Sex steroids and mortality in men referred for coronary angiography

Abstract

Summary: Objective Accumulating evidence suggests that sex steroids are associated with various chronic diseases. We aimed at evaluating whether total testosterone (TT), free testosterone (FT) and sex hormone–binding globulin (SHBG) are associated with all‐cause mortality and specific fatal events. Design, Setting and Participants We measured TT and SHBG levels in 2078 men who were routinely referred for coronary angiography (1997–2000). FT was calculated according to Vermeulen. Measurements The main outcome measures were Cox proportional hazard ratios (HRs) for mortality from all causes, from cardiovascular and non‐cardiovascular causes and from cancer according to SHBG, FT and TT. Results Multivariable‐adjusted HRs (with 95% confidence intervals) in the fourth compared to the first SHBG quartile for all‐cause, non‐cardiovascular and cancer mortality were 1·61 (1·16–2·23), 2·44 (1·39–4·28), and 2·86 (1·03–7·32), respectively. There was no significant association of SHBG levels with cardiovascular mortality. All‐cause mortality was significantly reduced per 1 SD increase in FT in the multivariate‐adjusted analyses [0·49 (0·30–0·81)]. We observed no significant associations of FT with cardiovascular and cancer mortality, and TT levels were not independently related to any fatal events. Conclusion High levels of SHBG are associated with adverse health outcomes in a large cohort of older men referred for coronary angiography. Further studies are warranted to confirm our results and to elucidate the underlying mechanisms for our findings.