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Cardiovascular disease and testosterone
Abstracts / Maturitas 81 (2015) 105–121
320 ng/dL or less is a stringent guideline for predicting true clinical hypogonadism. Applying these criteria to a cohort of over 3000 men, collaborating researchers concluded the true prevalence of hypogonadism to be about 2% in men over 40. Recommendations on the diagnosis, treatment and monitoring of late-onset hypogonadism in men have recently been updated although there remains considerable debate regarding the safety of such endocrine therapy especially in the older population with concerns about myocardial infarction and other morbidity. The diagnosis and safety of testosterone therapy is reviewed and the concept of hormonophobia is considered with consensus opinion presented to the audience. http://dx.doi.org/10.1016/j.maturitas.2015.02.052 INV41 Diagnosing andropause
117
meta-analysis of all placebo-controlled randomized clinical trials (RCTs) on the effect of TS on related CV-problems. Results: Out of 2747 retrieved articles, 75 were analyzed, including 3016 and 2448 patients in TS and placebo groups, respectively, and a mean duration of 34 weeks. Our analyses, performed on the largest number of studies collected so far, indicate that TS is not related to any increase in CV risk, even when composite or single adverse events were considered. In RCTs performed in subjects with metabolic derangements a protective effect of TS on CV risk was observed. Conclusions: The present systematic review and meta-analysis does not support a causal role between TS and adverse CV events. Our results are in agreement with a large body of literature from the last twenty years supporting TS of hypogonadal men as a valuable strategy in improving a patient’s metabolic profile, reducing body fat and increasing lean muscle mass, which would ultimately reduce the risk of heart disease.
Nikolaos Samaras 1,2 1 Geneva University Hospital, Internal Medicine and Geriatrics, Geneva, Switzerland 2 Clinique Generale Beaulieu, Geneva, Switzerland
Testosterone levels’ decrease with age is now well documented. Indeed 20% of healthy men over 60 and 30–50% over 80 years of age have levels under the reference range. Low testosterone levels are not sufficient to diagnose age related male hypogonadism or “andropause”. Andropause diagnosis requires the presence of both low testosterone levels and clinical symptoms. Depending on the study, several cut-offs have been used in order to define low testosterone levels. The use of free testosterone as a more specific marker in cases where Sex Hormone Binding Globulin (SHBG) alterations are suspected has also been a matter of discussion. Several questionnaires have been elaborated in order to help andropause diagnosis, such as the St. Louis Androgen Deficiency in the Aging Male (ADAM) questionnaire and the Aging Male Symptom (AMS) rating. Although sensitivity was quite satisfying for both the ADAM and the AMS (88% and 96% respectively) specificity was low (60% and 30% respectively). Scores on both questionnaires reflected testosterone levels even less with higher age. Diagnosing andropause is important since it has been related to various age-related diseases such as sarcopenia, low bone mineral density, mood and cognitive disorders. Nevertheless, diagnosis remains challenging since most symptoms related to low testosterone levels are rather unspecific. This is partly responsible for a very low rate of hypogonadism treatment (5% in the USA) despite a prevalence increasing with age (0.1% and 5.1% for patients 40–49 and 70–79 years old respectively). A comprehensive approach including the search for factors influencing testosterone and SHBG levels as well as comorbidities confusing clinical presentation has to be applied for andropause diagnosis. http://dx.doi.org/10.1016/j.maturitas.2015.02.053 INV42 Cardiovascular disease and testosterone Mario Maggi Sexual Medicine & Andrology, University of Florence, Florence, Italy Introduction: Recent reports have significantly halted the enthusiasm regarding androgen boosting, suggesting that testosterone supplementation (TS) increases cardiovascular (CV) events. Methods: In order to overcome some of the limitations of the current evidence, we performed an updated systematic review and
http://dx.doi.org/10.1016/j.maturitas.2015.02.054 INV43 Lifestyle predictors of healthy ageing in men Marita Södergren Karolinska Institutet, Centre of Family Medicine, Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden Objectives: The ageing process includes loss of functional capability and changes that depend on genetic, environmental, and lifestyle factors. A growing body of research has indicated important gender differences in lifestyle behaviours, and also how these behaviours might affect health outcomes. With a male perspective we explored lifestyle predictors of healthy ageing, such as physical activity and sedentary behaviours, smoking, diet and alcohol consumption. Methods: The existing literature was reviewed for quantitative studies concerning lifestyle predictors of healthy ageing in men. The result summarises the current knowledge and substantive findings on this topic. Results: The review show that not only do men with healthy lifestyles survive longer, but they also do so in good health and disability is postponed and compressed into fewer years at the end of life. It is obvious that engaging in regular physical activity and refraining from smoking is essential to preventing chronic diseases and delaying natural deterioration due to ageing. What remains less clear is whether the decline in skeletal muscle capacity is truly a function of the ageing process or if sedentary behaviours among older adults could have confounded the results of previous studies. Conclusions: Experimental studies in this field are difficult to undertake, future research should therefor concentrate on understanding the causal pathways through which lifestyle factors exert their effects, and where opportunities exist to affect those pathways. Adoption of healthier lifestyles could result in postponement of age associated diseases and/or the slowing down of the ageing process. However, future generations may not age in as good health as those who are currently over 65 years of age, particularly because of the rising prevalence of obesity. http://dx.doi.org/10.1016/j.maturitas.2015.02.055
320 ng/dL or less is a stringent guideline for predicting true clinical hypogonadism. Applying these criteria to a cohort of over 3000 men, collaborating researchers concluded the true prevalence of hypogonadism to be about 2% in men over 40. Recommendations on the diagnosis, treatment and monitoring of late-onset hypogonadism in men have recently been updated although there remains considerable debate regarding the safety of such endocrine therapy especially in the older population with concerns about myocardial infarction and other morbidity. The diagnosis and safety of testosterone therapy is reviewed and the concept of hormonophobia is considered with consensus opinion presented to the audience. http://dx.doi.org/10.1016/j.maturitas.2015.02.052 INV41 Diagnosing andropause
117
meta-analysis of all placebo-controlled randomized clinical trials (RCTs) on the effect of TS on related CV-problems. Results: Out of 2747 retrieved articles, 75 were analyzed, including 3016 and 2448 patients in TS and placebo groups, respectively, and a mean duration of 34 weeks. Our analyses, performed on the largest number of studies collected so far, indicate that TS is not related to any increase in CV risk, even when composite or single adverse events were considered. In RCTs performed in subjects with metabolic derangements a protective effect of TS on CV risk was observed. Conclusions: The present systematic review and meta-analysis does not support a causal role between TS and adverse CV events. Our results are in agreement with a large body of literature from the last twenty years supporting TS of hypogonadal men as a valuable strategy in improving a patient’s metabolic profile, reducing body fat and increasing lean muscle mass, which would ultimately reduce the risk of heart disease.
