingen, Switzerland
| | - Christoph Henzen
- Department of Internal Medicine, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Luca Bernasconi
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Andreas Huber
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
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23
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Röhrig G. [Anemia in the aged]. Z Gerontol Geriatr 2018; 51:935-946. [PMID: 30498858 DOI: 10.1007/s00391-018-01479-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/05/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Abstract
Anemia in the aged is still often an underestimated clinical problem; however, in recent years increasing research on this topic has permitted deeper insights, allowing a differentiated approach to anemia in the aged. Meanwhile, multicausality and a negative impact on functional outcome have become characteristics of anemia in older people. This has led to a scientific discussion on the question of accepting anemia as a geriatric syndrome. The present article gives a concise overview of the current state of research on this clinically relevant subject.
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Affiliation(s)
- Gabriele Röhrig
- Zentrum für spezialisierte geriatrische Diagnostik, MVZ Medicum Köln Ost, Johann-Classen-Str. 68, 51103, Köln, Deutschland.
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24
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Justice JN, Ferrucci L, Newman AB, Aroda VR, Bahnson JL, Divers J, Espeland MA, Marcovina S, Pollak MN, Kritchevsky SB, Barzilai N, Kuchel GA. A framework for selection of blood-based biomarkers for geroscience-guided clinical trials: report from the TAME Biomarkers Workgroup. GeroScience 2018; 40:419-436. [PMID: 30151729 PMCID: PMC6294728 DOI: 10.1007/s11357-018-0042-y] [Citation(s) in RCA: 190] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/15/2018] [Indexed: 12/25/2022] Open
Abstract
Recent advances indicate that biological aging is a potentially modifiable driver of late-life function and chronic disease and have led to the development of geroscience-guided therapeutic trials such as TAME (Targeting Aging with MEtformin). TAME is a proposed randomized clinical trial using metformin to affect molecular aging pathways to slow the incidence of age-related multi-morbidity and functional decline. In trials focusing on clinical end-points (e.g., disease diagnosis or death), biomarkers help show that the intervention is affecting the underlying aging biology before sufficient clinical events have accumulated to test the study hypothesis. Since there is no standard set of biomarkers of aging for clinical trials, an expert panel was convened and comprehensive literature reviews conducted to identify 258 initial candidate biomarkers of aging and age-related disease. Next selection criteria were derived and applied to refine this set emphasizing: (1) measurement reliability and feasibility; (2) relevance to aging; (3) robust and consistent ability to predict all-cause mortality, clinical and functional outcomes; and (4) responsiveness to intervention. Application of these selection criteria to the current literature resulted in a short list of blood-based biomarkers proposed for TAME: IL-6, TNFα-receptor I or II, CRP, GDF15, insulin, IGF1, cystatin C, NT-proBNP, and hemoglobin A1c. The present report provides a conceptual framework for the selection of blood-based biomarkers for use in geroscience-guided clinical trials. This work also revealed the scarcity of well-vetted biomarkers for human studies that reflect underlying biologic aging hallmarks, and the need to leverage proposed trials for future biomarker discovery and validation.
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Affiliation(s)
- Jamie N Justice
- Internal Medicine Section on Gerontology and Geriatrics, and the Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, Baltimore, MD, 21224, USA
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15260, USA
| | - Vanita R Aroda
- Department of Medicine, Division of Diabetes, Endocrinology, and Hypertension Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Judy L Bahnson
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Jasmin Divers
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Mark A Espeland
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Santica Marcovina
- Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, WA, 98109, USA
| | - Michael N Pollak
- Department of Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, H3T1E2, Canada
| | - Stephen B Kritchevsky
- Internal Medicine Section on Gerontology and Geriatrics, and the Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Nir Barzilai
- Department of Medicine, Institute for Aging Research, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - George A Kuchel
- UConn Center on Aging, University of Connecticut School of Medicine, Farmington, CT, 06030, USA
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Zurfluh S, Nickler M, Ottiger M, Steuer C, Kutz A, Christ-Crain M, Zimmerli W, Thomann R, Hoess C, Henzen C, Bernasconi L, Huber A, Mueller B, Schuetz P. Association of adrenal hormone metabolites and mortality over a 6-year follow-up in COPD patients with acute exacerbation. Clin Chem Lab Med 2018; 56:669-680. [PMID: 29220883 DOI: 10.1515/cclm-2017-0873] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 10/31/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND The release of hormones from the adrenal gland is vital in acute and chronic illnesses such as chronic obstructive pulmonary disease (COPD) involving recurrent exacerbations. Using a metabolomic approach, we aim to investigate associations of different adrenal hormone metabolites with short- and long-term mortality in COPD patients. METHODS We prospectively followed 172 COPD patients (median age 75 years, 62% male) from a previous Swiss multicenter trial. At baseline, we measured levels of a comprehensive spectrum of adrenal hormone metabolites, including glucocorticoid, mineralocorticoid and androgen hormones by liquid chromatography coupled with tandem mass spectrometry (MS). We calculated Cox regression models adjusted for gender, age, comorbidities and previous corticosteroid therapy. RESULTS Mortality was 6.4% after 30 days and increased to 61.6% after 6 years. Higher initial androgen hormones predicted lower long-term mortality with significant results for dehydroepiandrosterone (DHEA) [adjusted hazard ratio (HR), 0.82; 95% confidence interval (CI), 0.70-0.98; p=0.026] and dehydroepiandrosterone sulfate (DHEA-S) (adjusted HR, 0.68; 95% CI, 0.50-0.91; p=0.009). An activation of stress hormones (particularly cortisol and cortisone) showed a time-dependent effect with higher levels pointing towards higher mortality at short term, but lower mortality at long term. Activation of the mineralocorticoid axis tended to be associated with increased short-term mortality (adjusted HR of aldosterone, 2.76; 95% CI, 0.79-9.65; p=0.111). CONCLUSIONS Independent of age, gender, corticosteroid exposure and exacerbation type, adrenal hormones are associated with mortality at short and long term in patients with COPD exacerbation with different time-dependent effects of glucocorticoids, androgens and mineralocorticoids. A better physiopathological understanding of the causality of these effects may have therapeutic implications.
