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Buch A, Marcus Y, Shefer G, Zimmet P, Stern N. Approach to Obesity in the Older Population. J Clin Endocrinol Metab 2021; 106:2788-2805. [PMID: 34406394 DOI: 10.1210/clinem/dgab359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Indexed: 12/14/2022]
Abstract
Until recently, weight loss in older obese people was feared because of ensuing muscle loss and frailty. Facing overall increasing longevity, high rates of obesity in older individuals (age ≥ 65 years) and a growing recognition of the health and functional cost of the number of obesity years, abetted by evidence that intentional weight loss in older obese people is safe, this approach is gradually, but not unanimously, being replaced by more active principles. Lifestyle interventions that include reduced but sufficient energy intake, age-adequate protein and micronutrient intake, coupled with aerobic and resistance exercise tailored to personal limitations, can induce weight loss with improvement in frailty indices. Sustained weight loss at this age can prevent or ameliorate diabetes. More active steps are controversial. The use of weight loss medications, particularly glucagon-like peptide-1 analogs (liraglutide as the first example), provides an additional treatment tier. Its safety and cardiovascular health benefits have been convincingly shown in older obese patients with type 2 diabetes mellitus. In our opinion, this option should not be denied to obese individuals with prediabetes or other obesity-related comorbidities based on age. Finally, many reports now provide evidence that bariatric surgery can be safely performed in older people as the last treatment tier. Risk-benefit issues should be considered with extreme care and disclosed to candidates. The selection process requires good presurgical functional status, individualized consideration of the sequels of obesity, and reliance on centers that are highly experienced in the surgical procedure as well as short-term and long-term subsequent comprehensive care and support.
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Affiliation(s)
- Assaf Buch
- The Sagol Center for Epigenetics of Aging and Metabolism, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- The Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Yonit Marcus
- The Sagol Center for Epigenetics of Aging and Metabolism, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- The Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Gabi Shefer
- The Sagol Center for Epigenetics of Aging and Metabolism, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- The Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Paul Zimmet
- The Sagol Center for Epigenetics of Aging and Metabolism, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria 3004, Australia
| | - Naftali Stern
- The Sagol Center for Epigenetics of Aging and Metabolism, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- The Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Nasser SA, Afify EA, Kobeissy F, Hamam B, Eid AH, El-Mas MM. Inflammatory Basis of Atherosclerosis: Modulation by Sex Hormones. Curr Pharm Des 2021; 27:2099-2111. [PMID: 33480335 DOI: 10.2174/1381612827666210122142811] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/17/2020] [Indexed: 11/22/2022]
Abstract
Atherosclerosis-related cardiovascular diseases (CVDs) are the leading cause of death globally. Several lines of evidence are supportive of the contributory role of vascular inflammation in atherosclerosis. Diverse immune cell types, including monocytes/macrophages, T-cells and neutrophils, as well as specialized proresolving lipid mediators, have been successfully characterized as key players in vascular inflammation. The increased prevalence of atherosclerotic CVD in men in comparison to age-matched premenopausal women and the abolition of sex differences in prevalence during menopause strongly suggest a pivotal role of sex hormones in the development of CVD. Indeed, many animal and human studies conclusively implicate sex hormones as a crucial component in driving the immune response. This is further corroborated by the effective identification of sex hormone receptors in vascular endothelial cells, vascular smooth muscle cells and immune cells. Collectively, these findings suggest a cellular communication between sex hormones and vascular or immune cells underlying the vascular inflammation in atherosclerosis. The aim of this review is to provide an overview of vascular inflammation as a causal cue underlying atherosclerotic CVDs within the context of the modulatory effects of sex hormones. Moreover, the cellular and molecular signaling pathways underlying the sex hormones- immune system interactions as potential culprits for vascular inflammation are highlighted with detailed and critical discussion. Finally, the review concludes by speculations on the potential sex-related efficacy of currently available immunotherapies in mitigating vascular inflammation. Conceivably, a deeper understanding of the immunoregulatory influence of sex hormones on vascular inflammation-mediated atherosclerosis permits sex-based management of atherosclerosis-related CVDs.
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Affiliation(s)
- Suzanne A Nasser
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Beirut Arab University, P.O. Box 11-5020, Beirut, Lebanon
| | - Elham A Afify
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, American University of Beirut, P.O. Box 11-0236, Beirut, Lebanon
| | - Bassam Hamam
- Department of Biological and Chemical Sciences, School of Arts and Sciences, Lebanese International University, P.O. Box 146404, Beirut, Lebanon
| | - Ali H Eid
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Mahmoud M El-Mas
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
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Chen Y, Zhang L, Zhao S, Yuan L, Shi J, Zhang Y, Wang J, Gu W, Wang W, Hong J. Association of night-time sleep and day napping with the prevalence of MOSH in young obese men. Andrology 2021; 9:1872-1878. [PMID: 34197044 DOI: 10.1111/andr.13074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/26/2021] [Accepted: 06/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Obesity in men is also shown to be associated with reduced reproductive potential, and this particular subtype was described as male obesity-associated secondary hypogonadism (MOSH). Recent studies showing the influence of sleep disorders on testosterone levels suggested a potential role of sleep disorders in determining the development of MOSH. OBJECTIVES To assess the association between night-time sleep duration and day napping and the prevalence of MOSH. MATERIALS AND METHODS In this cross-sectional study, 226 obese male participants aged 18-30 years were enrolled. Daytime napping and night-time sleep duration data were collected using a standardized self-reported Chinese-language questionnaire. MOSH was defined as obese men (BMI ≥ 30 kg/m2 ) with hypogonadal symptoms and decreased total testosterone level and/or free testosterone level, excluding other causes of hypogonadism. RESULTS The overall prevalence of MOSH was 48.2% in this study. An inverse association was observed between night sleep duration and the risk of prevalent MOSH. Men who reported fewer than 6 h of night-time sleep had reduced total testosterone and free testosterone levels and an increased risk of MOSH. Further regression analysis revealed that after adjustment for potential confounders, the odds ratio of MOSH for the short night-time sleep group (<6 h vs. 6-8 h) was 6.17 (p = 0.040). No significant association was observed between day napping status and prevalence of MOSH. DISCUSSION AND CONCLUSION Short night sleep duration was associated with an increased risk of MOSH in the young obese Chinese population. Chronic sleep curtailment has a negative effect on obese men's health in terms of hypogonadism.
