Relationships between serum levels of testosterone and cardiovascular disease observational studies

At the outset, it is important to emphasize the limitations of observational studies on associations between serum levels of endogenous androgens and cardiovascular disease. The cardiovascular disease endpoints were extremely variable (mortality, morbidity such as myocardial infarction and angina, decompensated and compensated heart failure, completed stroke and transient ischemic attack, angiography, ultrasound, computer tomography, or post-mortem based diagnosis or unspecified events), study groups were heterogeneous and selection criteria diverse. Most cardiovascular disease patients willbeonmedications and have modified their lifestyle. In some studies, selection of poorly-matched controls may have introduced biases. The time interval from onset of disease to study varied from three months to several years and timing of blood sampling was not always standardised for diurnal variation of hormone levels. The majority of these studies did not adjust for confounding factors. For example, hypoandrogenemia in men and hyperandrogene-mia in women are confounded with various metabolic disorders including obesity, insulin resistance, dyslipidemia and impaired fibrinolysis. Finally, chronic coronary artery disease and heart failure as well as acute myocardial infarction induce a fall in serum levels of testosterone (Kontoleon etal. 2003; Pugh etal. 2002; Wu and von Eckardstein 2003; Zitzmann and Nieschlag 2001).

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