Low Testosterone & Cardiac Health
Testosterone and Cardiovascular Disease
Cardiovascular Disease (CVD) refers to diseases of the heart and blood vessels. Examples of diseases in this category are congestive heart failure, coronary artery disease, angina, high blood pressure and stroke. Cardiovascular disease, in many cases, is caused by atherosclerosis - an excess build-up of plaque on the inner wall of a large blood vessel, which restricts blood flow.
In a small observational study comparing men presenting for scheduled angiography, testosterone levels were significantly lower in males with coronary artery disease compared to men with normal coronaries. (1)
Reports tell us that testosterone that is acquired from outside the body's own testosterone-making system (exogenous testosterone) is associated with a reduced risk of cardiovascular disease and more favorable levels of certain risk factors for heart disease; however, the relationship between the development of cardiovascular disease and serum testosterone levels remains uncertain.
Elevated lipids and apoproteins in the blood are risk factors associated with cardiovascular diseases, in particular, high total cholesterol and high LDL (low density lipoprotein). These lipids are pro-atherogenic – they may form deposits in the walls of the blood vessels - whereas HDL (high density lipoprotein) is protective against these deposits.
There is a more consistent relationship with testosterone and other lipid fractions. The good news is that when elderly and hypogonadal populations are studied, total cholesterol, LDL and apoprotein go down when patients are treated with exogenous testosterone.
A study measuring the effects of testosterone replacement on lipid levels in the hypogonadal population, showed reductions of up to 22% in total cholesterol and 15% in LDL.(2)
High blood pressure (hypertension) is another established risk factor for coronary artery disease, and lowering high blood pressure reduces the risk of cardiovascular events. Interestingly, testosterone levels are lower in men with hypertension than in men with normal blood pressures. This may be because testosterone causes dilation of the blood vessels by reducing peripheral vascular resistance; therefore, lowering blood pressure.
Patients with vascular disease try and lower the incidence of repeat problems, thereby prolonging their life and helping the quality of their life. Secondary prevention efforts go a long way toward accomplishing this goal. Now, there are well-established therapies for coronary disease that target the known cardiovascular risk factors. There is a lot of evidence that suggests that testosterone treatment in men has potentially beneficial effects on virtually all of the coronary risk factors, and helps the quality of life in patients with symptomatic coronary disease. This is important, since it is rare that a secondary prevention treatment can make a patient feel better.
To learn more about testosterone treatment options, please call Dr. Werner's office at (646) 380-2700 in NYC, (914) 997-4100 in Westchester, or (203) 831-9900 in Connecticut, or send us an email at firstname.lastname@example.org.
(1) English KM, Mandour O, Steeds RP, Diver MJ, Jones TH, Channer KS. Men with coronary artery disease have lower levels of androgens than men with normal coronary angiograms. Eur Heart J 2000; 21:890–4.
(2) Zgliczynski S, Ossowski M, Slowinska-Srzednicka J, Brzezinska A, Zglicznski W, Soszynski P, Chotkowska E, Srzednicki M, Sadowski Z. Effect of testosterone replacement therapy on lipids and lipoproteins in hypogonadal and elderly men. Atherosclerosis 1996; 121:35–43.