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Affiliation(s)
- Yufei Chen
- Department of Endocrine and Metabolic Diseases, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China.,Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Ling Zhang
- Department of Endocrine and Metabolic Diseases, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China.,Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Shaoqian Zhao
- Department of Endocrine and Metabolic Diseases, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China.,Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Lihui Yuan
- Department of Endocrine and Metabolic Diseases, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China.,Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Juan Shi
- Department of Endocrine and Metabolic Diseases, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China.,Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Yifei Zhang
- Department of Endocrine and Metabolic Diseases, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China.,Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Jiqiu Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China.,Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Weiqiong Gu
- Department of Endocrine and Metabolic Diseases, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China.,Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China.,Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Jie Hong
- Department of Endocrine and Metabolic Diseases, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China.,Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
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Kalicińska E, Wojtas K, Majda J, Zacharski M, Skiba J, Śliwowski J, Banasiak W, Ponikowski P, Jankowska EA. Expression of sex steroid receptors and aromatase in adipose tissue in different body regions in men with coronary artery disease with and without ischemic systolic heart failure. Aging Male 2020; 23:141-153. [PMID: 30193537 DOI: 10.1080/13685538.2018.1494144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: The hormonal metabolism of adipose tissue differs across regions of fat. This issue has never been verified in male patients with coronary artery disease (CAD) with and without systolic heart failure (SHF).Methods: We examined 90 male patients with CAD with and without SHF and 42 healthy controls.Results: In patients with CAD with and without SHF, androgen receptor (AR) expression in adipose tissue of the lower leg was higher than AR expression of the thoracic wall and epicardial adipose tissue (EAT) (both p < .0001 for SHF patients and both p < .001 for patients without SHF). Expression of aromatase in adipose tissue of the lower leg among patients with CAD and SHF was higher than aromatase expression of the thoracic wall and EAT (p < .001 and p < .05, respectively), and in patients without SHF, it was higher only than aromatase expression of the thoracic wall (p < .05). There were no differences in expression of estrogen receptor (ER) between three regions of adipose tissue both in men with CAD with and without SHF.Conclusions: In male patients with CAD, site-related differences of adipose tissue in expression of AR and aromatase are present regardless of coexisting SHF with the highest hormonal activity within peripheral subcutaneous adipose tissue.
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Affiliation(s)
- Elżbieta Kalicińska
- Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | | | - Jacek Majda
- Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Maciej Zacharski
- Biochemistry and Molecular Biology Department, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Jacek Skiba
- Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Jan Śliwowski
- Orthopedics Department, Military Hospital, Wroclaw, Poland
| | | | - Piotr Ponikowski
- Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
- Department of Heart Diseases, Laboratory for Applied Research on Cardiovascular System, Wroclaw Medical University, Wroclaw, Poland
| | - Ewa A Jankowska
- Department of Heart Diseases, Laboratory for Applied Research on Cardiovascular System, Wroclaw Medical University, Wroclaw, Poland
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Maldonado O, Ramos A, Guapillo M, Rivera J, Palma I, Rubio-Gayosso I, Ramirez-Sanchez I, Najera N, Ceballos G, Mendez-Bolaina E. Effects of chronic inhibition of Testosterone metabolism on cardiac remodeling after ischemia/reperfusion-induced myocardial damage in gonadectomized rats. Biol Open 2019; 8:bio.041905. [PMID: 31085546 PMCID: PMC6550079 DOI: 10.1242/bio.041905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The effects of testosterone on cardiovascular homeostasis are still not well understood. The objective of this work was to evaluate the effects of testosterone in the absence or presence of inhibition of Aromatase (4-hydroxyandrostenedione) and/or 5α reductase (Finasteride) enzymatic activities on the myocardial remodeling 30 days after ischemia/reperfusion (I/R) injury in gonadectomized rats. Results showed that testosterone administration to ORX rats resulted in decreased myocardial damaged area, inflammatory infiltrates and reduced MMP-3 and 13 expressions. Interestingly, Finasteride administration resulted in a greater decrease in scar tissue, inflammatory infiltrates, along with a significant decrease in MMP-3 and 13 expressions. In contrast, 4-hydroxyandrostenedione administrations increased all parameters. Our results suggest that testosterone does not have a direct effect since simultaneous inhibition of aromatase and 5α-reductase did not induce significant changes in I/R induced myocardial injury. Summary: Coronary ischemia/reperfusion-induced injury in gonadectomyzed male rats is decreased by testosterone, protection is increased by blocking its 5α-reduction and blocked by inhibition of its aromatization.
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Affiliation(s)
- Octavio Maldonado
- CIB-Doctorado en Ciencias Biomédicas-UV. Centro de Investigaciones Biomédicas, Universidad Veracruzana, Av. Dr. Luis Castelazo Ayala s/n, Colonia Industrial Anima, CP. 91000, Xalapa, Veracruz, Mexico.,Departamento de Nanotecnología, Universidad Tecnológica del Centro de Veracruz, Av. Universidad No. 350, Carretera Federal Cuitláhuac - La Tinaja, Localidad Dos Caminos, CP. 94910, Cuitláhuac, Veracruz, Mexico
| | - Angel Ramos
- MCPB-Facultad de Ciencias Químicas, Universidad Veracruzana, Prolongación Oriente 6, No. 1009, Colonia Rafael Alvarado, CP. 94340, Orizaba, Veracruz, Mexico
| | - Mario Guapillo
- Laboratorio de Biología Molecular, Facultad de Ciencias Químicas, Universidad Veracruzana, Prolongación Oriente 6, No. 1009, Colonia Rafael Alvarado, CP. 94340, Orizaba, Veracruz, Mexico
| | - Jose Rivera
- MCPB-Facultad de Ciencias Químicas, Universidad Veracruzana, Prolongación Oriente 6, No. 1009, Colonia Rafael Alvarado, CP. 94340, Orizaba, Veracruz, Mexico
| | - Icela Palma
- Seccion de Estudios de posgrado, Escuela Superior de Medicina, Instituto Politecnico Nacional, Plan de San Luis y Díaz Mirón, CP. 11340, Ciudad de México, Mexico
| | - Ivan Rubio-Gayosso
- Seccion de Estudios de posgrado, Escuela Superior de Medicina, Instituto Politecnico Nacional, Plan de San Luis y Díaz Mirón, CP. 11340, Ciudad de México, Mexico
| | - Israel Ramirez-Sanchez
- Seccion de Estudios de posgrado, Escuela Superior de Medicina, Instituto Politecnico Nacional, Plan de San Luis y Díaz Mirón, CP. 11340, Ciudad de México, Mexico
| | - Nayelli Najera
- Seccion de Estudios de posgrado, Escuela Superior de Medicina, Instituto Politecnico Nacional, Plan de San Luis y Díaz Mirón, CP. 11340, Ciudad de México, Mexico
| | - Guillermo Ceballos
- Seccion de Estudios de posgrado, Escuela Superior de Medicina, Instituto Politecnico Nacional, Plan de San Luis y Díaz Mirón, CP. 11340, Ciudad de México, Mexico
| | - Enrique Mendez-Bolaina
- CIB-Doctorado en Ciencias Biomédicas-UV. Centro de Investigaciones Biomédicas, Universidad Veracruzana, Av. Dr. Luis Castelazo Ayala s/n, Colonia Industrial Anima, CP. 91000, Xalapa, Veracruz, Mexico.,MCPB-Facultad de Ciencias Químicas, Universidad Veracruzana, Prolongación Oriente 6, No. 1009, Colonia Rafael Alvarado, CP. 94340, Orizaba, Veracruz, Mexico
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6
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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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7
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Corona G, Rastrelli G, Di Pasquale G, Sforza A, Mannucci E, Maggi M. Endogenous Testosterone Levels and Cardiovascular Risk: Meta-Analysis of Observational Studies. J Sex Med 2018; 15:1260-1271. [DOI: 10.1016/j.jsxm.2018.06.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 06/23/2018] [Accepted: 06/27/2018] [Indexed: 01/19/2023]
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8
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Subramanya V, Zhao D, Ouyang P, Lima JA, Vaidya D, Ndumele CE, Bluemke DA, Shah SJ, Guallar E, Nwabuo CC, Allison MA, Heckbert SR, Post WS, Michos ED. Sex hormone levels and change in left ventricular structure among men and post-menopausal women: The Multi-Ethnic Study of Atherosclerosis (MESA). Maturitas 2017; 108:37-44. [PMID: 29290213 DOI: 10.1016/j.maturitas.2017.11.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/02/2017] [Accepted: 11/06/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Sex hormone (SH) levels may contribute to sex differences in the risk of heart failure with preserved ejection fraction (HFpEF). We examined the associations of SH levels with left ventricular mass (LVM) and mass (M):volume (V) ratio, which are risk markers for HFpEF. STUDY DESIGN We studied 1941 post-menopausal women and 2221 men, aged 45-84 years, participating in the Multi-Ethnic Study of Atherosclerosis (MESA). Serum SH levels, cardiac magnetic resonance imaging (MRI) and ejection fraction (EF) ≥50% had been recorded at baseline (2000-2002). Of these participants, 2810 underwent repeat MRI at Exam 5 (2010-2012). Stratified by sex, linear mixed-effect models were used to test associations between SH and sex hormone binding globulin (SHBG) level [per 1 SD greater log-transformed (SH)] with baseline and change in LV structure. Models were adjusted for age, race/ethnicity, center, height, weight, education, physical activity and smoking, and, in women, for hormone therapy and years since menopause. MAIN OUTCOME MEASURES LVM and M:V ratio. RESULTS After a median of 9.1 years, higher free testosterone levels were independently associated with a modest increase in LVM (g/yr) in women [0.05 (95% CI 0.01, 0.10)] and men [0.16 (0.03, 0.28)], while higher SHBG levels were associated with less LVM change (g/yr) in women [-0.07 (-0.13, -0.01)] and men [-0.15 (-0.27, -0.02)]. In men, higher dehydroepiandrosterone and estradiol levels were associated with increased LVM. Among women, free testosterone levels were positively and SHBG levels inversely associated with change in M:V ratio. CONCLUSION A more androgenic profile (higher free testosterone and lower SHBG levels) is associated with a greater increase in LVM in men and women and greater increase in M:V ratio in women over the course of 9 years.
