A J-shaped association between plasma testosterone and risk of ischemic arterial event in elderly men: The French 3C cohort study

Objectives

Low plasma testosterone is associated with increased mortality in men. However, the relation between testosterone and cardiovascular disease is uncertain. We assessed the association of plasma sex hormones with the incidence of ischemic arterial disease (IAD) in elderly men.

Methods

We used data from the French Three-City prospective cohort study (3650 men aged >65 years). A case-cohort design was set up including a random sample of 495 men and 146 incident cases of first IAD event (112 coronary heart disease (CHD) and 34 strokes) after a 4-year follow-up. Plasma total and bioavailable testosterone, total estradiol and sex hormone-binding globulin (SHBG) were measured at baseline. Multivariate hazard ratios (HRs) and 95% confidence intervals for IAD were assessed using Cox model.

Results

After adjustment for cardiovascular risk factors, a J-shaped association between plasma total testosterone and IAD risk was found (p < 0.01). The HRs associated with the lowest and the highest total testosterone quintiles relative to the second quintile were 2.23 (95% CI: 1.02; 4.88) and 3.61 (95% CI: 1.55; 8.45) respectively. Additional analysis for CHD showed similar results (HR: 3.11, 95% CI: 1.27; 7.63 and HR: 4.75, 95% CI: 1.75; 12.92, respectively). Similar J-shaped association was observed between bioavailable testosterone and IAD risk (p = 0.01). No significant association of estradiol and SHBG with IAD was found.

Conclusion

High and low plasma testosterone levels are associated with an increased risk of IAD in elderly men. Optimal range of plasma testosterone may confer cardiovascular protection and these results may have clinical implications in the management of testosterone deficiency.     

Hormone replacement therapy in menopause and the risk of cerebrovascular accident]

BACKGROUND AND PURPOSE: Hormone replacement therapy relieves climacteric symptom and prevents postmenopausal osteoporosis. A protective effect of estrogen against coronary heart disease remains debatable and inconclusive results have been reported with respect to the risk of stroke. We have therefore performed an updated quantitative assessment of the risk for stroke associated with hormone replacement therapy. METHODS: MEDLINE database was used. Studies analyzing postmenopausal women and considering any subtypes of stroke--i.e. fatal or non-fatal, ischaemic or haemorrhagic--as the outcome of interest were selected. An overall estimate was calculated as a weighted average of the odds ratios or relative risks, with the weights being the reciprocal of their variance. Random effects models were used to take into account the heterogeneity of data. RESULTS: Six case-control studies, seventeen cohort studies and one randomized trial were selected between 1978 and 1998. Seven studies assessed the risk of ischaemic stroke associated with hormone replacement therapy and the pooled estimate of the risk was 1.12 (95% confidence interval, 1.01 to 1.25). The random effects model showed an increased risk of 18% (relative risk 1.18, 95% confidence interval, 0.98 to 1.43). Regarding haemorrhagic stroke, the analysis based on two case-control studies and one cohort study showed a significantly reduced risk of 35%. Lastly, based on five studies, no significant change in the risk of subarachnoidal hemorrhage was found. CONCLUSION: This updated analysis suggests an increased risk for ischaemic stroke among postmenopausal women who use oral estrogen replacement therapy. No data regarding transdermal estrogen are available.     

Relations of cardiovascular risk factors to aortic pulse wave velocity in asymptomatic middle-aged women

Cross-sectional associations between aortic elasticity assessed by carotid to femoral pulse wave velocity (PWV) and cardiovascular risk factors were examined in 429 apparently healthy middle-aged women. PWV was strongly and positively related to blood pressure and hypertension. Weak but significant positive associations were also found between PWV and age, heart rate, some lipids and lipoproteins, blood glucose (either as a continuous or dichotomous variable), body mass index, haematocrit, leucocyte count and family history of diabetes. No associations were observed between PWV and high density lipoprotein cholesterol, apolipoprotein Al, fibrinogen, cigarette smoking, menopausal status and a family history of hypertension or myocardial infarction. After adjustment for systolic blood pressure, PWV remained significantly related to heart rate, leucocyte count, blood glucose (as a dichotomous variable) and a family history of diabetes. Multiple regression analysis showed that systolic blood pressure and, to a lesser extent, heart rate, leucocyte count and a family history of diabetes were all independent determinants of PWV. This pattern of associations suggests that arterial stiffness measured by PWV reflects the sclerotic rather than the atherotic component of atherosclerosis. The potential influence of a family history of diabetes on the elastic properties of the aorta needs to be ascertained in further studies.     

Dimensions of the aortic ring. Anatomic and surgical study of 2 series of patients

Both surgical (236 aortic valve replacements) and anatomical (62 dissections) studies have defined the aortic annulus diameter. Measurements (23.5 mm for women; 26 mm for men) are more considerable than established values. Furthermore, surgical study allows the authors to compare these results to several variables, more especially corporeal surface and stature: the height's increase perhaps explains the large sizes discovered.