Endogenous Testosterone Levels and the Risk of Incident Cardiovascular Events in Elderly Men: The MrOS Prospective Study

Osteoporotic Fractures in Men (MrOS) Research Group

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Context: Observational studies show discordant links between endogenous testosterone levels and cardiovascular diseases (CVD). Objective: We assessed whether sex hormones and sex hormone-binding globulin (SHBG) are associated with CVD in community-dwelling elderly men. Design, Setting and Participants: Prospective study of incident CVD among 552 men ≥ 65 years in the MrOS Sleep Study without prevalent CVD and no testosterone therapy at baseline. Outcomes: Fasting serum levels of total testosterone and estradiol were measured using liquid chromatography-mass spectrometry, and SHBG by chemiluminescent substrate. The association of sex hormones and SHBG with incident coronary heart disease (CHD), cerebrovascular (stroke and transient ischemic attack) and peripheral arterial disease (PAD) events were assessed by quartile and per SD increase in proportional hazards models. Results: After 7.4 years, 137 men (24.8%) had at least 1 CVD event: 90 CHD, 45 cerebrovascular and 26 PAD. The risk of incident CVD events was not associated with quartiles of baseline sex hormones or SHBG (all P ≥ 0.16). For +1 SD in total testosterone, the multivariate-adjusted hazard ratio was 1.04 (95% CI, 0.80-1.34) for CHD, 0.86 (0.60-1.25) for cerebrovascular, and 0.81 (0.52-1.26) for PAD events. When analyzed as continuous variables or comparing highest to low quartile, levels of bioavailable testosterone, total estradiol, testosterone/estradiol ratio and SHBG were not associated with CVD events. Conclusions: In community-dwelling elderly men, endogenous levels of testosterone, estradiol, and SHBG were not associated with increased risk of CHD, cerebrovascular, or PAD events. These results are limited by the small number of events and should be explored in future studies.

Original languageEnglish (US)
Article numberbvaa038
JournalJournal of the Endocrine Society
Issue number5
StatePublished - Apr 22 2020

Bibliographical note

Funding Information:
The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Institute on Aging (NIA), the National Center for Research Resources (NCRR), NIH Roadmap for Medical Research (grant numbers U01AR45580, U01 AR45614, U01 AR45632, U01 AR45647, U01 AR45654, U01 AR45583, U01 AG18197, U01-AG027810, and UL1 RR024140), and the American Diabetes Association (1-04-JF-46, Strotmeyer ES).

Funding Information:
Dr T-H Collet’s research is supported by grants from the Swiss National Science Foundation (P3SMP3-155318, PZ00P3-167826) and the Swiss Society of Endocrinology and Diabetes. The authors want to acknowledge the contributions of Prof. Elizabeth Barrett-Connor who recently passed away and reviewed a prior version of this manuscript. The authors wish to thank Dr. Christopher Dant for his assistance with a previous version of this manuscript.


  • aging
  • cardiovascular events
  • men
  • testosterone

PubMed: MeSH publication types

  • Journal Article

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