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Affiliation(s)
- Vinita Subramanya
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Pamela Ouyang
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Joao A Lima
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Dhananjay Vaidya
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Chiadi E Ndumele
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison WI, USA.
| | - Sanjiv J Shah
- Division of Cardiology, Northwestern School of Medicine, Chicago, IL, USA.
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Chike C Nwabuo
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA.
| | - Matthew A Allison
- Division of Preventive Medicine, University of California San Diego, La Jolla, CA, USA.
| | - Susan R Heckbert
- Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - Wendy S Post
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Dimitriadis GK, Barber TM. Obesity-related metabolic and reproductive dysfunction: variations between the sexes. Expert Rev Endocrinol Metab 2016; 11:387-393. [PMID: 30058907 DOI: 10.1080/17446651.2016.1220301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Obesity prevalence remains at epidemic levels globally and is showing no signs of abating in either adult or child populations. Areas covered: Obesity-associated metabolic and reproductive diseases appear to be sexually dimorphic. Polycystic Ovary Syndrome (PCOS) and male obesity-associated secondary (hypogonadotrophic) hypogonadism (MOSH) represent two of the most common obesity associated endocrinopathies with sex-specific metabo-reproductive aberrations. These two diseases have entirely separate pathogeneses, with characteristic sex-specific clinico-pathological findings. These differences result from effects of sex-specific hormones, including estrogens and androgens. Such differences in sex-hormones also influence patterns of body-fat distribution. Expert commentary: This article focuses on sex-specific obesity-related metabolic and reproductive dysfunction. To illustrate key sex-related differences in the mechanisms by which obesity contributes towards metabolic and reproductive dysfunction, two common obesity-related conditions affecting women and men are considered: respectively, Polycystic Ovary Syndrome (PCOS) and Male Obesity-associated Secondary Hypogonadism (MOSH).
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Affiliation(s)
- Georgios K Dimitriadis
- a Division of Biomedical Sciences, Warwick Medical School , University of Warwick , Coventry , UK
- b Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism , University Hospitals of Coventry and Warwickshire NHS Trust , Coventry , UK
- c Division of Endocrinology and Investigative Medicine , Imperial College London , London , UK
| | - Thomas M Barber
- a Division of Biomedical Sciences, Warwick Medical School , University of Warwick , Coventry , UK
- b Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism , University Hospitals of Coventry and Warwickshire NHS Trust , Coventry , UK
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10
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Tostes RC, Carneiro FS, Carvalho MHC, Reckelhoff JF. Reactive oxygen species: players in the cardiovascular effects of testosterone. Am J Physiol Regul Integr Comp Physiol 2015; 310:R1-14. [PMID: 26538238 DOI: 10.1152/ajpregu.00392.2014] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 10/23/2015] [Indexed: 01/12/2023]
Abstract
Androgens are essential for the development and maintenance of male reproductive tissues and sexual function and for overall health and well being. Testosterone, the predominant and most important androgen, not only affects the male reproductive system, but also influences the activity of many other organs. In the cardiovascular system, the actions of testosterone are still controversial, its effects ranging from protective to deleterious. While early studies showed that testosterone replacement therapy exerted beneficial effects on cardiovascular disease, some recent safety studies point to a positive association between endogenous and supraphysiological levels of androgens/testosterone and cardiovascular disease risk. Among the possible mechanisms involved in the actions of testosterone on the cardiovascular system, indirect actions (changes in the lipid profile, insulin sensitivity, and hemostatic mechanisms, modulation of the sympathetic nervous system and renin-angiotensin-aldosterone system), as well as direct actions (modulatory effects on proinflammatory enzymes, on the generation of reactive oxygen species, nitric oxide bioavailability, and on vasoconstrictor signaling pathways) have been reported. This mini-review focuses on evidence indicating that testosterone has prooxidative actions that may contribute to its deleterious actions in the cardiovascular system. The controversial effects of testosterone on ROS generation and oxidant status, both prooxidant and antioxidant, in the cardiovascular system and in cells and tissues of other systems are reviewed.
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Affiliation(s)
- Rita C Tostes
- University of São Paulo, Ribeirao Preto Medical School, Ribeirao Preto, São Paulo, Brazil;
| | - Fernando S Carneiro
- University of São Paulo, Ribeirao Preto Medical School, Ribeirao Preto, São Paulo, Brazil
| | | | - Jane F Reckelhoff
- University of Mississippi Medical Center, Women's Health Research Center, Jackson, Mississippi
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11
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Kemp T, Rheeder P. The prevalence and associations of erectile dysfunction in a South African male diabetic urban population. JOURNAL OF ENDOCRINOLOGY METABOLISM AND DIABETES OF SOUTH AFRICA 2015. [DOI: 10.1080/16089677.2015.1090185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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12
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Bušić Ž, Čulić V. Central and peripheral testosterone effects in men with heart failure: An approach for cardiovascular research. World J Cardiol 2015; 7:504-510. [PMID: 26413227 PMCID: PMC4577677 DOI: 10.4330/wjc.v7.i9.504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 07/23/2015] [Indexed: 02/06/2023] Open
Abstract
Heart failure (HF) is a syndrome recognized as a health problem worldwide. Despite advances in treatment, patients with HF still have increased morbidity and mortality. Testosterone is one of the most researched hormones in the course of HF. Growing interest regarding the effect of testosterone, on a variety of body systems, has increased the knowledge about its mechanisms of action. The terms central and peripheral effects are used to distinguish the effects of testosterone on cardiac and extracardiac structures. Central effects include influences on cardiomyocytes and electrophysiology. Peripheral effects include influences on blood vessels, baroreceptor reactivity, skeletal muscles and erythropoesis. Current knowledge about peripheral effects of testosterone may explain much about beneficiary effects in the pathophysiology of HF syndrome. However, central, i.e., cardiac effects of testosterone are to be further explored.