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Affiliation(s)
- Seline Zurfluh
- Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Manuela Nickler
- Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Manuel Ottiger
- Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Christian Steuer
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Alexander Kutz
- Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Mirjam Christ-Crain
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Werner Zimmerli
- Basel University Medical Clinic Liestal, Liestal, Switzerland
| | - Robert Thomann
- Department of Internal Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Claus Hoess
- Department of Internal Medicine, Kantonsspital Münsterlingen, Münsterlingen, Switzerland
| | - Christoph Henzen
- Department of Internal Medicine, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Luca Bernasconi
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Andreas Huber
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Philipp Schuetz
- Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
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Rabijewski M, Papierska L, Maksym R, Tomasiuk R, Kajdy A, Siekierski BP. The Relationship Between Health-Related Quality of Life and Anabolic Hormone Levels in Middle-Aged and Elderly Men With Prediabetes: A Cross-Sectional Study. Am J Mens Health 2018; 12:1593-1603. [PMID: 29882445 PMCID: PMC6142157 DOI: 10.1177/1557988318777926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The aim of this study was to compare health-related quality of life (HRQoL) between men with prediabetes (PD) and a control group as well as to investigate the relationship between HRQoL and anabolic hormones. The analysis was carried out in 176 middle-aged (40–59 years) and elderly (60 80 years) men with PD, and 184 control peers. PD was defined according the American Diabetes Association and HRQoL was assessed by the SF-36 questionnaire. Total testosterone (TT), calculated free testosterone, dehydroepiandrosterone sulfate (DHEAS), and insulin-like growth factor 1 (IGF-1) were measured. Analysis of the standardized physical and mental component summary scores (SF-36p and SF-36m) revealed that patients with PD had lower SF-36p and SF-36m than control group (p < .02 and p < .001). Middle-aged men with PD had lower SF-36p and SF-36m than control peers, whereas elderly men with PD had lower only SF-36p. In men with PD negative correlations between glycated hemoglobin (HbA1c) and SF-35m score (r = −0.3768; p = .02) and between HbA1c and SF-36p score (r = −0.3453; p = .01) were reported. In middle-aged prediabetic men, SF-36p was associated with high free testosterone and low HbA1c while SF-36m with high TT and high DHEAS. In elderly patients with PD, SF-36p was associated with high TT, high IGF-1, and low HbA1c, while SF-36m correlated with high free testosterone and high DHEAS. In conclusion, PD in men is associated with decreased HRQoL in comparison with healthy men, and generally better quality of life is associated with higher testosterone, higher free testosterone, higher DHEAS, and lower HbA1c.
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Affiliation(s)
- Michał Rabijewski
- 1 Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Lucyna Papierska
- 2 Department of Endocrinology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Radosław Maksym
- 1 Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Ryszard Tomasiuk
- 3 Department of Laboratory Diagnostics, Mazovian Bródno Hospital, Warsaw, Poland
| | - Anna Kajdy
- 1 Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
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Abstract
The deterioration of physical and mental capabilities is inevitable with aging. Some hereditary factors cannot be changed, but other external factors can be manipulated to provide our body with better weapons to improve quality of life as we age. Different cellular pathways leading to cell deterioration and aging usually act through excessive oxidative damage and chronic inflammation. Suppression of inflammation is the most important driver of successful longevity and increases in importance with advancing age. Modifying caloric intake, amount and type of food, and maintaining an active lifestyle can decrease the risk of most common chronic diseases of aging.
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Decaroli MC, Rochira V. Aging and sex hormones in males. Virulence 2017; 8:545-570. [PMID: 27831823 PMCID: PMC5538340 DOI: 10.1080/21505594.2016.1259053] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 11/03/2016] [Accepted: 11/07/2016] [Indexed: 01/07/2023] Open
Abstract
Several large cohort studies have disclosed the trajectories of sex steroids changes overtime in men and their clinical significance. In men the slow, physiological decline of serum testosterone (T) with advancing age overlaps with the clinical condition of overt, pathological hypogonadism. In addition, the increasing number of comorbidities, together with the high prevalence of chronic diseases, all further contribute to the decrease of serum T concentrations in the aging male. For all these reasons both the diagnosis of late-onset hypogonadism (LOH) in men and the decision about starting or not T replacement treatment remain challenging. At present, the biochemical finding of T deficiency alone is not sufficient for diagnosing hypogonadism in older men. Coupling hypogonadal symptoms with documented low serum T represents the best strategy to refine the diagnosis of hypogonadism in older men and to avoid unnecessary treatments.
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Affiliation(s)
- Maria Chiara Decaroli
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Azienda USL of Modena, Modena, Italy
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Wu TT, Chen Y, Zhou Y, Adi D, Zheng YY, Liu F, Ma YT, Xie X. Prognostic Value of Dehydroepiandrosterone Sulfate for Patients With Cardiovascular Disease: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2017; 6:JAHA.116.004896. [PMID: 28476876 PMCID: PMC5524067 DOI: 10.1161/jaha.116.004896] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of the present study was to estimate the impact of dehydroepiandrosterone sulfate (DHEAS) on the prognosis of patients with cardiovascular disease by performing a systematic review and meta-analysis. METHODS AND RESULTS The Embase, PubMed, Web of Science, CNKI, and WanFang databases were searched up to September 5, 2016, to identify eligible studies. The quality of each study was assessed using the Newcastle-Ottawa Scale. The association between DHEAS, either on admission or at discharge, and cardiovascular disease outcomes were reviewed. The overall risk ratio for the effect of DHEAS on all-cause mortality and fatal and nonfatal cardiovascular events was pooled using a fixed-effects or a random-effects model. The publication bias was evaluated using funnel plots. Twenty-five studies were included for systematic review. The follow-up duration ranged from 1 to 19 years. Eighteen studies were included in the meta-analysis. We found that lower DHEAS levels indicated a significant increased risk for all-cause mortality (risk ratio, 1.47; 95% CI, 1.38-1.56 [P<0.00001]), fatal cardiovascular event (risk ratio, 1.58; 95% CI, 1.30-1.91 [P<0.00001]), and nonfatal cardiovascular event (risk ratio, 1.42; 95% CI, 1.24-1.62 [P<0.0001]) in patients with cardiovascular disease. CONCLUSIONS Patients with cardiovascular disease who have lower DHEAS levels may have poorer prognosis than those with higher DHEAS levels.
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Affiliation(s)
- Ting-Ting Wu
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yuan Chen
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yun Zhou
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Dilare Adi
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ying-Ying Zheng
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Fen Liu
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi, China
| | - Yi-Tong Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiang Xie
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Endocrinology of Aging From a Muscle Function Point of View: Results From the Toledo Study for Healthy Aging. J Am Med Dir Assoc 2017; 18:234-239. [DOI: 10.1016/j.jamda.2016.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 09/08/2016] [Indexed: 11/22/2022]
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Abstract
While US testosterone prescriptions have tripled in the last decade with lower trends in Europe, debate continues over the risks, benefits and appropriate use of testosterone replacement therapy (TRT). Several authors blame advertising and the availability of more convenient formulations, whilst others have pointed out that the routine testing of men with erectile dysfunction (ED) (a significant marker of cardiovascular risk) and those with diabetes would inevitably increase the diagnosis of hypogonadism and lead to an increase in totally appropriate prescribing. They commented that this was merely an appropriate correction of previous under-diagnosis and under-treatment in line with evidence based guidelines. It is unlikely that persuasive advertising or convenient formulations could grow a market over such a sustained period if the treatment was not effective. Urologists and primary care physicians are the most frequent initiators of TRT usually for ED. Benefits are clearly established for sexual function, increase in lean muscle mass and strength, mood and cognitive function, with a possible reduction in frailty and osteoporosis. There remains no evidence that TRT is associated with increased risk of prostate cancer or symptomatic benign prostatic hyperplasia, yet the decision to initiate and continue therapy is often decided by urologists. The cardiovascular issues associated with TRT have been clarified by recent studies showing that therapy associated with clear increases in serum testosterone levels to the normal range is associated with reduced all-cause mortality. Studies reporting to show increased risk have been subject to flawed designs with inadequate baseline diagnosis and follow-up testing. Effectively, they have compared non-treated patients with under-treated or non-compliant subjects involving a range of different therapy regimes. Recent evidence suggests long-acting injections may be associated with decreased cardiovascular risk, but the transdermal route may be associated with potentially relatively greater risk because of conversion to dihydrotestosterone by the effect of 5-alpha reductase in skin. The multiple effects of TRT may add up to a considerable benefit to the patient that might be underestimated by the physician primarily concerned with his own specialty. In a response to concerns about the possible risks associated with inappropriate prescribing expressed by Public Citizen, the Food and Drug Administration (FDA) published a complete refutation of all the concerns, only to issue a subsequent bulletin of concern over inappropriate use, whilst confirming the benefits in treating men with established testosterone deficiency. No additional evidence was provided for this apparent change of opinion, but longer term safety data on testosterone products were strongly suggested. In contrast, the European Medicines Agency (EMA), in November 2014, concluded that “there is no consistent evidence of increased cardiovascular risk with testosterone products”. This paper explores the most recent evidence surrounding the benefits and risks associated with TRT.
