This article is more than 5 years old. Information may no longer be current.
Atherosclerosis risk increased among men with diabetes, low testosterone
A greater risk for developing atherosclerosis is found among middle-aged men with low testosterone and type 2 diabetes, according to recent study findings published in The Journal of Clinical Endocrinology & Metabolism.
“Our study indicates a strong association between low testosterone concentration and the severity of atherosclerotic plaques as well as other key atherosclerotic markers in middle-aged men with type 2 diabetes,” Javier Mauricio Farias, MD, of the Hospital Universitario Sanatorio Guemes in Buenos Aires, said in a press release. “The results of our study advance our understanding of the interplay between low testosterone and cardiovascular disease in patients with diabetes.”
Farias and colleagues conducted a cross-sectional prospective study among 115 men younger than 70 years with type 2 diabetes and no history of CVD to determine the effect of testosterone levels on the development of atherosclerosis. Participants were divided into either normal (≥12.1 nmol/L; n=79) or low (≤12.1 nmol/L; n=36) total testosterone levels, whereas free testosterone levels <70 pg/mL were present in 48 participants. All participants underwent measurements for highly sensitive C-reactive protein (Hs-CRP), carotid artery carotid intima-media thickness (IMT) and atherosclerotic plaque, as well as being assessed for endothelial function.
The normal testosterone level group had higher HDL cholesterol levels (P<.002). The low total testosterone group had lower mean total testosterone levels, free testosterone levels and sex hormone-binding globulin. Participants with low and normal testosterone had similar treatments for type 2 diabetes and other pharmacological treatments. The most common treatment was metformin (55%), followed by insulin secretagogues (approximately 30%), DPP-IV (10%) and insulin (5.5%). Forty-five percent of the low and normal testosterone groups used statins, whereas 48.6% of those in the low testosterone group and 53% in the normal testosterone group used angiotensin-converting enzyme inhibitors.
Patients with low testosterone had higher IMT compared with those with normal testosterone (P<.0001). Compared with the normal free testosterone group, those in the low free testosterone group had higher IMT (P<.0001). More patients in the low testosterone group (80%) had an IMT of ≥0.1 cm compared with those with low testosterone (39%). Atherosclerotic plaques were found more often among participants with low testosterone (68.5%) vs. those with normal testosterone (44.8%; P<.02). Participants with normal or low free testosterone had similar plaque presence (P<.65).
Participants with positive endothelial function had serum total testosterone levels of 13.52 nmol/L and free testosterone levels of 96.5 pg/mL, whereas participants without endothelial dysfunction had serum total testosterone levels of 18 nmol/L and free testosterone levels of 66.1 pg/mL (P<.001). The low total testosterone group had significantly higher Hs-CRP concentrations compared with the normal testosterone group (P<.0001). A higher risk for vascular disease was found among 54% of participants with low total testosterone and 10% with normal testosterone.
“We still need to determine whether testosterone is directly involved in the development of atherosclerosis or if it is merely an indicator of advanced disease,” Farias said. “This study is a stepping stone to better understanding the risks of cardiovascular events in men who have both low testosterone and type 2 diabetes.”
Disclosure: See the full study for a complete list of the researchers’ financial disclosures.