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Wang F, Yang J, Sun J, Dong Y, Zhao H, Shi H, Fu L. Testosterone replacement attenuates mitochondrial damage in a rat model of myocardial infarction. J Endocrinol 2015; 225:101-11. [PMID: 25770118 DOI: 10.1530/joe-14-0638] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2015] [Indexed: 01/08/2023]
Abstract
Testosterone can affect cardiovascular disease, but its effects on mitochondrial dynamics in the post-infarct myocardium remain unclear. To observe the effects of testosterone replacement, a rat model of castration-myocardial infarction (MI) was established by ligating the left anterior descending coronary artery 2 weeks after castration with or without testosterone treatment. Expression of mitochondrial fission and fusion proteins was detected by western blot and immunofluorescence 14 days after MI. Cardiac function, myocardial inflammatory infiltration and fibrosis, cardiomyocyte apoptosis, mitochondrial microstructure, and ATP levels were also assessed. Compared with MI rats, castrated rats showed aggravated mitochondrial and myocardial insults, including mitochondrial swelling and disordered arrangement; loss of cristae, reduced mitochondrial length; decreased ATP levels; cardiomyocyte apoptosis; and impaired cardiac function. Results of western blotting analyses indicated that castration downregulated peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1A) and mitofusin 2, but upregulated dynamin-related protein 1. The results were also supported by results obtained using immunofluorescence. However, these detrimental effects were reversed by testosterone supplementation, which also elevated the upstream AMP-activated protein kinase (AMPK) activation of PGC1A. Thus, testosterone can protect mitochondria in the post-infarct myocardium, partly via the AMPK-PGC1A pathway, thereby decreasing mitochondrial dysfunction and cardiomyocyte apoptosis. The effects of testosterone were confirmed by the results of ELISA analyses.
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Affiliation(s)
- Fengyue Wang
- Laboratory of Cardiovascular Internal Medicine Department First Affiliated Hospital, Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, Heilongjiang 150001, China Laboratory of Cardiovascular Internal Medicine Department The Heilongjiang Province Hospital, 82 Zhongshan Lu, Xiangfang District, Harbin, Heilongjiang 150001, China
| | - Jing Yang
- Laboratory of Cardiovascular Internal Medicine Department First Affiliated Hospital, Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, Heilongjiang 150001, China Laboratory of Cardiovascular Internal Medicine Department The Heilongjiang Province Hospital, 82 Zhongshan Lu, Xiangfang District, Harbin, Heilongjiang 150001, China
| | - Junfeng Sun
- Laboratory of Cardiovascular Internal Medicine Department First Affiliated Hospital, Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, Heilongjiang 150001, China Laboratory of Cardiovascular Internal Medicine Department The Heilongjiang Province Hospital, 82 Zhongshan Lu, Xiangfang District, Harbin, Heilongjiang 150001, China
| | - Yanli Dong
- Laboratory of Cardiovascular Internal Medicine Department First Affiliated Hospital, Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, Heilongjiang 150001, China Laboratory of Cardiovascular Internal Medicine Department The Heilongjiang Province Hospital, 82 Zhongshan Lu, Xiangfang District, Harbin, Heilongjiang 150001, China
| | - Hong Zhao
- Laboratory of Cardiovascular Internal Medicine Department First Affiliated Hospital, Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, Heilongjiang 150001, China Laboratory of Cardiovascular Internal Medicine Department The Heilongjiang Province Hospital, 82 Zhongshan Lu, Xiangfang District, Harbin, Heilongjiang 150001, China
| | - Hui Shi
- Laboratory of Cardiovascular Internal Medicine Department First Affiliated Hospital, Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, Heilongjiang 150001, China Laboratory of Cardiovascular Internal Medicine Department The Heilongjiang Province Hospital, 82 Zhongshan Lu, Xiangfang District, Harbin, Heilongjiang 150001, China
| | - Lu Fu
- Laboratory of Cardiovascular Internal Medicine Department First Affiliated Hospital, Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, Heilongjiang 150001, China Laboratory of Cardiovascular Internal Medicine Department The Heilongjiang Province Hospital, 82 Zhongshan Lu, Xiangfang District, Harbin, Heilongjiang 150001, China
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Mannic T, Viguie J, Rossier MF. In vivo and in vitro evidences of dehydroepiandrosterone protective role on the cardiovascular system. Int J Endocrinol Metab 2015; 13:e24660. [PMID: 25926854 PMCID: PMC4389253 DOI: 10.5812/ijem.24660] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/05/2014] [Accepted: 02/14/2015] [Indexed: 02/06/2023] Open
Abstract
CONTEXT Dehydroepiandrosterone (DHEA) and its sulfate ester, Dehydroepiandrosterone Sulfate (DHEA-S) have been considered as putative anti-aging hormones for many years. Indeed, while DHEAS is the most abundant circulating hormone, its concentration is markedly decreased upon aging and early epidemiologic trials have revealed a strong inverse correlation between the hormone concentrations and the occurrence of several dysfunctions frequently encountered in the elderly. Naturally, hormonal supplementation has been rapidly suggested to prevent DHEA (S) deficiency and therefore, age-related development of these pathologies, using the same strategy as estrogen replacement therapy proposed in postmenopausal women. EVIDENCE ACQUISITION All references were searched using PubMed and the following strategy: our initial selection included all articles in English and we sorted them with the following keywords: "DHEA or DHEA-S" and "heart or vascular or endothelium or cardiovascular disease". The search was limited to neither the publication date nor specific journals. The final selection was made according to the relevance of the article content with the aims of the review. According to these criteria, fewer than 10% of the articles retrieved at the first step were discarded. RESULTS In this short review, we have focused on the cardiovascular action of DHEA. We started by analyzing evidences in favor of a strong inverse association between DHEA (S) levels and the cardiovascular risk as demonstrated in multiple observational epidemiologic studies for several decades. Then we discussed the different trials aimed at supplementing DHEA (S), both in animals and human, for preventing cardiovascular diseases and we analyzed the possible reasons for the discrepancy observed among the results of some studies. Finally, we presented putative molecular mechanisms of action for DHEA (S), demonstrated in vitro in different models of vascular and cardiac cells, highlighting the complexity of the involved signaling pathways. CONCLUSIONS The identification of the beneficial cardiovascular effects of DHEA (S) and a better understanding of the involved mechanisms should be helpful to develop new strategies or pharmacologic approaches for many lethal diseases in Western countries.
