Oral Virtual Presentation (Virtual only) ESA-SRB-ANZBMS 2021

Low blood levels of testosterone and DHEA are associated with an increased risk of ischemic cardiovascular events in older women (#57)

Rakibul M Islam 1 , Robin J Bell 1 , David J Handelsman 2 , John J McNeil 1 , Mark R Nelson 3 , Christopher M Reid 4 , Andrew M Tonkin 1 , Rory Wolfe 1 , Susan R Davis 1
  1. Monash University, Melbourne, VIC, Australia
  2. University of Sydney, Sydney
  3. University of Tasmania, Hobart
  4. Curtin University, Western Australia

Background

Whether higher circulating testosterone is favourable or disadvantageous for ischemic cardiovascular risk and total mortality in older women is not known

 

Methods

Australian women, aged 70+ years, with no prior cardiovascular disease events, dementia, or physical disability were recruited between 2010 and 2014. The primary endpoint for this study was major adverse cardiovascular events (MACE): fatal coronary heart disease (excluding heart failure), nonfatal myocardial infarction, and fatal or nonfatal ischemic stroke. All-cause mortality was examined. Sex steroids were measured by liquid chromatography, tandem mass spectrometry.

 

Results

Of the 9187 Australian female participants, 6392 provided biobank samples and 6358 had sex steroid measured.  The included women were aged 70 to 94·8 years, median (IQR)= 73.9 (5.8). Most (98·9%) were of European ancestry, 66% had two or more cardiovascular disease risk factors and 31% were obese. After a median of 4.5 years of follow-up (28,187 person-years) 158 of the 6358 women experienced a first ever MACE, an incidence rate of 5.6/1000 person-years.  After adjusting for likely confounders including the number of known cardiovascular disease risk factors, the hazard ratio (HR) for women in the 4th (highest) quartile of testosterone compared with the 1st (lowest) quartile was 0.53 [95% CI, 0.34-0.81, p=0.004]. The HR for Q3 was significantly different from Q1 (p=0.03) and Q2 approached significance (p=0.06). Compared with Q1, all other DHEA quartiles were associated with significantly lower risk of MACE in the fully adjusted models. Sex steroid concentrations were not significantly associated with all-cause mortality.

 

Conclusions

Testosterone and DHEA concentrations above the lowest quartile in older women are associated with a reduced risk of a first ever MACE. As the physiological effects of DHEA are mediated through its steroid metabolites, should these findings be replicated, primary prevention trials of testosterone to prevent MACE in older women would be warranted.