Abstract
Globally, cardiovascular disease is the single largest cause of mortality. The differences
in pattern of cardiovascular disease between the two genders have not been explained
properly. The spotlight has largely been focused on estrogens but no conclusive evidence
has proven its role in reducing the incidence of cardiovascular disease. Consequently,
androgens have attracted significant interest in explaining the gender difference
in cardiovascular disease. More studies in last two decades have increased our knowledge
about the effects of androgens on cardiovascular disease progression. Evidence for
age related fall in testosterone levels in males and increasing cardiovascular events
with age had lead to the postulation of idea of ‘andropause or male menopause’. Unfortunately,
for the last few decades the androgens have been highlighted as agents of abuse among
athletes all over the world. There have been multiple reports of their association
with sudden cardiac death and adverse cardiovascular outcomes when abused. Contrastingly,
there has been an increasing prescription use of testosterone supplementation in various
conditions related to androgen deficiency state and for many other off-label indications.
Human observational studies have mostly concluded that men with lower testosterone
levels tend to have higher incidence of coronary artery disease. Emerging evidence
supports that lower androgen levels predict poor cardiovascular risk profile. Role
with supplementation of testosterone for cardiovascular disease is being studied in
both primary and secondary prevention stages and its safety being evaluated. This
is an appropriate time to review the role of androgens specifically from a cardiovascular
standpoint.
Abbreviations:
CAD (Coronary artery disease), CVD (Cardiovascular disease), DHEA (Dehydroepiandrosterone), SHBG (Sex hormone binding globulin), IMT (Intima media thickness), FMD (Flow mediated dilatation)Keywords
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Article info
Publication history
Published online: November 18, 2009
Accepted:
October 18,
2009
Received:
September 3,
2009
Identification
Copyright
© 2009 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.