Unfavourable vascular risk profile of smokers with testosterone deficiency

Abstract Purpose Testosterone deficiency and cigarette smoking are both associated with increased cardiovascular (CV) mortality risk. We examined whether vascular function and structure parameters are significantly impaired in smokers with low testosterone levels. Methods Carotid intima media thickness (cIMT) and aortic pulse wave velocity (aPWV) were measured in a total of 690 patients (mean 58±7 yrs) without manifest CV/atherosclerotic disease. All patients underwent exercise stress test (and coronary angiography) to reveal coronary artery disease (CAD). Plasma total testosterone (TT) levels were measured in all patients. Results Participants were divided into four subgroups according to smoking (yes/no) and measured low or normal TT levels (low TT<3.5 ng/ml). The subgroups had similar prevalence of hypertension and smoking and comparable LDL-C levels. The mean age of patients with low TT was greater than that of subjects with normal TT (P<0.05). Aortic PWV was significantly higher in smokers with low TT compared to smokers with normal TT (P=0.01) and non-smokers with either low TT (P=0.005) or normal TT (P<0.001) (left plot). Similarly, cIMT was significantly higher in smokers with low TT compared to smokers with normal TT (P=0.01) and non-smokers with either low TT (P=0.005) or normal TT (P<0.001) (right plot). All associations remained statistically significant after adjustment for age. Among smokers with low TT both aPWV and cIMT significantly increased with increasing cigarette smoking intensity (all P<0.05), whereas the associations between smoking intensity and either aPWV or cIMT were not significant among smokers with normal TT concentration (all P=NS). Interestingly, the prevalence of angiographically documented CAD was significantly higher among smokers with low TT (18%) compared to the CAD prevalence of the three other subgroups (overall P<0.001). TT level, smoking and vascular profile Conclusions Carotid IMT and aortic PWV are significantly increased and the prevalence of angiographically documented CAD is greater in smokers with testosterone deficiency. Further studies should be conducted to evaluate how much of the unfavorable effect of both cigarette smoking and testosterone deficiency on coronary atherosclerotic burden is mediated by their associations with function and structure changes in the vascular wall.