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Claes Ohlsson, Journal of American College of Cardiology: High Serum Testosterone Is Associated With Reduced Risk of Cardiovascular Events in Elderly Men

High Serum Testosterone Is Associated With Reduced Risk of Cardiovascular Events in Elderly Men
by Claes Ohlsson, MD, PhD*,Elizabeth Barrett-Connor, MD{ddagger},Shalender Bhasin, MD, PhD§, Eric Orwoll, MD, PhD||,Fernand Labrie, MD, PhD,Magnus K. Karlsson, MD, PhD#,Östen Ljunggren, MD, PhD**,Liesbeth Vandenput, PharmD, PhD*,Dan Mellström, MD, PhD* andÅsa Tivesten, MD, PhD{dagger}
,*, [n0tes after the fold —rk]

J Am Coll Cardiol, 2011; 58:1674-1681, doi:10.1016/j.jacc.2011.07.019
© 2011 by the American College of Cardiology Foundation

Objectives: We tested the hypothesis that serum total testosterone and sex hormone–binding globulin (SHBG) levels predict cardiovascular (CV) events in community-dwelling elderly men.

Background: Low serum testosterone is associated with increased adiposity, an adverse metabolic risk profile, and atherosclerosis. However, few prospective studies have demonstrated a protective link between endogenous testosterone and CV events. Polymorphisms in the SHBG gene are associated with risk of type 2 diabetes, but few studies have addressed SHBG as a predictor of CV events.

Methods: We used gas chromatography/mass spectrometry to analyze baseline levels of testosterone in the prospective population-based MrOS (Osteoporotic Fractures in Men) Sweden study (2,416 men, age 69 to 81 years). SHBG was measured by immunoradiometric assay. CV clinical outcomes were obtained from central Swedish registers.

Results: During a median 5-year follow-up, 485 CV events occurred. Both total testosterone and SHBG levels were inversely associated with the risk of CV events (trend over quartiles: p = 0.009 and p = 0.012, respectively). Men in the highest quartile of testosterone (≥550 ng/dl) had a lower risk of CV events compared with men in the 3 lower quartiles (hazard ratio: 0.70, 95% confidence interval: 0.56 to 0.88). This association remained after adjustment for traditional CV risk factors and was not materially changed in analyses excluding men with known CV disease at baseline (hazard ratio: 0.71, 95% confidence interval: 0.53 to 0.95). In models that included both testosterone and SHBG, testosterone but not SHBG predicted CV risk.

Conclusions: High serum testosterone predicted a reduced 5-year risk of CV events in elderly men.

* Centre for Bone and Arthritis Research, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
{dagger} Wallenberg Laboratory for Cardiovascular Research, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
{ddagger} Department of Family and Preventive Medicine, School of Medicine, University of California San Diego, La Jolla, California
§ Section of Endocrinology, Diabetes, and Nutrition, Boston School of Medicine and Boston Medical Center, Boston, Massachusetts
|| Bone and Mineral Unit, Oregon Health & Science University, Portland, Oregon
 Laboratory of Molecular Endocrinology and Oncology, Laval University, Québec, Québec, Canada
# Department of Clinical Sciences and Orthopaedics, Lund University, Malmö, Sweden
** Department of Medical Sciences, University of Uppsala, Uppsala, Sweden

Manuscript received February 26, 2011; accepted July 7, 2011.

* Reprint requests and correspondence: Dr. Åsa Tivesten, Wallenberg Laboratory for Cardiovascular Research, Bruna Stråket 16, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden (



Key Words: cardiovascular disease • men • testosterone

Abbreviations and Acronyms
  Apo = apolipoprotein
  BMI = body mass index
  CHD = coronary heart disease
  CI = confidence interval
  CV = cardiovascular
  HR = hazard ratio
  ICD = International Classification of Diseases
  SHBG = sex hormone-binding globulin

Related Article


Inside This Issue
J. Am. Coll. Cardiol. 2011 58: A26. [Full Text] [PDF]



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