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Affiliation(s)
- Tiphaine Mannic
- Department of Human Protein Science, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Genetics and laboratory Medicine, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
- Corresponding author: Tiphaine Mannic, Department of Genetics and laboratory Medicine, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland. Tel: +41-223795775, Fax: +41-223795502, E-mail:
| | - Joanna Viguie
- Department of Neurosciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Michel Florian Rossier
- Department of Human Protein Science, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Service of Clinical Chemistry and Toxicology, Central Institute of the Hospital of Valais, Sion, Switzerland
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Tamler R, Deveney T. Hypogonadism, Erectile Dysfunction, and Type 2 Diabetes Mellitus: What the Clinician Needs to Know. Postgrad Med 2015; 122:165-75. [DOI: 10.3810/pgm.2010.11.2234] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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16
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Walsh TJ, Shores MM, Fox AE, Moore KP, Forsberg CW, Kinsey CE, Heckbert SR, Zeliadt S, Thompson ML, Smith NL, Matsumoto AM. Recent trends in testosterone testing, low testosterone levels, and testosterone treatment among Veterans. Andrology 2015; 3:287-92. [PMID: 25684636 DOI: 10.1111/andr.12014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 02/09/2014] [Accepted: 01/06/2015] [Indexed: 11/30/2022]
Abstract
Low serum testosterone (T) is common and increasingly prevalent with increased age. Recent studies report an 'epidemic' of T prescribing and concern about unnecessary T treatment. We investigated the number of men tested for T, the prevalence of low serum T levels, and initiation of T treatment among those with low T levels in men treated at Veterans Affairs (VA) facilities in the Northwest US (VISN 20). We identified male Veterans aged 40-89 years and examined yearly proportions of men tested for T, found to have low T levels (total T < 280 ng/dL, free T < 34 pg/mL, or bioavailable T < 84 ng/dL), and subsequently treated with T from 2002 to 2011. We excluded men who had T treatment in the year prior and men with diagnoses of prostate or breast cancer. Treatment initiation was defined as the first prescription for T within a year following a low T test. From 2002 to 2011, the yearly population of eligible men in VISN 20 increased from 129 247 to 163 572. The proportion of men who had serum T tests increased from 3.2% in 2002 to 5.8% in 2011. Among the tested men, the percentage of men with low T levels increased from 35.0 to 47.3%. However, the proportion of men with low T levels who were given T treatment within a year decreased from 31.0 to 28.0%. Despite large increases in T testing, and detection of men with low T levels, there was a slight decrease in the proportion of men with low T levels who were treated with T. The decrease in T treatment during this time period contrasts with other studies and may be related to higher comorbidity in Veterans and/or VA formulary restrictions on the use of transdermal T formulations.
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Affiliation(s)
- T J Walsh
- University of Washington, Seattle, WA, USA
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Morgentaler A, Miner MM, Caliber M, Guay AT, Khera M, Traish AM. Testosterone therapy and cardiovascular risk: advances and controversies. Mayo Clin Proc 2015; 90:224-51. [PMID: 25636998 DOI: 10.1016/j.mayocp.2014.10.011] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/15/2014] [Accepted: 10/16/2014] [Indexed: 01/25/2023]
Abstract
Two recent studies raised new concerns regarding cardiovascular (CV) risks with testosterone (T) therapy. This article reviews those studies as well as the extensive literature on T and CV risks. A MEDLINE search was performed for the years 1940 to August 2014 using the following key words: testosterone, androgens, human, male, cardiovascular, stroke, cerebrovascular accident, myocardial infarction, heart attack, death, and mortality. The weight and direction of evidence was evaluated and level of evidence (LOE) assigned. Only 4 articles were identified that suggested increased CV risks with T prescriptions: 2 retrospective analyses with serious methodological limitations, 1 placebo-controlled trial with few major adverse cardiac events, and 1 meta-analysis that included questionable studies and events. In contrast, several dozen studies have reported a beneficial effect of normal T levels on CV risks and mortality. Mortality and incident coronary artery disease are inversely associated with serum T concentrations (LOE IIa), as is severity of coronary artery disease (LOE IIa). Testosterone therapy is associated with reduced obesity, fat mass, and waist circumference (LOE Ib) and also improves glycemic control (LOE IIa). Mortality was reduced with T therapy in 2 retrospective studies. Several RCTs in men with coronary artery disease or heart failure reported improved function in men who received T compared with placebo. The largest meta-analysis to date revealed no increase in CV risks in men who received T and reduced CV risk among those with metabolic disease. In summary, there is no convincing evidence of increased CV risks with T therapy. On the contrary, there appears to be a strong beneficial relationship between normal T and CV health that has not yet been widely appreciated.
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Almehmadi Y, Yassin DJ, Yassin AA. Erectile dysfunction is a prognostic indicator of comorbidities in men with late onset hypogonadism. Aging Male 2015; 18:186-94. [PMID: 26030350 DOI: 10.3109/13685538.2015.1046044] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The role of testosterone deficiency in erectile dysfunction (ED) is increasingly recognized; however, there is a need to clarify the nature of the relationship between ED and late onset hypogonadism (LOH). AIM In this study, we sought to determine the correlators of ED severity amongst men with LOH. METHODS 130 patients diagnosed with LOH fulfilling the criteria of total testosterone ≤3.5 ng/ml (<12 nmol/l) and with an erectile function domain score <21 on the International Index of Erectile Function questionnaire (IIEF questions 1-5) were enrolled for a subsequent trial of Testosterone Undecanoate. Demographic data were recorded at baseline. MAIN OUTCOME MEASURES Subjects completed three standardised questionnaires to assess sexual health including International Prostate Symptom Score (IPSS), Aging Males Symptoms (AMS) and IIEF Sexual Health Inventory for Men (SHIM). Patients were stratified by ED severity with SHIM scores of 1-7 considered severe ED, 8-11 moderate ED and 12-16 mild to moderate. Serum testosterone, sex hormone binding globulin (SHBG) and lipids (total cholesterol, triglycerides, high-density lipoprotein and low-density lipoprotein) were assessed along with plasma fasting glucose and HbA1c. Weight, BMI and waist circumference were also recorded. RESULTS A significant association was observed between severity of ED and mean weight (p = 0.000), waist circumference (p = 0.000), triglycerides (p = 0.009), total cholesterol (p = 0.027), HbA1c (p = 0.000), fasting glucose (p = 0.003) and AMS scores (p = 0.043). No significant differences were seen in testosterone fractions and SHBG levels between ED subgroups. A positive correlation existed between the prevalence of diabetes mellitus (type 1 and type 2) and ED severity in this cohort (p = 0.018). CONCLUSIONS The descriptive data of our cohort show that increased severity of ED within LOH patients correlated with an increased waist circumference, hyperglycemia, hypertriglyceridemia, hyperlipidemia and a history of diabetes mellitus. Severe ED functions as a prognostic indicator of co-morbidities in men with LOH.
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Affiliation(s)
- Yousef Almehmadi
- a Institute of Urology/Andrology , Norderstedt, Hamburg , Germany
| | - Dany-Jan Yassin
- b Department of Urology , Klinikum Braunschweig , Braunschweig , Germany , and
| | - Aksam A Yassin
- a Institute of Urology/Andrology , Norderstedt, Hamburg , Germany
- c Dresden International University , Dresden , Germany
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Hans SS, Dhindsa SS, Chemitiganti R. Testosterone Replacement and Cardiovascular Safety: No Straight and Narrow! CLINICAL MEDICINE INSIGHTS: CARDIOLOGY 2015; 9:33-7. [PMID: 25983562 PMCID: PMC4412415 DOI: 10.4137/cmc.s23395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 02/10/2015] [Accepted: 02/21/2015] [Indexed: 11/05/2022] Open
Abstract
The past decade has seen a tremendous increase in the number of men treated for hypogonadism with the expectation of symptomatic benefit. However, the long-term cardiovascular safety of testosterone replacement remains unknown because retrospective studies of testosterone replacement have been inconsistent, and definitive, prospective, randomized studies are lacking. The purpose of this review is to critically appraise the studies on testosterone replacement and cardiovascular outcomes.