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Konaka H, Sugimoto K, Orikasa H, Iwamoto T, Takamura T, Takeda Y, Shigehara K, Iijima M, Koh E, Namiki M. Effects of long-term androgen replacement therapy on the physical and mental statuses of aging males with late-onset hypogonadism: a multicenter randomized controlled trial in Japan (EARTH Study). Asian J Androl 2016; 18:25-34. [PMID: 25761833 PMCID: PMC4736352 DOI: 10.4103/1008-682x.148720] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Androgen replacement therapy (ART) efficacy on late-onset hypogonadism (LOH) has been widely investigated in Western countries; however, it remains controversial whether ART can improve health and prolong active lifestyles. We prospectively assessed long-term ART effects on the physical and mental statuses of aging men with LOH in Japan. The primary endpoint was health-related quality of life assessed by questionnaires. Secondary endpoints included glycemic control, lipid parameters, blood pressure, waist circumference, body composition, muscular strength, International Prostate Symptom Scores (IPSS), International Index of Erectile Function-5 (IIEF-5) scores, and serum prostate-specific antigen levels. Of the 1637 eligible volunteers, 334 patients > 40 years with LOH were randomly assigned to either the ART (n = 169) or control groups (n = 165). Fifty-two weeks after the initial treatment, ART significantly affected the role physical subdomain of the short form-36 health survey (SF-36) scale (P = 0.0318). ART was also associated with significant decreases in waist circumstance (P = 0.002) and serum triglyceride (TG) (P = 0.013) and with significant increases in whole-body and leg muscle mass volumes (P = 0.071 and 0.0108, respectively), serum hemoglobin (P < 0.001), IPSS voiding subscore (P = 0.0418), and the second question on IIEF-5 (P = 0.0049). There was no significant difference between the groups in terms of severe adverse events. In conclusion, in patients with LOH, long-term ART exerted beneficial effects on Role Physical subdomain of the SF-36 scale, serum TG, waist circumstance, muscle mass volume, voiding subscore of IPSS, and the second question of IIEF-5. We hope our study will contribute to the future development of this area.
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Affiliation(s)
- Hiroyuki Konaka
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
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Milman S, Huffman DM, Barzilai N. The Somatotropic Axis in Human Aging: Framework for the Current State of Knowledge and Future Research. Cell Metab 2016; 23:980-989. [PMID: 27304500 PMCID: PMC4919980 DOI: 10.1016/j.cmet.2016.05.014] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 05/24/2016] [Accepted: 05/26/2016] [Indexed: 12/19/2022]
Abstract
Mutations resulting in reduced signaling of the growth hormone/insulin-like growth factor-1 (GH/IGF-1) axis are associated with increased life- and healthspan across model organisms. Similar findings have been noted in human cohorts with functional mutations in the somatotropic axis, suggesting that this pathway may also be relevant to human aging and protection from age-related diseases. While epidemiological data indicate that low circulating IGF-1 level may protect aging populations from cancer, results remain inconclusive regarding most other diseases. We propose that studies in humans and animals need to consider differences in sex, pathway function, organs, and time-specific effects of GH/IGF-1 signaling in order to better define the role of the somatotropic axis in aging. Agents that modulate signaling of the GH/IGF-1 pathway are available for human use, but before they can be implemented in clinical studies that target aging and age-related diseases, researchers need to address the challenges discussed in this Review.
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Affiliation(s)
- Sofiya Milman
- Department of Medicine, Division of Endocrinology, Institute for Aging Research, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Department of Medicine, Division of Geriatrics, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
| | - Derek M Huffman
- Department of Medicine, Division of Endocrinology, Institute for Aging Research, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Nir Barzilai
- Department of Medicine, Division of Endocrinology, Institute for Aging Research, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Department of Medicine, Division of Geriatrics, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Department of Genetics, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Viña J, Tarazona-Santabalbina FJ, Pérez-Ros P, Martínez-Arnau FM, Borras C, Olaso-Gonzalez G, Salvador-Pascual A, Gomez-Cabrera MC. Biology of frailty: Modulation of ageing genes and its importance to prevent age-associated loss of function. Mol Aspects Med 2016; 50:88-108. [PMID: 27164416 DOI: 10.1016/j.mam.2016.04.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 04/12/2016] [Indexed: 12/19/2022]
Abstract
Frailty is associated with loss of functional reserve as well as with the prediction of adverse events in the old population. The traditional criteria of frailty are based on five physical determinations described in the Cardiovascular Health Study. We propose that biological and genetic markers of frailty should be used to increase the predictive capacity of the established clinical indeces. In recent times, research for biological markers of frailty has gained impetus. Finding a biological markers with diagnostic and prognostic capacity would be a major milestone to identify frailty risk, and also pre-frailty status. In the first section of the manuscript, we review the available biomarkers that help to monitor and prevent the evolution and the efficacy of interventions to delay the onset of frailty and to prevent its progression to incapacity. We also discuss the contribution of genetics to frailty. There are scientific bases that support that genetics influences frailty, although environmental factors probably will have the highest contribution. We review the known SNPs of the genes associated with frailty and classify them, taking into account the pathway in which they are involved. We also highlight the importance of longevity genes and their possible relation with frailty, citing centenarians who reach a very old age as an example of successful ageing. Finally, the reversibility of frailty is discussed. It can potentially be treated with nutritional or pharmacological interventions. However, physical exercise seems to be the most effective strategy to treat and prevent frailty. The last section of the manuscript is devoted to explaining the recommendations on the appropriate design of an exercise protocol to maximize its beneficial effects in a population of frail individuals.
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Affiliation(s)
- Jose Viña
- Department of Physiology, Investigación Hospital Clínico Universitario/INCLIVA, University of Valencia, Spain
| | | | - Pilar Pérez-Ros
- School of Nursing, Catholic University of Valencia San Vicente Mártir, Spain
| | | | - Consuelo Borras
- Department of Physiology, Investigación Hospital Clínico Universitario/INCLIVA, University of Valencia, Spain
| | - Gloria Olaso-Gonzalez
- Department of Physiology, Investigación Hospital Clínico Universitario/INCLIVA, University of Valencia, Spain
| | - Andrea Salvador-Pascual
- Department of Physiology, Investigación Hospital Clínico Universitario/INCLIVA, University of Valencia, Spain
| | - Mari Carmen Gomez-Cabrera
- Department of Physiology, Investigación Hospital Clínico Universitario/INCLIVA, University of Valencia, Spain.
