1. ¹Centre for Clinical and Basic Research – IRCCS San Raffaele, Rome, Italy
2. ²Department of Cardiology, University of Turin, Italy
3. ³Department of Cardiology: Clinical Institute Humanitas, Milan, Italy
4. ⁴Department of Cardiology, University of Cagliari, Italy
5. ⁵Department Medical Pathophysiology, University of Rome 'La Sapienza', Rome, Italy

Correspondence: Dr A Aversa, Department Medical Pathophysiology, University of Rome La Sapienza, Viale Policlinico 155, Rome 00161, Italy. E-mail: antonio.aversa@uniroma1.it

Received 26 April 2006; Revised 12 May 2006; Accepted 19 June 2006; Published online 31 August 2006.

Abstract

Historically, high androgen levels have been linked with an increased risk for coronary artery disease (CAD). However, more recent data suggest that low androgen levels are associated with adverse cardiovascular risk factors, including an atherogenic lipid profile, obesity and insulin resistance. The aim of the present study was to evaluate the relationship between plasma sex hormone levels and presence and degree of CAD in patients undergoing coronary angiography and in matched controls. We evaluated 129 consecutive male patients (mean age 584 years, range 43–72 years) referred for diagnostic coronary angiography because of symptoms suggestive of CAD, but without acute coronary syndromes or prior diagnosis of hypogonadism. Patients were matched with healthy volunteers. Out of 129 patients, 119 had proven CAD; in particular, 32 of them had one, 63 had two and 24 had three vessel disease, respectively. Patients had significantly lower levels of testosterone than controls (9.86.5 and 13.55.4 nmol/l, P<0.01) and higher levels of gonadotrophin (12.01.5 vs 6.61.9 IU/l and 7.92.1 vs 4.41.4, P<0.01 for follicle-stimulating hormone and luteinizing hormone, respectively). Also, both bioavailable testosterone and plasma oestradiol levels were lower in patients as compared to controls (0.840.45 vs 1.190.74 nmol/l, P<0.01 and 10.71.4 vs 13.33.5 pg/ml, P<0.05). Hormone levels were compared in cases with one, two or three vessel disease showing significant differences associated with increasing severity of coronary disease. An inverse relationship between the degree of CAD and plasma testosterone levels was found (r=-0.52, P<0.01). In conclusion, patients with CAD have lower testosterone and oestradiol levels than healthy controls. These changes are inversely correlated to the degree of CAD, suggesting that low plasma testosterone may be involved with the increased risk of CAD in men.