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Affiliation(s)
- Sartaj S. Hans
- Division of Cardiology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sandeep S. Dhindsa
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Texas Tech University Health Sciences Center – Permian Basin Campus, Odessa, TX, USA
| | - Rama Chemitiganti
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Texas Tech University Health Sciences Center – Permian Basin Campus, Odessa, TX, USA
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20
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Muraleedharan V, Jones TH. Testosterone and mortality. Clin Endocrinol (Oxf) 2014; 81:477-87. [PMID: 25041142 DOI: 10.1111/cen.12503] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/11/2014] [Accepted: 05/13/2014] [Indexed: 11/26/2022]
Abstract
Epidemiological studies have found that men with low or low normal endogenous testosterone are at an increased risk of mortality than those with higher levels. Cardiovascular disease accounts for the greater proportion of deaths in those with low testosterone. Cancer and respiratory deaths in some of the studies are also significantly more prevalent. Disease-specific studies have identified that there are higher mortality rates in men with cardiovascular, respiratory and renal diseases, type 2 diabetes and cancer with low testosterone. Obesity, metabolic syndrome, type 2 diabetes, cardiovascular disease and inflammatory disorders are all associated with an increased prevalence of testosterone deficiency. Two major questions that arise from these findings are (1) is testosterone deficiency directly involved in the pathogenesis of these conditions and/or a contributory factor impairing the body's natural defences or is it merely a biomarker of ill health and the severity of underlying disease process? (2) Does testosterone replacement therapy retard disease progression and ultimately enhance the clinical prognosis and survival? This review will discuss the current state of knowledge and discuss whether or not there are any answers to either of these questions. There is convincing evidence that low testosterone is a biomarker for disease severity and mortality. Testosterone deficiency is associated with adverse effects on certain cardiovascular risk factors that when combined could potentially promote atherosclerosis. The issue of whether or not testosterone replacement therapy improves outcomes is controversial. Two retrospective studies in men with diagnosed hypogonadism with or without type 2 diabetes have reported significantly improved survival.
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Affiliation(s)
- Vakkat Muraleedharan
- Robert Hague Centre for Diabetes & Endocrinology, Barnsley Hospital, NHS Foundation Trust, Barnsley; Department of Human Metabolism, University of Sheffield Medical School, Sheffield, UK
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21
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Zarotsky V, Huang MY, Carman W, Morgentaler A, Singhal PK, Coffin D, Jones TH. Systematic literature review of the risk factors, comorbidities, and consequences of hypogonadism in men. Andrology 2014; 2:819-34. [PMID: 25269643 DOI: 10.1111/andr.274] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 08/05/2014] [Accepted: 08/12/2014] [Indexed: 12/16/2022]
Affiliation(s)
- V. Zarotsky
- Product Value Strategy Consulting; Optum; Eden Prairie MN USA
| | - M.-Y. Huang
- Global Health Outcomes; Merck & Co. Inc.; West Point PA USA
- School of Pharmacy; Temple University; Philadelphia PA USA
| | - W. Carman
- Epidemiology; Optum; Ann Arbor MI USA
| | - A. Morgentaler
- Men's Health Boston; Brookline MA USA
- Harvard Medical School; Boston MA USA
| | - P. K. Singhal
- Global Health Outcomes; Merck & Co. Inc.; West Point PA USA
| | - D. Coffin
- Boolean Research Consulting; Westmount QC Canada
| | - T. H. Jones
- Robert Hague Centre for Diabetes and Endocrinology; Barnsley Hospital NHS Foundation Trust; Barnsley UK
- Department of Human Metabolism; School of Medicine and Biomedical Sciences; University of Sheffield; Sheffield UK
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22
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Abstract
PURPOSE OF REVIEW The purpose of this study is to review recent studies that examined the association of endogenous and exogenous testosterone and mortality in older men. RECENT FINDINGS Over the past several years, there has been a steep rise in testosterone prescriptions. The increased use of testosterone occurred in the context of several studies that reported an association between low serum testosterone and increased cardiovascular events and mortality. In contrast, recent studies have reported an association between testosterone treatment and adverse events. A testosterone treatment trial of mobility-impaired elderly men with prevalent cardiovascular disease was stopped due to increased cardiovascular events in the T-treated men and a meta-analysis reported increased cardiovascular events in T-treated men. In two recent large observational studies, testosterone treatment was associated with an increased risk for serious adverse cardiovascular events. SUMMARY Low testosterone is associated with mortality in multiple cohort studies; however, it is unclear if this is a causal association or due to low testosterone being a biomarker of poor health. Given recent reports of adverse outcomes associated with testosterone treatment, a conservative use of testosterone is warranted in men with cardiovascular disease who may be at greater risk for adverse outcomes.
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Affiliation(s)
- Molly M. Shores
- VA Puget Sound Health Care System, Seattle, WA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Alvin M. Matsumoto
- Department of Medicine, Division of Gerontology & Geriatric Medicine, University of Washington, Seattle, WA
- Geriatric Research, Education and Clinical Care (GRECC), Seattle, WA
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23
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Shores MM, Biggs ML, Arnold AM, Smith NL, Longstreth WT, Kizer JR, Hirsch CH, Cappola AR, Matsumoto AM. Testosterone, dihydrotestosterone, and incident cardiovascular disease and mortality in the cardiovascular health study. J Clin Endocrinol Metab 2014; 99:2061-8. [PMID: 24628549 PMCID: PMC4037728 DOI: 10.1210/jc.2013-3576] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Low testosterone (T) is associated with prevalent cardiovascular disease (CVD) and mortality. DHT, a more potent androgen, may also be associated with CVD and mortality, but few studies have examined this. OBJECTIVE The study objective was to examine whether T and DHT are risk factors for incident CVD and mortality. DESIGN In a longitudinal cohort study, we evaluated whether total T, calculated free T (cFT), DHT, and calculated free DHT were associated with incident CVD and mortality in men in the Cardiovascular Health Study (mean age 76, range 66-97 years) who were free of CVD at the time of blood collection. MAIN OUTCOME The main outcomes were incident CVD and all-cause mortality. RESULTS Among 1032 men followed for a median of 9 years, 436 incident CVD events and 777 deaths occurred. In models adjusted for cardiovascular risk factors, total T and cFT were not associated with incident CVD or all-cause mortality, whereas DHT and calculated free DHT had curvilinear associations with incident CVD (P < .002 and P = .04, respectively) and all-cause mortality (P < .001 for both). CONCLUSIONS In a cohort of elderly men, DHT and calculated free DHT were associated with incident CVD and all-cause mortality. Further studies are needed to confirm these results and to clarify the underlying physiologic mechanisms.
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Affiliation(s)
- Molly M Shores
- VA Puget Sound Health Care System (M.M.S., N.L.S., A.M.M.), VA Epidemiologic Research and Information Center (N.L.S.), and Geriatric Research, Education, and Clinical Care (A.M.M.), Seattle, Washington 98108; Departments of Psychiatry and Behavioral Sciences (M.M.S.), Biostatistics (M.L.B., A.M.A.), Epidemiology (N.L.S., W.T.L.), Neurology (W.T.L.), and Medicine (A.M.M.), Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington 98195; Department of Medicine and Department of Epidemiology and Population Health (J.R.K.), Albert Einstein College of Medicine, Bronx, New York 10461; Department of Internal Medicine (C.H.H.), Geriatric Medicine, University of California-Davis, Davis, California 95616; and Department of Internal Medicine (A.R.C.), Endocrinology Division, University of Pennsylvania, Philadelphia, Pennsylvania 19104
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24
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Su JJ, Park SK, Hsieh TM. The Effect of Testosterone on Cardiovascular Disease. Am J Mens Health 2014; 8:470-91. [DOI: 10.1177/1557988314522642] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Cardiovascular disease is the leading cause of death in the United States. Testosterone is the principal male sex hormone and plays an important role in men’s health and well-being. Historically, testosterone was believed to adversely affect cardiovascular function. However, contemporary literature has refuted this traditional thinking; testosterone has been suggested to have a protective effect on cardiovascular function through its effects on the vascular system. Data from modern research indicate that hypogonadism is closely related to the development of various cardiovascular risk factors, including hyperlipidemia and insulin resistance. Several studies have demonstrated beneficial effects of testosterone supplementation therapy on reversing symptoms of hypogonadism and improving cardiovascular disease risk profiles. In this review, we perform a critical analysis on the association between testosterone and cardiovascular disease.