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Khazai B, Golden SH, Colangelo LA, Swerdloff R, Wang C, Honoris L, Gapstur SM, Ouyang P, Cushman M, Li D, Kopp P, Vaidya D, Liu K, Dobs A, Budoff M. Association of endogenous testosterone with subclinical atherosclerosis in men: the multi-ethnic study of atherosclerosis. Clin Endocrinol (Oxf) 2016; 84:700-7. [PMID: 26663365 DOI: 10.1111/cen.12997] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 09/14/2015] [Accepted: 11/25/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Whether endogenous sex hormones play a role in cardiovascular disease (CVD) risk in men is unclear. Few studies have examined associations of sex hormones with atherosclerosis measured by coronary artery calcium score (CACS) and carotid intima-media thickness (cIMT). We evaluated the association of testosterone (T) and other sex hormones with CACS and cIMT. METHODS Using the large multi-ethnic cohort of 3164 men without known CVD in the Multi-Ethnic Study of Atherosclerosis (MESA), cross-sectional associations of tertiles of endogenous sex hormones with CACS and cIMT were analysed. RESULTS In regard to CAC, there was a significant negative trend (P-trend = 0·02) for CACS>0 over tertiles of free T (FT) with RRs (95% CI) for the lowest to highest tertiles. There was also a marginally significant positive trend (P-trend = 0·06) for CACS>0 over tertiles of sex hormone-binding globulin (SHBG) with RRs for the lowest to highest tertiles. There were no significant associations with CACS >0 for tertiles of TT (Total T), bioavailable T (BT), oestradiol (E2) and dehydroepiandrosterone (DHEA). There was significantly higher log CACS after adjustment for CVD risk factors for lower TT levels, compared to higher levels, using 9·54 and 10·4 nmol/l as cut-off points. In regard to cIMT, there was a significant positive trend (P = 0·003) in mean cIMT over the tertiles of BT, but not for TT, FT, E2, DHEA and SHBG. There was significantly lower cIMT after adjustment for CVD risk factors for lower TT levels compared to higher levels. CONCLUSION In a population of male subjects with no known CVD, lower FT is associated with higher RR of CACS>0 and lower TT is associated with higher log CACS. Lower BT and TT are associated with lower cIMT. While these findings support the positive correlation between low T and coronary atherosclerosis, the opposite findings on cIMT warrant further evaluation.
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Affiliation(s)
- Bahram Khazai
- Los Angeles Biomedical Research Institute, UCLA School of Medicine, Torrance, CA, USA
| | | | - Laura A Colangelo
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ronald Swerdloff
- Los Angeles Biomedical Research Institute, UCLA School of Medicine, Torrance, CA, USA
| | - Christina Wang
- Los Angeles Biomedical Research Institute, UCLA School of Medicine, Torrance, CA, USA
| | - Lily Honoris
- Los Angeles Biomedical Research Institute, UCLA School of Medicine, Torrance, CA, USA
| | | | - Pamela Ouyang
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Dong Li
- Los Angeles Biomedical Research Institute, UCLA School of Medicine, Torrance, CA, USA
| | - Peter Kopp
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Kiang Liu
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Adrian Dobs
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew Budoff
- Los Angeles Biomedical Research Institute, UCLA School of Medicine, Torrance, CA, USA
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De Vita F, Maggio M, Lauretani F, Crucitti L, Bandinelli S, Mammarella F, Landi F, Ferrucci L, Ceda GP. INSULIN-LIKE GROWTH FACTOR-1 AND ANEMIA IN OLDER SUBJECTS: THE INCHIANTI STUDY. Endocr Pract 2015; 21:1211-8. [PMID: 26214107 PMCID: PMC5189915 DOI: 10.4158/ep14100.or] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Recent studies indicate a role for the age-related decline of anabolic hormones, especially testosterone, in the onset of "anemia of aging." Some of testosterone's erythropoietic activities are mediated by insulin-like growth factor (IGF)-1, which also seems to have independent erythropoietic effects. However, the associations among IGF-1, anemia, and hemoglobin (Hb) have not been adequately investigated in older populations. METHODS We used data from a representative sample of 953 subjects ≥65 years who participated in the InCHIANTI (Invecchiare in Chianti) Study and were not on growth hormone (GH) or erythropoietin therapy and were not diagnosed with hematologic malignancies or other cancers. Anemia was defined according to the World Health Organization (WHO) criteria by Hb level ≤13 g/dL in males and ≤12 g/dL in females. Backward multiple regression analyses including age, IGF binding protein (IGFBP)-3, testosterone, comorbidities, inflammatory markers, and anemia-related measures were used to address the relationship between IGF-1 and Hb and between IGF-1 and anemia in both sexes. RESULTS We found that 46/410 (11.2%) males and 71/543 (13.0%) females were defined as anemic. After adjustment for age, anemic males (100 ± 54 vs. 130 ± 56, P<.001) and females (89.1 ± 48 vs. 110 ± 52, P = .001) exhibited lower IGF-1 levels than their nonanemic counterparts. IGF-1 levels were independently and negatively associated with anemia in males (β ± SE = -0.0005 ± 0.0002, P = .04) but not in females (β ± SE = -0.0002 ± 0.0002, P = .40). In both males (β ± SE = 0.002 ± 0.001, P = .03) and females (β ± SE = 0.002 ± 0.0009, P = .03), IGF-1 levels were independently and positively associated with Hb levels. CONCLUSION In older males but not in females, IGF-1 levels are negatively associated with anemia. IGF-1 levels are independent and positive determinants of Hb concentration in both sexes.
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Affiliation(s)
- Francesca De Vita
- Geriatric Rehabilitation Department, University Hospital of Parma, Parma, Italy
| | - Marcello Maggio
- Geriatric Rehabilitation Department, University Hospital of Parma, Parma, Italy
- Department of Clinical and Experimental Medicine, Section of Geriatrics, Food Sciences Unit and Endocrinology of Aging Unit, University of Parma, Parma, Italy
| | - Fulvio Lauretani
- Geriatric Rehabilitation Department, University Hospital of Parma, Parma, Italy
| | - Lara Crucitti
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milano, Italy
| | | | - Federica Mammarella
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Gian Paolo Ceda
- Geriatric Rehabilitation Department, University Hospital of Parma, Parma, Italy
- Department of Clinical and Experimental Medicine, Section of Geriatrics, Food Sciences Unit and Endocrinology of Aging Unit, University of Parma, Parma, Italy
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Cardiometabolic effects of testosterone in older men. Cardiovasc Endocrinol 2015. [DOI: 10.1097/xce.0000000000000050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
PURPOSE OF REVIEW Ageing is accompanied by a reduction in circulating testosterone and progressive accumulation of medical morbidities. There is an intense debate whether low testosterone contributes to ill-health as opposed to being a biomarker for its presence. Prescriptions for testosterone are rising on a background of concern over potential adverse effects. This review examines evidence relating androgens to cardiovascular risk in older men. RECENT FINDINGS Observational studies show lower risk of cardiovascular events in older men with higher testosterone, and lower mortality from ischaemic heart disease in men with higher concentrations of its more potent androgenic metabolite dihydrotestosterone. However, randomized controlled trials of testosterone supplementation have been underpowered for the outcome of cardiovascular events. Recent meta-analyses have reached contrasting conclusions regarding cardiovascular adverse events associated with testosterone therapy. Retrospective studies of prescription databases have produced controversial and conflicting results. SUMMARY Additional randomized controlled trials are required to clarify the role of testosterone supplementation in older men in the absence of pituitary or gonadal disease. Pending such studies, testosterone therapy should be considered in androgen-deficient men, with evaluation of potential benefits and risks.
