Sage Journals: Discover world-class research

Abstract

Background

Gonadal function is thought to be involved in existing atherosclerotic plaques stabilization and might affect reperfusion after primary percutaneous coronary intervention (pPCI). We aimed to compare the prevalence of hypotestosteromenia between ST-elevation myocardial infarction (STEMI) and stable angina (SA) patients and between patients with and without microvascular obstruction (MVO).

Design

Cross-sectional observational study.

Methods

Males with STEMI (n = 70, age 57.1 ± 7.8 years) or with stable angina (n = 30, age 59.9 ± 8.4 years) were enrolled. Angiographic MVO (angio-MVO) was defined as final TIMI flow 2 or final TIMI flow 3 with MBG ≤ 2 while electrocardiographic MVO (ECG-MVO) as a ST-segment resolution <70% at 90 minutes post-pPCI. Variables associated with STEMI and MVO were assessed among clinical, angiographic and laboratory data including testosterone (T) and insulin-like factor 3 (INSL-3), a marker of Leydig cells function. Hypotestosteronemia was defined as T < 2.50 ng/ml with INSL-3 < 305.5 pg/ml.

Results

Hypotestosteronemia was detected in 32 (45.7%) STEMI patients and in 4 (13.3%) SA patients (p = 0.003). STEMI patients presenting with angio-MVO were more frequently hypotestosteronemic as compared with those without (60.9% vs 38.3%, p = 0.043). Hypotestosteronemia prevalence was higher among STEMI patients presenting with ECG-MVO as compared with those without (69.0% vs 31.7%, p = 0.003). At multivariate analysis hypotestosteronemia independently predicted both angio-MVO (OR = 4.47, 95% CI 1.30–15.36, p = 0.018) and ECG-MVO (OR = 7.56, 95% CI 2.20–25.99, p = 0.001).

Conclusions

Our study shows higher prevelence of hypotestosteronemia among STEMI patients as compared with SA patients and among STEMI patients with MVO as compared with those without, thus suggesting a possible role of T deficiency in coronary instability and MVO pathogenesis.

Keywords

ST-elevation myocardial infarction primary percutanous coronary intervention microvascular obstruction hypotestosteronemia

Get full access to this article

View all access options for this article.

References

von Eckardstein

. Androgens and coronary artery disease. Endocr Rev 2003; 24: 183–217.

Hak

Witteman

de Jong

. Low levels of endogenous androgens increase the risk of atherosclerosis in elderly men: the Rotterdam study. J Clin Endocrinol Metab 2002; 87: 3632–3639.

Selvin

Feinleib

Zhang

. Androgens and diabetes in men: results from the Third National Health and Nutrition Examination Survey (NHANES III). Diabetes Care 2007; 30: 234–238.

Boyanov

Boneva

Christov

. Testosterone supplementation in men with type 2 diabetes, visceral obesity and partial androgen deficiency. Aging Male 2003; 6: 1–7.

Haring

Baumeister

Volzke

. Prospective association of low total testosterone concentrations with an adverse lipid profile and increased incident dyslipidemia. Eur J Cardiovasc Prev Rehabil 2011; 18: 86–96.

Foresta

Caretta

Lana

. Reduced number of circulating endothelial progenitor cells in hypogonadal men. J Clin Endocrinol Metab 2006; 91: 4599–4602.

Jones

Pugh

Jones

. The vasodilatory action of testosterone: a potassium-channel opening or a calcium antagonistic action? Br J Pharmacol 2003; 138: 733–744.

Webb

Elkington

Kraidly

. Effects of oral testosterone treatment on myocardial perfusion and vascular function in men with low plasma testosterone and coronary heart disease. Am J Cardiol 2008; 101: 618–624.

Malkin

Pugh

Jones

. The effect of testosterone replacement on endogenous inflammatory cytokines and lipid profiles in hypogonadal men. J Clin Endocrinol Metab 2004; 89: 3313–3318.

10.

Guler

Batyraliev

Dulger

. The effects of short term (3 weeks) testosterone treatment on serum inflammatory markers in men undergoing coronary artery stenting. Int J Cardiol 2006; 109: 339–343.

11.

Miyatake

Morimoto

Oishi

. Circadian rhythm of serum testosterone and its relation to sleep: comparison with the variation in serum luteinizing hormone, prolactin, and cortisol in normal men. J Clin Endocrinol Metab 1980; 51: 1365–1371.

12.

Foresta

Di Mambro

Pagano

. Insulin-like factor 3 as a marker of testicular function in obese men. Clin Endocrinol (Oxf) 2009; 71: 722–726.

13.

Sorajja

Gersh

Costantini

. Combined prognostic utility of ST-segment recovery and myocardial blush after primary percutaneous coronary intervention in acute myocardial infarction. Eur Heart J 2005; 26: 667–674.