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Muraleedharan V, Marsh H, Kapoor D, Channer KS, Jones TH. Testosterone deficiency is associated with increased risk of mortality and testosterone replacement improves survival in men with type 2 diabetes. Eur J Endocrinol 2013; 169:725-33. [PMID: 23999642 DOI: 10.1530/eje-13-0321] [Citation(s) in RCA: 246] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Men with type 2 diabetes are known to have a high prevalence of testosterone deficiency. No long-term data are available regarding testosterone and mortality in men with type 2 diabetes or any effect of testosterone replacement therapy (TRT). We report a 6-year follow-up study to examine the effect of baseline testosterone and TRT on all-cause mortality in men with type 2 diabetes and low testosterone. RESEARCH DESIGN AND METHODS A total of 581 men with type 2 diabetes who had testosterone levels performed between 2002 and 2005 were followed up for a mean period of 5.81.3 S.D. years. mortality rates were compared between total testosterone 10.4nmol/l (300ng/dl; n=343) and testosterone 10.4nmol/l (n=238). the effect of TRT (as per normal clinical practise: 85.9% testosterone gel and 14.1% intramuscular testosterone undecanoate) was assessed retrospectively within the low testosterone group. RESULTS Mortality was increased in the low testosterone group (17.2%) compared with the normal testosterone group (9%; P=0.003) when controlled for covariates. In the Cox regression model, multivariate-adjusted hazard ratio (HR) for decreased survival was 2.02 (P=0.009, 95% CI 1.2-3.4). TRT (mean duration 41.6±20.7 months; n=64) was associated with a reduced mortality of 8.4% compared with 19.2% (P=0.002) in the untreated group (n=174). The multivariate-adjusted HR for decreased survival in the untreated group was 2.3 (95% CI 1.3-3.9, P=0.004). CONCLUSIONS Low testosterone levels predict an increase in all-cause mortality during long-term follow-up. Testosterone replacement may improve survival in hypogonadal men with type 2 diabetes.
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Affiliation(s)
- Vakkat Muraleedharan
- Robert Hague Centre for Diabetes and Endocrinology, Barnsley Hospital NHSFT, Gawber Road, Barnsley S75 2EP, UK
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26
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Abstract
Coronary heart disease is a leading cause of premature death in men. Epidemiological studies have shown a high prevalence of low serum testosterone levels in men with cardiovascular disease (CVD). Furthermore, a low testosterone level is associated in some but not in all observational studies with an increase in cardiovascular events and mortality. Testosterone has beneficial effects on several cardiovascular risk factors, which include cholesterol, endothelial dysfunction and inflammation: key mediators of atherosclerosis. A bidirectional relationship between low endogenous testosterone levels and concurrent illness complicates attempts to validate causality in this association and potential mechanistic actions are complex. Testosterone is a vasoactive hormone that predominantly has vasodilatory actions on several vascular beds, although some studies have reported conflicting effects. In clinical studies, acute and chronic testosterone administration increases coronary artery diameter and flow, improves cardiac ischaemia and symptoms in men with chronic stable angina and reduces peripheral vascular resistance in chronic heart failure. Although the mechanism of the action of testosterone on vascular tone in vivo is not understood, laboratory research has found that testosterone is an L-calcium channel blocker and induces potassium channel activation in vascular smooth muscle cells. Animal studies have consistently demonstrated that testosterone is atheroprotective, whereas testosterone deficiency promotes the early stages of atherogenesis. The translational effects of testosterone between in vitro animal and human studies, some of which have conflicting effects, will be discussed in this review. We review the evidence for a role of testosterone in vascular health, its therapeutic potential and safety in hypogonadal men with CVD, and some of the possible underlying mechanisms.
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Affiliation(s)
- Daniel M Kelly
- Department of Human Metabolism, Medical School, The University of Sheffield, Sheffield S10 2RX, UK
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27
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Saboor Aftab SA, Kumar S, Barber TM. The role of obesity and type 2 diabetes mellitus in the development of male obesity-associated secondary hypogonadism. Clin Endocrinol (Oxf) 2013; 78:330-7. [PMID: 23121123 DOI: 10.1111/cen.12092] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 07/02/2012] [Accepted: 10/30/2012] [Indexed: 12/24/2022]
Abstract
Obesity, secondary (hypogonadotrophic) hypogonadism (SH), sleep disorders [such as obstructive sleep apnoea (OSA)] and type 2 diabetes mellitus (T2DM) in men have complex interlinks both with respect to mutual aetiopathogenesis as well as therapeutics. Correction of the attendant hypogonadism in obese men may serve to break this link and have beneficial effects beyond restoration of normal sexual function. Male obesity-associated secondary hypogonadism (MOSH) should be regarded as a distinct clinical entity and subtype of SH. A high index of suspicion for the presence of MOSH must be maintained by clinicians when assessing obese men. The pathogenesis of MOSH remains incompletely understood. Furthermore, the optimal management of MOSH and its associated sequelae will require long-term prospective studies that in turn will inform the development of future clinical guidelines for this important and prevalent condition.
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Affiliation(s)
- S A Saboor Aftab
- Clinical Sciences Research Laboratories, Division of Metabolic and Vascular Health, Warwick Medical School, The University of Warwick, University Hospitals Coventry and Warwickshire, Coventry, UK
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Yeap BB, Araujo AB, Wittert GA. Do low testosterone levels contribute to ill-health during male ageing? Crit Rev Clin Lab Sci 2012; 49:168-82. [PMID: 23094995 DOI: 10.3109/10408363.2012.725461] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Testosterone regulates male sexual development and body composition. In adult men, testosterone levels exhibit a gradual decline with increasing age. Whether it is age per se or health and behaviour related factors that are responsible for this decline, and the implications thereof for subsequent health remain controversial. Observational studies report associations of lower testosterone levels with poorer health outcomes in ageing men, including frailty, reduced sexual activity, insulin resistance and cardiovascular events and mortality. However, outcome data from randomised clinical trials of testosterone are limited, and are lacking for major endpoints such as cardiovascular events. The risks and benefits of testosterone intervention in older men require further clarification. This article will review the role of testosterone in men, discuss epidemiological and interventional data illuminating its potential role to preserve health during male ageing, consider the limitations of the evidence base and implications for clinical practice, and explore future directions for research in this topical area.
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Affiliation(s)
- Bu B Yeap
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia.