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Affiliation(s)
- Bu B Yeap
- School of Medicine and Pharmacology, University of Western Australia and Department of Endocrinology and Diabetes, Fiona Stanley and Fremantle Hospitals, Perth, Western Australia, Australia
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Howe LM. Current perspectives on the optimal age to spay/castrate dogs and cats. VETERINARY MEDICINE-RESEARCH AND REPORTS 2015; 6:171-180. [PMID: 30101104 PMCID: PMC6070019 DOI: 10.2147/vmrr.s53264] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Spaying and castrating of dogs and cats has been considered for decades to be a routine standard of practice in veterinary medicine in the US for the prevention of numerous undesirable behaviors, medical conditions, and diseases. Additionally, the procedures have been promoted as a method of curbing the severe pet-overpopulation problem in the US. Recently, however, this routine practice has come under scrutiny and become a very controversial topic. The general wisdom and safety of the procedures have been questioned by those who are concerned that the procedures may have some unintended consequences that are only recently being recognized. The purpose of this paper is to critically examine the scientific literature regarding elective spay/castration procedures and present both risks and benefits of elective gonadectomy. After the literature is examined, it becomes clear that there may not be a single absolute optimal age to spay or castrate all dogs and cats, but that the optimal age may be dependent upon several factors, including species, breed, body size, and breed-specific diseases, among others. Determining the optimal age to perform elective gonadectomy is much clearer in cats, and the literature demonstrates that the procedures can typically be safely performed at any age after 6–8 weeks of age. The optimal age to spay or castrate dogs of certain breeds (rottweiler, golden retriever, Labrador retriever, and vizsla) is becoming less clear as studies are being conducted as to the health benefits and risks in those breeds. This review will examine these controversies and make recommendations as to the optimal age to spay/castrate dogs based upon the scientific literature.
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Affiliation(s)
- Lisa M Howe
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA,
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Nguyen PL, Jarolim P, Basaria S, Zuflacht JP, Milian J, Kadivar S, Graham PL, Hyatt A, Kantoff PW, Beckman JA. Androgen deprivation therapy reversibly increases endothelium-dependent vasodilation in men with prostate cancer. J Am Heart Assoc 2015; 4:jah3918. [PMID: 25896892 PMCID: PMC4579953 DOI: 10.1161/jaha.115.001914] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Androgen deprivation therapy (ADT) is a standard treatment for patients with aggressive prostate cancer. Although ADT improves survival, it increases the risk of diabetes. Emerging evidence suggests that ADT increases adverse cardiovascular events as early as 3 months after initiation in patients with cardiovascular disease, but the mechanism is unknown. We hypothesized that ADT may impair endothelium‐dependent vasodilation due to increases in lipids and insulin resistance and may provide a link for heightened cardiovascular risk in this population. Methods and Results We prospectively evaluated conduit artery endothelium‐dependent and ‐independent vasodilation, lipids, and insulin resistance in 16 consecutively treated men (mean age 66±7 years; 25% with diabetes) with prostate cancer before and after 3 months of ADT. High‐resolution B‐mode ultrasound was used to assess flow‐mediated (endothelium‐dependent) and nitroglycerine‐mediated (endothelium‐independent) brachial artery vasodilation. ADT significantly increased insulin resistance, total cholesterol, HDL, and LDL. Endothelium‐dependent vasodilation was greater at 3 months than at baseline (10.8% [interquartile range: 7.7% to 14.6%] versus 8.9% [interquartile range: 4.0% to 12.6%], respectively; P=0.046, allometric P=0.037). Nitroglycerine‐mediated vasodilation did not change from baseline (P>0.2). The subset of participants on ADT for 6 months returned for reevaluation at 1 year. In this group, endothelium‐dependent vasodilation increased from baseline to 3 months and returned to baseline 6 months after ADT withdrawal (9.4% [interquartile range: 6.9% to 10.9%], 11.6% [interquartile range: 7.9% to 15.2%], and 9.0% [interquartile range: 5.1% to 12.5%], respectively; P=0.05). Conclusions In contrast to our expectation, ADT improved endothelium‐dependent vasodilation and its cessation returned endothelium‐dependent vasodilation to baseline. Determining the mechanism of this change requires further investigation.
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Affiliation(s)
- Paul L Nguyen
- Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA (P.L.N., P.L.G., A.H.)
| | - Petr Jarolim
- Department of Pathology, Brigham and Women's Hospital, Boston, MA (P.J.)
| | - Shehzad Basaria
- Endocrinology, Brigham and Women's Hospital, Boston, MA (S.B.)
| | - Jonah P Zuflacht
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (J.P.Z., J.M., S.K., J.A.B.)
| | - Jessica Milian
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (J.P.Z., J.M., S.K., J.A.B.)
| | - Samoneh Kadivar
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (J.P.Z., J.M., S.K., J.A.B.)
| | - Powell L Graham
- Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA (P.L.N., P.L.G., A.H.)
| | - Andrew Hyatt
- Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA (P.L.N., P.L.G., A.H.)
| | - Philip W Kantoff
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (P.W.K.)
| | - Joshua A Beckman
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (J.P.Z., J.M., S.K., J.A.B.)
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Doğan BA, Karakılıç E, Tuna MM, Arduç A, Berker D, Güler S. Effect of androgen replacement therapy on atherosclerotic risk markers in young-to-middle-aged men with idiopathic hypogonadotropic hypogonadism. Clin Endocrinol (Oxf) 2015; 82:422-8. [PMID: 25280063 DOI: 10.1111/cen.12617] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 08/17/2014] [Accepted: 08/28/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Idiopathic hypogonadotropic hypogonadism is a rare disorder. This study evaluated the effect of androgen replacement therapy on atherosclerotic risk markers in young-to-middle-aged men with this disorder. DESIGN AND METHODS Forty-three male patients aged 30 (range: 24-39 years) who were newly diagnosed with idiopathic hypogonadotropic hypogonadism and 20 age-, sex- and weight-matched controls (range: 26-39 years) were included in the study. Androgen replacement therapy was given according to the Algorithm of Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes (2010; Journal of Clinical Endocrinology and Metabolism, 95, 2536). The patients were assessed at a pretreatment visit and 3 and 6 months after the treatment. Inflammatory markers and lipid parameters were evaluated. Endothelial function was assessed with brachial flow-mediated dilation of a brachial artery and high-resolution ultrasonography of the carotid intima-media thickness. RESULTS The carotid intima-media thickness (P < 0·001) was higher and the brachial flow-mediated diameter (P = 0·002) was lower in patients with idiopathic hypogonadotropic hypogonadism compared to the control subjects at the pretreatment visit. There was a negative correlation between the total testosterone level and carotid intima-media thickness (r = -0·556, P = <0·001). The carotid intima-media thickness and per cent flow-mediated diameter were significantly improved in the patient group 6 months after the androgen replacement therapy (P = 0·002 and 0·026, respectively). CONCLUSIONS This study indicated that low total testosterone levels can be considered a significant marker of atherosclerosis in patients with idiopathic hypogonadotropic hypogonadism and that androgen replacement therapy significantly reduces atherosclerotic risk markers in these patients after 6 months.
