Evaluation of sex hormone levels and some metabolic factors in men with coronary atherosclerosis

Abstract

Background: Because of the great controversy over the role of androgens in the pathogenesis of atherosclerosis, we investigated the relationship between serum sex hormone levels and angiographically confirmed coronary artery disease in men.

Material and methods: We investigated 86 men aged 40-60 years, 56 with coronary artery disease and 30 healthy men, matched by age, as a control group. Body mass index and waist to hip ratio were calculated and total body fat mass and percentage of abdominal deposit were investigated by dual-energy X-ray absorptiometry (Dpx (+) Lunar, USA). The serum levels of sex hormones and insulin were measured using commercial radioimmunoassay and IRMA (by SHBG) kits (DPC, USA). The serum levels of lipids and glucose were assessed by means of enzymatic methods.

Results: Men with coronary artery disease had lower total testosterone levels (17.01+/-6.42 vs. 19.37+/-6.58 nmol/l; p < 0.05), testosterone/estradiol ratio (228.5+/-88.5 vs. 289.8+/-120.1; p < 0.05) and free androgen index (FAI) (59.49+/-14.79 vs. 83.03+/-25.81; p < 0.0001), and higher levels of estrone (49.5+/-27.7 vs. 36.6+/-12.7 pg/ml) than men in the control group. Moreover, men with coronary artery disease were more insulin-resistant than controls and had an atherogenic lipid profile. There was an inverse correlation (p < 0.05) between testosterone level and serum level of glucose (r = -0.29), triglycerides (r= -0.37), body mass index (r= -0.55), waist (r = - 0.43), total body fat mass (r = - 0.3) and fasting insulin resistance index. A significant positive association (p < 0.05) was found between testosterone and the quantitative insulin sensitivity check index and high density lipoprotein cholesterol level in serum (r = 0.26).

Conclusions: Low levels of total testosterone, testosterone/estradiol ratio and free androgen index and higher levels of estrone in men with coronary artery disease appear together with many features of metabolic syndrome and may be involved in the pathogenesis of coronary atherosclerosis.