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Cattabiani C, Basaria S, Ceda GP, Luci M, Vignali A, Lauretani F, Valenti G, Volpi R, Maggio M. Relationship between testosterone deficiency and cardiovascular risk and mortality in adult men. J Endocrinol Invest 2012; 35:104-20. [PMID: 22082684 DOI: 10.3275/8061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Classic male hypogonadism is associated with known adverse effects including decreased libido, erectile dysfunction, osteoporosis, and changes in body composition. Recently, we have come to appreciate that reduction in serum testosterone (T) levels resulting from aging or chronic disease or androgen deprivation therapy (ADT) have consequences similar to those seen in classic male hypogonadism which include increased fat mass, decreased lean body mass, decreased muscle strength, and sexual dysfunction. These data suggest that low T levels may represent a newly recognized cardiometabolic risk factor. Therefore, we carried out a careful review of the literature, focusing on major turning points of research and studies which gave more important and controversial contribution to the cardiovascular role of T. Observational studies and clinical trials investigating the relationship between T levels and cardiovascular disease and mortality were identified byMedline search. The results were synthesized, tabulated, and interpreted. The aim of this review is to discuss the association between low T levels and adverse metabolic profile such as insulin resistance, metabolic syndrome, and diabetes. We will also investigate the potential mechanisms by which male hypogonadism, especially age related or induced by ADT, may increase cardio-metabolic risk. Finally we will detail the emerging relationship between low T and mortality in men addressing also the reverse hypothesis that low T has a protective role by turning off T-dependent functions.
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Affiliation(s)
- C Cattabiani
- Department of Internal Medicine and Biomedical Sciences, Section of Geriatrics, University of Parma, Parma, Italy
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Abstract
Studies over the last few years have clearly established that at least 25% of men with type 2 diabetes have subnormal free testosterone concentrations in association with inappropriately low LH and FSH concentrations. Another 4% have subnormal testosterone concentrations with elevated LH and FSH concentrations. The Endocrine Society, therefore, now recommends the measurement of testosterone in patients with type 2 diabetes on a routine basis. The subnormal testosterone concentrations are not related to glycosylated hemoglobin or duration of diabetes, but are associated with obesity, very high C-reactive protein concentrations, and mild anemia. In addition, subnormal testosterone concentrations in these men are associated with a two to three times elevated risk of cardiovascular events and death in two early studies. Short-term studies of testosterone therapy in hypogonadal men with type 2 diabetes have demonstrated an increase in insulin sensitivity and a decrease in waist circumference. However, the data on the effect of testosterone replacement on glycemic control and cardiovascular risk factors such as cholesterol and C-reactive protein concentrations are inconsistent. As far as sexual function is concerned, testosterone treatment increases libido but does not improve erectile dysfunction and thus, phosphodiesterase inhibitors may be required. Trials of a longer duration are clearly required to definitively establish the benefits and risks of testosterone replacement in patients with type 2 diabetes and low testosterone.
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Affiliation(s)
- Paresh Dandona
- Division of Endocrinology, State University of New York at Buffalo and Kaleida Health, Buffalo, New York 14209, USA.
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Abstract
The endocrinology of the aging male is complex, with multiple hormones along the hypothalamic-pituitary-testicular (HPT) axis interacting with one another in feedback. As men age, there is a small and progressive (not precipitous, as in women) decline in several sex hormones, in particular testosterone and dehydroepiandrosterone, and related increases in luteinizing hormone, follicle-stimulating hormone, and sex hormone-binding globulin. The importance of these changes is wide-ranging because of the ubiquitous role of sex hormones in male physiology. This chapter discusses the endocrinology of the aging male. We provide an overview of the regulation of the HPT axis with an emphasis on the changes that occur with aging and the measurement of gonadal steroids, including hormone pulsatility, within-subject and circadian variations. The difficulties of assessing the symptoms of late-onset hypogonadism are highlighted. There is a comprehensive discussion of the epidemiology of sex hormone changes, including their age associations, prevalence of symptomatic hypogonadism, secular changes, risk factors, and the association of sex hormones with outcomes.
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Affiliation(s)
- Andre B. Araujo
- Director, Epidemiology, New England Research Institutes, Inc., 9 Galen Street, Watertown, MA 02472, Tel: 617.923.7747 x452, Fax: 617.673.9509,
| | - Gary A. Wittert
- Head, Discipline of Medicine, The University of Adelaide, Principal Research Scientist, New England Research Institutes, Inc., Phone: +61 882225502, Fax: +61 882233870,
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Ventetuolo CE, Ouyang P, Bluemke DA, Tandri H, Barr RG, Bagiella E, Cappola AR, Bristow MR, Johnson C, Kronmal RA, Kizer JR, Lima JAC, Kawut SM. Sex hormones are associated with right ventricular structure and function: The MESA-right ventricle study. Am J Respir Crit Care Med 2011; 183:659-67. [PMID: 20889903 PMCID: PMC3081282 DOI: 10.1164/rccm.201007-1027oc] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Accepted: 09/30/2010] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Sex hormones have effects on the left ventricle, but hormonal influences on the right ventricle (RV) are unknown. OBJECTIVES We hypothesized that sex hormones would be associated with RV morphology in a large cohort free of cardiovascular disease. METHODS Sex hormones were measured by immunoassay and RV ejection fraction (RVEF), stroke volume (RVSV), mass, end-diastolic volume, and end-systolic volume (RVESV) were measured by cardiac magnetic resonance imaging in 1,957 men and 1,738 postmenopausal women. The relationship between each hormone and RV parameter was assessed by multivariate linear regression. MEASUREMENTS AND MAIN RESULTS Higher estradiol levels were associated with higher RVEF (β per 1 ln[nmol/L], 0.88; 95% confidence interval [CI], 0.32 to 1.43; P = 0.002) and lower RVESV (β per 1 ln[nmol/L], -0.87; 95% CI, -1.67 to -0.08; P = 0.03) in women using hormone therapy. In men, higher bioavailable testosterone levels were associated with higher RVSV (β per 1 ln[nmol/L], 1.97; 95% CI, 0.20 to 3.73; P = 0.03) and greater RV mass and volumes (P ≤ 0.01). Higher dehydroepiandrosterone levels were associated with higher RVSV (β per 1 ln[nmol/L], 1.37; 95% CI, 0.15 to 2.59; P = 0.03) and greater RV mass (β per 1 ln[nmol/L], 0.25; 95% CI, 0.00 to 0.49; P = 0.05) and volumes (P ≤ 0.001) in women. CONCLUSIONS Higher estradiol levels were associated with better RV systolic function in women using hormone therapy. Higher levels of androgens were associated with greater RV mass and volumes in both sexes.
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Affiliation(s)
- Corey E. Ventetuolo
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Pamela Ouyang
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - David A. Bluemke
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Harikrishna Tandri
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - R. Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Emilia Bagiella
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Anne R. Cappola
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Michael R. Bristow
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Craig Johnson
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Richard A. Kronmal
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Jorge R. Kizer
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Joao A. C. Lima
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
| | - Steven M. Kawut
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, Maryland; Department of Epidemiology and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Department of Medicine, Penn Cardiovascular Institute, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, Anschutz Medical Center, University of Colorado Denver, Aurora, Colorado; Department of Biostatistics, University of Washington, Seattle, Washington; and Department of Medicine and Department of Public Health, Weill-Cornell Medical College, New York, New York
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Corona G, Lotti F, Sforza A, Maggi M, Chiarini V. Obesità, sindrome metabolica ipogonadismo maschile e rischio cardiovascolare. ITALIAN JOURNAL OF MEDICINE 2009. [DOI: 10.1016/j.itjm.2009.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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