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Affiliation(s)
- Berçem Ayçiçek Doğan
- Department of Endocrinology and Metabolism Disease, Darica Farabi State Hospital, Darica, Kocaeli, Turkey
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Afiadata A, Ellsworth P. Testosterone replacement therapy: who to evaluate, what to use, how to follow, and who is at risk? Hosp Pract (1995) 2015; 42:69-82. [PMID: 25485919 DOI: 10.3810/hp.2014.12.1160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Hypogonadism, defined as a low serum testosterone in the presence of signs and symptoms, is common, particularly in aging men. Testosterone supplementation therapy (TST) is the standard treatment for male hypogonadism. It has been demonstrated to have a significant impact on the signs and symptoms of hypogonadism, but there are concerns about the increase in TST and its potential adverse effects, particularly cardiovascular effects. OBJECTIVE This review presents health care providers with current information regarding the prevalence and impact of hypogonadism, as well as the diagnosis, evaluation, and treatment of hypogonadism. The beneficial and potential adverse effects are reviewed with a discussion on the current cardiovascular controversy. METHODS We reviewed current and "landmark" articles in the English-language literature pertaining to hypogonadism, its prevalence, etiologies, presentation, evaluation, and treatment. RESULTS Authorities in the field have offered guidelines and recommendations regarding the diagnosis, evaluation, and management of hypogonadism. Although there is a consensus as to the definition of hypogonadism as the presence of a low serum testosterone with signs and symptoms of hypogonadism, there is variability in the definition of "low testosterone." Various testosterone formulations exist, differing in route and frequency of administration as well as in side-effect profiles. Testosterone supplementation therapy should be continued in individuals demonstrating an improvement in signs and symptoms, which may take 3 months to a year for maximum response. Individuals treated with TST require monitoring for adverse effects. Further studies are needed to determine the impact of TST on cardiovascular health. CONCLUSION Hypogonadism is common, particularly in aging men. Symptomatic individuals who have no contraindications to TST should be offered treatment. A careful assessment of treatment response after adequate titration and duration of therapy as well as monitoring for adverse effects is essential in treating patients for hypogonadism. Although hypogonadism is associated with increased all-cause and cardiovascular-related mortality, controversy exists regarding the impact of TST on cardiovascular risk, highlighting the need for further studies.
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Affiliation(s)
- A Afiadata
- University of Massachusetts Medical School, Worcester, MA
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Maggio M, Lauretani F, De Vita F, Basaria S, Lippi G, Butto V, Luci M, Cattabiani C, Ceresini G, Verzicco I, Ferrucci L, Ceda GP. Multiple hormonal dysregulation as determinant of low physical performance and mobility in older persons. Curr Pharm Des 2015; 20:3119-48. [PMID: 24050169 DOI: 10.2174/13816128113196660062] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 09/13/2013] [Indexed: 12/16/2022]
Abstract
Mobility-disability is a common condition in older individuals. Many factors, including the age-related hormonal dysregulation, may concur to the development of disability in the elderly. In fact, during the aging process it is observed an imbalance between anabolic hormones that decrease (testosterone, dehydroepiandrosterone sulphate (DHEAS), estradiol, insulin like growth factor-1 (IGF-1) and Vitamin D) and catabolic hormones (cortisol, thyroid hormones) that increase. We start this review focusing on the mechanisms by which anabolic and catabolic hormones may affect physical performance and mobility. To address the role of the hormonal dysregulation to mobility-disability, we start to discuss the contribution of the single hormonal derangement. The studies used in this review were selected according to the period of time of publication, ranging from 2002 to 2013, and the age of the participants (≥65 years). We devoted particular attention to the effects of anabolic hormones (DHEAS, testosterone, estradiol, Vitamin D and IGF-1) on both skeletal muscle mass and strength, as well as other objective indicators of physical performance. We also analyzed the reasons beyond the inconclusive data coming from RCTs using sex hormones, thyroid hormones, and vitamin D (dosage, duration of treatment, baseline hormonal values and reached hormonal levels). We finally hypothesized that the parallel decline of anabolic hormones has a higher impact than a single hormonal derangement on adverse mobility outcomes in older population. Given the multifactorial origin of low mobility, we underlined the need of future synergistic optional treatments (micronutrients and exercise) to improve the effectiveness of hormonal treatment and to safely ameliorate the anabolic hormonal status and mobility in older individuals.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Gian Paolo Ceda
- Department of Clinical and Experimental Medicine, Section of Geriatrics via Gramsci 14, 43100, Parma, Italy.
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Maggio M, De Vita F, Fisichella A, Colizzi E, Provenzano S, Lauretani F, Luci M, Ceresini G, Dall'Aglio E, Caffarra P, Valenti G, Ceda GP. DHEA and cognitive function in the elderly. J Steroid Biochem Mol Biol 2015; 145:281-92. [PMID: 24794824 DOI: 10.1016/j.jsbmb.2014.03.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 03/20/2014] [Accepted: 03/27/2014] [Indexed: 11/28/2022]
Abstract
The adrenal prohormone dehydroepiandrosterone (DHEA) and its sulphate conjugate (DHEAS) steadily decrease with age by 10% per decade reaching a nadir after the age of 80. Both DHEA and DHEAS (DHEA/S) exert many biological activities in different tissues and organs. In particular, DHEA and DHEAS are produced de novo in the brain, hence their classification as neurosteroids. In humans, the brain-to-plasma ratios for DHEA and DHEAS are 4-6.5 and 8.5, respectively, indicating a specific neuroendocrine role for these hormones. DHEA/S stimulates neurite growth, neurogenesis and neuronal survival, apoptosis, catecholamine synthesis and secretion. Together with antioxidant, anti-inflammatory and anti-glucocorticoid properties, it has been hypothesized a neuroprotective effect for DHEA/S. We conducted an accurate research of the literature using PubMed. In the period of time between 1994 and 2013, we selected the observational human studies testing the relationship between DHEA/S and cognitive function in both sexes. The studies are presented according to the cross-sectional and longitudinal design and to the positive or neutral effects on different domains of cognitive function. We also analysed the Clinical Trials, available in the literature, having cognitive domains as the main or secondary outcome. Although the cross-sectional evidence of a positive association between DHEA/S and cognitive function, longitudinal studies and RCTs using DHEA oral treatment (50mg/day) in normal or demented adult-older subjects, have produced conflicting and inconsistent results. In summary, the current data do not provide clear evidence for the usefulness of DHEA treatment to improve cognitive function in adult-older subjects. This article is part of a Special Issue entitled 'Essential role of DHEA'.
