Background: there is an overt bias between cardiovascular morbidity and mortality in male and female patients. Research of the past decades postulated that this difference could be due to the lipid-lowering effect of male sexual-steroids, that show decreased values in cardiovascular disease.
Methods: the aim of our study was to determine total serum testosterone and dehydroepiandrosterone sulfate (DHEA-S) on a peripheral arterial disease patient’s cohort (n=35), in comparison with a healthy control group, (n=23) and to establish correlations with other biological risk factors like serum lipids, C-reactive protein, plasma fibrinogen, and the ankle-brachial pressure index.
Results: our results showed that total serum testosterone and DHEA-S were significantly decreased in PAD patients in comparison to the control group. We could not observe any significant correlation with the presence of critical ischemia, the levels of total cholesterol, HDL-cholesterol, triglycerides, lipoprotein (a), C-reactive protein or plasma fibrinogen.
Conclusion: these results express that low androgen levels could be implicated in the pathogenesis of peripheral arterial disease, but testosterone and DHEA-S are not markers of disease severity. The elucidation of their exact role needs larger, population-based studies.
If the inline PDF is not rendering correctly, you can download the PDF file here.
1. Alzamora MT Forés R Pera G et al. Incidence of peripheral arterial disease in the ARTPER population cohort after 5 years of follow-up. BMC Cardiovasc Disord. 2016;16(1):8 DOI:10.1186/s12872-015-0170-6
2. George J Rapsomaniki E Pujades-Rodriguez M et al. How Does Cardiovascular Disease First Present in Women and Men? Incidence of 12 Cardiovascular Diseases in a Contemporary Cohort of 1 937 360 People. Circulation. 2015;132:1320-1328.
3. Criqui MH Aboyans V. Epidemiology of Peripheral Artery Disease. Circ Res. 2015;116:1509-1526.
4. Hak AE Witteman JCM De Jong FH et al. Low levels of Endogenous Androgens Increase the Risk of Atherosclerosis in Elderly Men: The Rotterdam Study. The Journal of Clinical Endocrinology & Metabolism. 2002;87(8):3632-3639.
5. Freeman BM Mountain DJ Brock TC et al. Low testosterone elevates interleukin family cytokines in a rodent model: a possible mechanism for the potentiation of vascular disease in androgen-deficient males. J Surg Res. 2014;190(1):319-27.
6. Haring R Travison TG Bhasin S et al. Relation between sex hormone concentrations peripheral arterial disease and change in ankle-brachial index: findings from the Framingham Heart Study. J Clin Endocrinol Metab. 201196(12):3724-32.
7. Kiechl S Willeit J Bonora E Schwarz S Xu Q. No Association Between Dehydroepiandrosterone Sulfate and Development Atherosclerosis in a Prospective Population Study (Bruneck Study). Arterioscler Thromb Vasc Biol. 2000;20:1094-1100.
8. Price JF Lee AJ Fowkes FG. Steroid sex hormones and peripheral arterial disease in the Edinburgh Artery Study. Steroids. 1997;62(12):789-94.
9. Yeap BB Alfonso H Chubb SA et al. Lower plasma testosterone or dihydrotestosterone but not estradiol is associated with symptoms of intermittent claudication in older men. Clin Endocrinol (Oxf). 2013;79(5):725-32.
10. Bataille V Perret B Evans A. et al. Sex hormone-binding globulin is a major determinant of the lipid profile: the PRIME study. Atherosclerosis. 2005;179(2):369-73
11. de Keyser CE de Lima FV de Jong FH et al. Use of statins is associated with lower serum total and non-sex hormone-binding globulin-bound testosterone levels in male participants of the Rotterdam Study. Eur J Endocrinol. 2015;173(2):155-65.
12. Malkin CJ Pugh PJ Jones RD Jones TH Channer KS. Testosterone as a protective factor against atherosclerosis –immunomodulation and influence upon plaque development and stability. Journal of Endocrinology 2003;178:373–380.
13. Jin H Lin J Fu L et al. Physiological testosterone stimulates tissue plasminogen activator and tissue factor pathway inhibitor and inhibits plasminogen activator inhibitor type 1 release in endothelial cells. Biochem. Cell Biol 2007;85(2):246-251.
14. Jones RD Jones TH Channer KS. The influence of testosterone upon vascular reactivity. European Journal of Endocrinology 2004;151:29-37.
15. Price J Leng GC. Steroid sex hormones for lower limb atherosclerosis. Cochrane Database Syst Rev. 2012;10:CD000188 doi: 10.1002/14651858.CD000188.pub2
16. Tivesten A Mellström D Jutberger H. et al. Low serum testosterone and high serum estradiol associate with lower extremity peripheral arterial disease in elderly men. The MrOS Study in Sweden. J. Am. Col. Cardiol. 2007;50(11):1070-1076.