Abstract 4063: Low Testosterone Levels are Associated with Increased Risk of Coronary Heart Disease Mortality in Older Women
Women’s favorable cardiovascular risk, compared to men, is usually explained by endogenous estrogen levels. Few studies have evaluated the role of endogenous testosterone in women. We examined the association of serum testosterone (T) levels with CHD (MI or revascularization) prevalence, incidence, and mortality (ICD9 codes 410–414) in 678 postmenopausal women, ages 50 to 90 (mean=72), who were followed for 20 yrs. CHD risk estimates were similar for the 4 highest T quintiles, suggesting a low threshold effect. We therefore examined the association of T in the lowest quintile (≤80 pg/ml, “low T”) versus all higher, using logistic regression for prevalent disease and Cox proportional hazards for incident and fatal disease. Women with low T were younger, less likely to smoke, and more likely to have undergone a hysterectomy (34%) or bilateral oophorectomy (35%) (all P<.001). They had lower diastolic BP and HDL cholesterol, higher triglycerides and IL-6 (all P<.05), and lower BMI (P=.08). Low T was associated with increased odds of prevalent CHD and increased risk of incident CHD and CHD mortality, before and after adjusting for potential confounders (Table⇓). Excluding women with diabetes (16%) or the metabolic syndrome (17%) or additional adjustment for ovarian status, estradiol, SHBG, IL-6, CRP, adiponectin, or leptin levels had minimal effect on results. In summary, low levels of circulating testosterone were associated with increased risk of prevalent and 20 year incident CHD events and mortality, independent of other sex hormones and CHD risk factors. These results suggest that androgen deficiency may be a risk factor for atherosclerotic heart disease in postmenopausal women.