Cardiology Letters 2018, 27(2):87-93

Gonadal status in males with acute coronary syndrome and the extent of coronary artery disease: a comparative cross-sectional analysis

Bednarova A¹, Koller T¹, Kuzma M¹, Cenkerova K², Malacky T², Payer J¹

¹ Comenius University Faculty of Medicine, 5th Department of Internal Medicine, University Hospital Bratislava

² Department of Cardiology, National Institute of Cardiovascular Diseases, Bratislava, Slovak Republic

Introduction and aims: Association between coronary artery disease (CAD) and male gonadal status has been previously suggested, but still remains inconclusive. The aims of our study in males with recent acute coronary syndrome (ACS) were to evaluate the prevalence of hypogonadism, to compare their gonadal status with non-ACS matched controls and to evaluate gonadal status by the extent of CAD.

Subjects and methods: A cross-sectional retrospective study included 96 males with recent ACS and age and 49 BMI matched non-ACS controls. Basic demography and standard CAD risk factors were recorded as well as fasting serum levels of total testosterone (TT), sex hormone binding globulin (SHBG), estradiol, follicle-stimulating and luteinizing hormone (FSH and LH) and calculated free androgen index (FAI). First, we evaluated the prevalence of hypogonadism (TT< 7 nmol/l and FAI<24%). Second, we compared patients and control group for ACS associated factors on univariate and multivariate analysis. Third, using the same analysis in patients undergoing coronary angiography we aimed at identifying factors associated with CAD extent (0-1 vessel vs. 2-3 vessel disease).

Results: 96 patients and 49 controls were included. Hypogonadism was confirmed in 20.8% of patients. Patients had lower levels of TT (12.638 ±6.138 vs. 15.702±4.903, p<0.01), FAI (30.292 ±12.489 vs. 36.902 ±9.816, p<0.01) and higher levels of LH (5.58 IQR 4.4-8.21 vs. 5.0 IQR 3.64- 6.35, p=0.04) compared with controls. In multivariate analysis, smoking, hypertension, dyslipidemia and FAI were identified as factors independently associated with ACS. 73 patients underwent coronary angiography, 43 had findings of 2-3 vessel disease. Hypertension, BMI and FAI were found as associated factors with CAD extent and FAI as its single independent risk factor.

Conclusion: Lower gonadal status was found common (20.8%) in males with recent ACS. It was independent on standard ACS risk factors and was independently associated with CAD extent.

Keywords: acute coronary syndrome; testosterone; free androgen index

Published: February 1, 2018  Show citation