14.

Kaufman

Vermeulen

. The decline of androgen levels in elderly men and its clinical and therapeutic implications. Endocr Rev 2005; 26: 833–876.

15.

van ‘t Hof

Liem

Suryapranata

. Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction: myocardial blush grade. Zwolle Myocardial Infarction Study Group. Circulation 1998; 97: 2302–2306.

16.

The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. TIMI Study Group. N Engl J Med 1985; 312: 932–936.

17.

Gibson

Murphy

Morrow

. Angiographic perfusion score: an angiographic variable that integrates both epicardial and tissue level perfusion before and after facilitated percutaneous coronary intervention in acute myocardial infarction. Am Heart J 2004; 148: 336–340.

18.

Alexandersen

Haarbo

Christiansen

. The relationship of natural androgens to coronary heart disease in males: a review. Atherosclerosis 1996; 125: 1–13.

19.

Glueck

Stroop

. Endogenous testosterone, fibrinolysis, and coronary heart disease risk in hyperlipidemic men. J Lab Clin Med 1993; 122: 412–420.

20.

English

Mandour

Steeds

. Men with coronary artery disease have lower levels of androgens than men with normal coronary angiograms. Eur Heart J 2000; 21: 890–894.

21.

Rosano

Sheiban

Massaro

. Low testosterone levels are associated with coronary artery disease in male patients with angina. Int J Impot Res 2007; 19: 176–182.

22.

Rui

Zhu

. Low testosterone level in middle-aged male patients with coronary artery disease. Eur J Intern Med 2011; 22: e133–e136.

23.

Guo

Jia

. Testosterone is negatively associated with the severity of coronary atherosclerosis in men. Asian J Androl 2012; 14: 875–878.

24.

Uyanik

Ari

Gumus

. Beneficial effects of testosterone undecanoate on the lipoprotein profiles in healthy elderly men. A placebo controlled study. Jpn Heart J 1997; 38: 73–82.

25.

English

Steeds

Jones

. Low-dose transdermal testosterone therapy improves angina threshold in men with chronic stable angina: a randomized, double-blind, placebo-controlled study. Circulation 2000; 102: 1906–1911.

26.

Burkhardt

Adham

Brosig

. Structural organization of the porcine and human genes coding for a Leydig cell-specific insulin-like peptide (LEY I-L) and chromosomal localization of the human gene (INSL3). Genomics 1994; 20: 13–19.

27.

Callies

Stromer

Schwinger

. Administration of testosterone is associated with a reduced susceptibility to myocardial ischemia. Endocrinology 2003; 144: 4478–4483.

28.

Bekesi

Kakucs

Varbiro

. In vitro effects of different steroid hormones on superoxide anion production of human neutrophil granulocytes. Steroids 2000; 65: 889–894.

29.

Chatrath

Ronningen

Severson

. Endothelium-dependent responses in coronary arteries are changed with puberty in male pigs. Am J Physiol Heart Circ Physiol 2003; 285: H1168–H1176.

30.

Campelo

Cutini

Massheimer

. Testosterone modulates platelet aggregation and endothelial cell growth through nitric oxide pathway. J Endocrinol 2012; 213: 77–87.

31.

. Inhibition of oxidative-stress-induced platelet aggregation by androgen at physiological levels via its receptor is associated with the reduction of thromboxane A2 release from platelets. Steroids 2007; 72: 875–880.

32.

Segal

Sautina

. Relaxin increases human endothelial progenitor cell NO and migration and vasculogenesis in mice. Blood 2012; 119: 629–636.

33.

Nijveldt

Beek

Hirsch

. Functional recovery after acute myocardial infarction: comparison between angiography, electrocardiography, and cardiovascular magnetic resonance measures of microvascular injury. J Am Coll Cardiol 2008; 52: 181–189.

34.

Porto

Burzotta

Brancati

. Relation of myocardial blush grade to microvascular perfusion and myocardial infarct size after primary or rescue percutaneous coronary intervention. Am J Cardiol 2007; 99: 1671–1673.

35.

Bolognese L, Carrabba N, Parodi G, et al. Impact of microvascular dysfunction on left ventricular remodeling and long-term clinical outcome after primary coronary angioplasty for acute myocardial infarction. Circulation 2004; 109(9): 1121–1126.

36.

Niccoli G, Cosentino N, Lombardo A, et al. Angiographic patterns of myocardial reperfusion after primary angioplasty and ventricular remodeling. Coron Artery Dis 2011; 22(7): 507–514.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.19 MB

Hypotestosteronemia is frequent in ST-elevation myocardial infarction patients and is associated with coronary microvascular obstruction

Abstract

Background

Design

Methods

Results

Conclusions

Keywords

Get full access to this article

References

Supplementary Material