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Affiliation(s)
- Marcello Maggio
- Geriatric Rehabilitation Department, University Hospital of Parma, Via Gramsci, 14, 43126 Parma (PR), Italy; Department of Clinical and Experimental Medicine, Section of Geriatrics, Food Sciences Unit and Endocrinology of Aging Unit, University of Parma, Via Gramsci, 14, 43126 Parma (PR), Italy.
| | - Francesca De Vita
- Geriatric Rehabilitation Department, University Hospital of Parma, Via Gramsci, 14, 43126 Parma (PR), Italy
| | - Alberto Fisichella
- Geriatric Rehabilitation Department, University Hospital of Parma, Via Gramsci, 14, 43126 Parma (PR), Italy
| | - Elena Colizzi
- Geriatric Rehabilitation Department, University Hospital of Parma, Via Gramsci, 14, 43126 Parma (PR), Italy
| | - Sandra Provenzano
- Geriatric Rehabilitation Department, University Hospital of Parma, Via Gramsci, 14, 43126 Parma (PR), Italy
| | - Fulvio Lauretani
- Geriatric Rehabilitation Department, University Hospital of Parma, Via Gramsci, 14, 43126 Parma (PR), Italy
| | - Michele Luci
- Geriatric Rehabilitation Department, University Hospital of Parma, Via Gramsci, 14, 43126 Parma (PR), Italy
| | - Graziano Ceresini
- Geriatric Rehabilitation Department, University Hospital of Parma, Via Gramsci, 14, 43126 Parma (PR), Italy; Department of Clinical and Experimental Medicine, Section of Geriatrics, Food Sciences Unit and Endocrinology of Aging Unit, University of Parma, Via Gramsci, 14, 43126 Parma (PR), Italy
| | - Elisabetta Dall'Aglio
- Department of Clinical and Experimental Medicine, Section of Geriatrics, Food Sciences Unit and Endocrinology of Aging Unit, University of Parma, Via Gramsci, 14, 43126 Parma (PR), Italy
| | - Paolo Caffarra
- Department of Neuroscience, University of Parma, Parma (PR), Italy; Outpatient Clinic for the Diagnosis and Therapy of Cognitive Disorders, AUSL, Parma (PR), Italy
| | - Giorgio Valenti
- Department of Clinical and Experimental Medicine, Section of Geriatrics, Food Sciences Unit and Endocrinology of Aging Unit, University of Parma, Via Gramsci, 14, 43126 Parma (PR), Italy
| | - Gian Paolo Ceda
- Geriatric Rehabilitation Department, University Hospital of Parma, Via Gramsci, 14, 43126 Parma (PR), Italy; Department of Clinical and Experimental Medicine, Section of Geriatrics, Food Sciences Unit and Endocrinology of Aging Unit, University of Parma, Via Gramsci, 14, 43126 Parma (PR), Italy
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Rabijewski M, Papierska L, Kuczerowski R, Piątkiewicz P. Hormonal determinants of erectile dysfunction and lower urinary tract symptoms in middle-aged and elderly men with prediabetes. Aging Male 2015; 18:256-64. [PMID: 26444448 DOI: 10.3109/13685538.2015.1083972] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) are common in diabetic men. The aim of this study was to investigate hormonal determinants, the prevalence and severity of ED and LUTS in middle-aged and elderly men with prediabetes (PD). METHODS We investigated 176 men with PD and 184 healthy peers. PD was defined according American Diabetes Association. ED according IIEF scale and LUTS according IPSS scale were assessed. Total testosterone (TT), calculated free testosterone (cFT), dehydroepiandrosterone sulfate (DHEAS) and insulin-like growth factor 1 (IGF-1) were measured. RESULTS The prevalence of ED in patients with PD was higher than in control group (30 versus 24%) as well as the prevalence and severity of ED and LUTS in elderly (60-80 years) and middle-aged (40-59 years) men with PD was higher than in healthy peers. In middle-aged pre-diabetic men, the more severe LUTS symptoms were associated with low TT and DHEAS, while in elderly men with low cFT and DHEAS. The higher prevalence of ED in middle-aged men with PD was associated with cFT and DHEAS, while in elderly pre-diabetic men with TT and IGF-1. CONCLUSIONS The prevalence and severity of LUTS and ED symptoms were higher in pre-diabetic men than in healthy peers. Hormonal determinants of these symptoms are different in middle-aged and elderly patients with PD.
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Affiliation(s)
- Michał Rabijewski
- a Department of Internal Diseases , Diabetology and Endocrinology, Medical University of Warsaw Poland and
| | - Lucyna Papierska
- b Department of Endocrinology , Medical Centre for Postgraduate Education , Warsaw , Poland
| | - Roman Kuczerowski
- a Department of Internal Diseases , Diabetology and Endocrinology, Medical University of Warsaw Poland and
| | - Paweł Piątkiewicz
- a Department of Internal Diseases , Diabetology and Endocrinology, Medical University of Warsaw Poland and
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Ohlsson C, Vandenput L, Tivesten A. DHEA and mortality: what is the nature of the association? J Steroid Biochem Mol Biol 2015; 145:248-53. [PMID: 24704256 DOI: 10.1016/j.jsbmb.2014.03.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 03/04/2014] [Accepted: 03/16/2014] [Indexed: 12/19/2022]
Abstract
Although very little is known about the importance of dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEA-S) in human physiology and pathophysiology, emerging observations imply pivotal roles of DHEA/-S. One such observation is the association between serum DHEA/-S levels and mortality risk. In this review, we focus on the literature addressing DHEA/-S and mortality with the aim to describe and discuss patterns and potential underlying mechanisms. Although the literature reports somewhat inconsistent results, we conclude that several larger population-based studies support an association between low DHEA/-S and risk of death, at least in elderly men. In women, the association may not be present; alternatively, there may be a U-shaped association. In men, most available evidence suggests an association with cardiovascular (CV) mortality rather than cancer mortality. Further, there are biologically plausible mechanisms for an effect of DHEA/-S on the development of CV disease. On the other hand, there is also strong evidence supporting that any disease may lower DHEA/-S. Thus, the cause-effect relation of this association is less clear. Future studies may employ a mendelian randomization approach using genetic determinants of DHEA-S levels as predictors of clinical outcomes, to delineate the true nature of the association between DHEA/-S and mortality.
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Affiliation(s)
- Claes Ohlsson
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Liesbeth Vandenput
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Asa Tivesten
- Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Bruna Stråket 16, S-413 45 Gothenburg, Sweden.
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Maggio M, De Vita F, Fisichella A, Lauretani F, Ticinesi A, Ceresini G, Cappola A, Ferrucci L, Ceda GP. The Role of the Multiple Hormonal Dysregulation in the Onset of "Anemia of Aging": Focus on Testosterone, IGF-1, and Thyroid Hormones. Int J Endocrinol 2015; 2015:292574. [PMID: 26779261 PMCID: PMC4686706 DOI: 10.1155/2015/292574] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 10/23/2015] [Accepted: 10/27/2015] [Indexed: 12/13/2022] Open
Abstract
Anemia is a multifactorial condition whose prevalence increases in both sexes after the fifth decade of life. It is a highly represented phenomenon in older adults and in one-third of cases is "unexplained." Ageing process is also characterized by a "multiple hormonal dysregulation" with disruption in gonadal, adrenal, and somatotropic axes. Experimental studies suggest that anabolic hormones such as testosterone, IGF-1, and thyroid hormones are able to increase erythroid mass, erythropoietin synthesis, and iron bioavailability, underlining a potential role of multiple hormonal changes in the anemia of aging. Epidemiological data more consistently support an association between lower testosterone and anemia in adult-older individuals. Low IGF-1 has been especially associated with anemia in the pediatric population and in a wide range of disorders. There is also evidence of an association between thyroid hormones and abnormalities in hematological parameters under overt thyroid and euthyroid conditions, with limited data on subclinical statuses. Although RCTs have shown beneficial effects, stronger for testosterone and the GH-IGF-1 axis and less evident for thyroid hormones, in improving different hematological parameters, there is no clear evidence for the usefulness of hormonal treatment in improving anemia in older subjects. Thus, more clinical and research efforts are needed to investigate the hormonal contribution to anemia in the older individuals.