Nikolaos Samaras 1,2 1 Geneva University Hospital, Internal Medicine and Geriatrics, Geneva, Switzerland 2 Clinique Generale Beaulieu, Geneva, Switzerland
Testosterone levels’ decrease with age is now well documented. Indeed 20% of healthy men over 60 and 30–50% over 80 years of age have levels under the reference range. Low testosterone levels are not sufficient to diagnose age related male hypogonadism or “andropause”. Andropause diagnosis requires the presence of both low testosterone levels and clinical symptoms. Depending on the study, several cut-offs have been used in order to define low testosterone levels. The use of free testosterone as a more specific marker in cases where Sex Hormone Binding Globulin (SHBG) alterations are suspected has also been a matter of discussion. Several questionnaires have been elaborated in order to help andropause diagnosis, such as the St. Louis Androgen Deficiency in the Aging Male (ADAM) questionnaire and the Aging Male Symptom (AMS) rating. Although sensitivity was quite satisfying for both the ADAM and the AMS (88% and 96% respectively) specificity was low (60% and 30% respectively). Scores on both questionnaires reflected testosterone levels even less with higher age. Diagnosing andropause is important since it has been related to various age-related diseases such as sarcopenia, low bone mineral density, mood and cognitive disorders. Nevertheless, diagnosis remains challenging since most symptoms related to low testosterone levels are rather unspecific. This is partly responsible for a very low rate of hypogonadism treatment (5% in the USA) despite a prevalence increasing with age (0.1% and 5.1% for patients 40–49 and 70–79 years old respectively). A comprehensive approach including the search for factors influencing testosterone and SHBG levels as well as comorbidities confusing clinical presentation has to be applied for andropause diagnosis. http://dx.doi.org/10.1016/j.maturitas.2015.02.053 INV42 Cardiovascular disease and testosterone Mario Maggi Sexual Medicine & Andrology, University of Florence, Florence, Italy Introduction: Recent reports have significantly halted the enthusiasm regarding androgen boosting, suggesting that testosterone supplementation (TS) increases cardiovascular (CV) events. Methods: In order to overcome some of the limitations of the current evidence, we performed an updated systematic review and
http://dx.doi.org/10.1016/j.maturitas.2015.02.054 INV43 Lifestyle predictors of healthy ageing in men Marita Södergren Karolinska Institutet, Centre of Family Medicine, Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden Objectives: The ageing process includes loss of functional capability and changes that depend on genetic, environmental, and lifestyle factors. A growing body of research has indicated important gender differences in lifestyle behaviours, and also how these behaviours might affect health outcomes. With a male perspective we explored lifestyle predictors of healthy ageing, such as physical activity and sedentary behaviours, smoking, diet and alcohol consumption. Methods: The existing literature was reviewed for quantitative studies concerning lifestyle predictors of healthy ageing in men. The result summarises the current knowledge and substantive findings on this topic. Results: The review show that not only do men with healthy lifestyles survive longer, but they also do so in good health and disability is postponed and compressed into fewer years at the end of life. It is obvious that engaging in regular physical activity and refraining from smoking is essential to preventing chronic diseases and delaying natural deterioration due to ageing. What remains less clear is whether the decline in skeletal muscle capacity is truly a function of the ageing process or if sedentary behaviours among older adults could have confounded the results of previous studies. Conclusions: Experimental studies in this field are difficult to undertake, future research should therefor concentrate on understanding the causal pathways through which lifestyle factors exert their effects, and where opportunities exist to affect those pathways. Adoption of healthier lifestyles could result in postponement of age associated diseases and/or the slowing down of the ageing process. However, future generations may not age in as good health as those who are currently over 65 years of age, particularly because of the rising prevalence of obesity. http://dx.doi.org/10.1016/j.maturitas.2015.02.055