Nelson Vergel
Founder, ExcelMale.com
Testosterone to oestradiol ratio reflects systemic and plaque inflammation and predicts future cardiovascular events in men with severe atherosclerosis
Testosterone to estradiol ratio reflects systemic and plaque inflammation and predicts future cardiovascular events in men with severe atherosclerosis
Aims
The effects of testosterone on cardiovascular disease (CVD) as reported in literature have been ambiguous. Recently, the interplay between testosterone and estradiol as assessed by testosterone/estradiol (T/E2) ratio was suggested to be better informative on the normal physiological balance. Considering the role in CVD, we hypothesized that a low T/E2 ratio in men with CVD is associated with increased inflammation, a more unstable plaque and a worse cardiovascular outcome.
Methods and results
Testosterone and estradiol concentrations were determined in blood samples of 611 male carotid endarterectomy patients included in the Athero-Express Biobank Study. T/E2 ratio was associated with baseline characteristics, atherosclerotic plaque specimens, inflammatory biomarkers and three-year follow-up information. Patients with low T/E2 ratio had more unfavorable inflammatory profiles compared to patients with high T/E2 as observed by higher levels of C-reactive protein (CRP) (2.81 g/mL vs. 1.22 g/mL (p < 0.001)) and higher leukocyte counts (8.98*10*9/L vs. 7.75*10*9/L (p = 0.001)) in blood. In atherosclerotic plaques, a negative association between T/E2 ratio and number of neutrophils (B=-0.366(p = 0.012), plaque calcifications (OR: 0.816(p = 0.044)), interleukin-6 (IL-6) (B=-0.15 p = 0.009) and Il-6receptor (B=-0.13 p = 0.024) was found. Furthermore, in multivariate Cox regression analysis, low T/E2 ratio was independently associated with an increased risk for major cardiovascular events (MACE) during three-year follow-up (HR 1.67(95%CI: 1.02-2.76) p = 0.043). In men with elevated body mass index, these effects were strongest.
Conclusions
In male patients with manifest atherosclerotic disease, low T/E2 ratio was associated with increased systemic inflammation, increased inflammatory plaque proteins and an increased risk of future major cardiovascular events as compared to men with normal T/E2 ratio. These effects are strongest in men with elevated body mass index and are expected to be affected by aromatase activity in white fat tissues. Normalization of T/E2 ratio may be considered as target for the secondary prevention of CVD in men.
Testosterone to estradiol ratio reflects systemic and plaque inflammation and predicts future cardiovascular events in men with severe atherosclerosis
Aims
The effects of testosterone on cardiovascular disease (CVD) as reported in literature have been ambiguous. Recently, the interplay between testosterone and estradiol as assessed by testosterone/estradiol (T/E2) ratio was suggested to be better informative on the normal physiological balance. Considering the role in CVD, we hypothesized that a low T/E2 ratio in men with CVD is associated with increased inflammation, a more unstable plaque and a worse cardiovascular outcome.
Methods and results
Testosterone and estradiol concentrations were determined in blood samples of 611 male carotid endarterectomy patients included in the Athero-Express Biobank Study. T/E2 ratio was associated with baseline characteristics, atherosclerotic plaque specimens, inflammatory biomarkers and three-year follow-up information. Patients with low T/E2 ratio had more unfavorable inflammatory profiles compared to patients with high T/E2 as observed by higher levels of C-reactive protein (CRP) (2.81 g/mL vs. 1.22 g/mL (p < 0.001)) and higher leukocyte counts (8.98*10*9/L vs. 7.75*10*9/L (p = 0.001)) in blood. In atherosclerotic plaques, a negative association between T/E2 ratio and number of neutrophils (B=-0.366(p = 0.012), plaque calcifications (OR: 0.816(p = 0.044)), interleukin-6 (IL-6) (B=-0.15 p = 0.009) and Il-6receptor (B=-0.13 p = 0.024) was found. Furthermore, in multivariate Cox regression analysis, low T/E2 ratio was independently associated with an increased risk for major cardiovascular events (MACE) during three-year follow-up (HR 1.67(95%CI: 1.02-2.76) p = 0.043). In men with elevated body mass index, these effects were strongest.
Conclusions
In male patients with manifest atherosclerotic disease, low T/E2 ratio was associated with increased systemic inflammation, increased inflammatory plaque proteins and an increased risk of future major cardiovascular events as compared to men with normal T/E2 ratio. These effects are strongest in men with elevated body mass index and are expected to be affected by aromatase activity in white fat tissues. Normalization of T/E2 ratio may be considered as target for the secondary prevention of CVD in men.
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