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Affiliation(s)
- Marcello Maggio
- Department of Clinical and Experimental Medicine, Section of Geriatrics, University of Parma, 43126 Parma, Italy
- Geriatric Rehabilitation Department, University Hospital of Parma, 43126 Parma, Italy
- *Marcello Maggio:
| | - Francesca De Vita
- Department of Clinical and Experimental Medicine, Section of Geriatrics, University of Parma, 43126 Parma, Italy
| | - Alberto Fisichella
- Department of Clinical and Experimental Medicine, Section of Geriatrics, University of Parma, 43126 Parma, Italy
| | - Fulvio Lauretani
- Geriatric Rehabilitation Department, University Hospital of Parma, 43126 Parma, Italy
| | - Andrea Ticinesi
- Department of Clinical and Experimental Medicine, Section of Geriatrics, University of Parma, 43126 Parma, Italy
| | - Graziano Ceresini
- Department of Clinical and Experimental Medicine, Section of Geriatrics, University of Parma, 43126 Parma, Italy
- Geriatric Rehabilitation Department, University Hospital of Parma, 43126 Parma, Italy
| | - Anne Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health (NIH), Baltimore, MD 21201, USA
| | - Gian Paolo Ceda
- Department of Clinical and Experimental Medicine, Section of Geriatrics, University of Parma, 43126 Parma, Italy
- Geriatric Rehabilitation Department, University Hospital of Parma, 43126 Parma, Italy
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Bao Y, Johansen KL. Diagnosis and Treatment of Low Testosterone among Patients with End-Stage Renal Disease. Semin Dial 2014; 28:259-65. [PMID: 25376701 DOI: 10.1111/sdi.12318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The prevalence of low testosterone level is particularly high among patients with end-stage renal disease (ESRD) and has been associated with mortality. In populations without ESRD, low testosterone level has also been associated with a number of morbidities including cardiovascular disease, diabetes mellitus, low muscle mass, low bone mass, low physical performance, and frailty. However, there is controversy regarding what constitutes low testosterone level in the aging population and at what level replacement therapy with testosterone is indicated. There are no randomized controlled trials investigating long-term outcomes of testosterone replacement therapy in populations with or without ESRD. Available trial results suggest equivocal improvements in sexual function. Muscle mass and bone mineral density appear to improve, but results in physical function and performance are mixed and there are no data on fracture prevention. Some recent data suggest harm when testosterone was given to men with limited mobility. Finally, there is little evidence that testosterone adds to existing erythropoietin agents in the treatment of anemia in ESRD. Due to lack of evidence supporting long-term use of testosterone, the authors recommend against the routine use of testosterone in ESRD patients with low testosterone levels. Testosterone treatment can be considered in those with low bone mass and total testosterone level <200 ng/dl, or in younger patients with sexual complaints with total testosterone level lower than the reference range. It is important to engage patients in discussion of risks and benefits before initiating testosterone therapy; testosterone therapy should be discontinued if the intended treatment effect is not observed after short-term use.
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Affiliation(s)
- Yeran Bao
- John Muir Medical Group, Walnut Creek, California
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Mora M, Serra-Prat M, Palomera E, Puig-Domingo M. Metabolic and hormonal contributors to survival in the participants of the Mataró Ageing Study at 8 years follow-up. Clin Endocrinol (Oxf) 2014; 81:775-83. [PMID: 24750184 DOI: 10.1111/cen.12467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 01/12/2014] [Accepted: 04/04/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Ageing is a physiological process that may be influenced by genetic factors as well as metabolic and hormonal determinants. The aim was to describe metabolic and hormonal factors related to survival in the cohort of non-institutionalized people aged >70 years old of the Mataró Ageing Study. DESIGN AND METHODS 313 individuals were included and followed-up during 8 years. Metabolic syndrome (MS) parameters by International Diabetes Federation and ATP-III as well as hormonal factors (TSH, free-T4, growth hormone, IGF-I, ghrelin, cortisol, dehydroepiandrosterone -DHEA-, DHEAs, testosterone, SHBG, estradiol, estrone, cortisol/DHEA and cortisol/DHEAs) were studied and their relationship with survival was assessed. RESULTS At 8 year of follow-up, 96 out of 313 subjects (30·7%) died. No association between MS and its components and survival was found. However, when abdominal perimeter was analyzed according to distribution in quartiles and categorized by gender, the lowest and highest quartile showed higher mortality (P = 0·009; waist circumference (WC) between 98-102 cm in men and 95-102 cm in women were associated to lower mortality). In men, IGF-I, estrone, cortisol/DHEA ratio and cortisol/DHEAs ratio were lower in survivors, and in women, growth hormone and ghrelin were higher in survivors and cortisol/DHEAs ratio was lower. When Cox regression was performed for survival analysis of the whole cohort (adjusting by age, gender, tobacco consumption and WC, cortisol (B = 0·036, P = 0·033), estrone (B = 0·014, P = 0·004) and cortisol/DHEA ratio (B = 0·018, P = 0·008) were significantly associated to mortality. Sequential adjustments including additionally in the model Lawton scale, MiniNutritional Assessment and MCE showed significant association to estrone (P = 0·018). CONCLUSIONS Waist circumference in a U-shaped relationship, together with hormonal factors (adrenal steroids and somatotropic axis) influenced survival in individuals participating in Mataró Ageing Study.
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Affiliation(s)
- Mireia Mora
- Department of Endocrinology and Nutrition, Hospital Clínic i Universitari of Barcelona, Barcelona, Spain
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Chen Q, Fu Z, Wu X, Jin L, Li J, Wang Y, Li X. Association of serum androgen concentrations with cardiovascular risk factors in elderly male patients with chronic systolic heart failure in China. Aging Male 2014; 17:155-60. [PMID: 24805790 DOI: 10.3109/13685538.2014.896893] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To survey the serum androgen concentrations and investigate the relationship between androgen levels and cardiovascular risk factors in elderly male patients with chronic systolic heart failure (HF) in China. METHODS 106 consecutive male patients hospitalized for chronic systolic HF aged from 60 to 87 were enrolled. About 400 healthy age-matched men were compared as a control group. Total testosterone (TT), free testosterone (FT), dehydroepiandrosterone sulfate (DHEAS) and sex hormone binding globulin (SHBG) were measured. Differences of androgen levels between HF patients and healthy men were determined by t-test and associations of androgen with cardiovascular risk factors were evaluated by partial correlations analyses. RESULTS Compared with healthy men, TT, FT and DHEAS levels in patients with HF decreased, whereas SHBG level increased significantly (both p < 0.01). TT was negatively correlated with TC, TG and DBP (p < 0.05), FT was negatively correlated with TC, LDL-C and DBP (p < 0.05). SHBG correlated with BMI and smoking history positively (p < 0.05). CONCLUSIONS Level of bio-available testosterone decreased with advancing age, especially in men with HF. Men with low levels of bio-available testosterone had worse profiles of cardiovascular risk factors. Treatment of HF is still challenging and testosterone supplementation therapy may be an effective therapeutic option.
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