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Lower plasma testosterone or dihydrotestosterone, but not estradiol, is associated with symptoms of intermittent claudication in older men
Author(s) -
Yeap Bu B.,
Alfonso Helman,
Chubb S. A. Paul,
Handelsman David J.,
Hankey Graeme J.,
Golledge Jonathan,
Flicker Leon,
Norman Paul E.
Publication year - 2013
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.12208
Subject(s) - intermittent claudication , medicine , claudication , endocrinology , testosterone (patch) , odds ratio , cardiology , arterial disease , vascular disease
Summary Objective In men, testosterone ( T ) levels decline with age, and lower T predicts all‐cause and cardiovascular mortality. However, the associations of T and its metabolites, dihydrotestosterone ( DHT ) and estradiol ( E 2), with symptomatic peripheral arterial disease remain unclear. We assessed associations of T , DHT and E 2 with lower limb intermittent claudication in older men. Design Cross‐sectional study. Participants Community‐dwelling men aged 70–89 years resident in P erth, W estern A ustralia. Measurements Intermittent claudication was ascertained by the Edinburgh Claudication Questionnaire. Early morning, plasma T , DHT and E 2 were assayed using liquid chromatography–tandem mass spectrometry. Results There were 268 men with intermittent claudication and 2435 without claudication or any leg pain. Men with nonspecific leg pain ( n = 986) were excluded. After adjusting for age, smoking, BMI , waist/hip ratio, hypertension, dyslipidaemia, diabetes, creatinine and prevalent cardiovascular disease ( CVD ), higher T was associated with reduced risk of having claudication (per 1 SD increase, odds ratio [ OR ] = 0·80, 95% confidence interval [ CI ] = 0·69–0·94, P = 0·006; quartiles, Q4/Q1, OR = 0·54, 95% CI = 0·36–0·81). Higher DHT was associated with reduced risk of having claudication (per 1 SD increase, OR = 0·86, 95% CI = 0·73–1·00, P = 0·048; Q4/Q1, OR = 0·64, 95% CI = 0·43–0·95). E2 was not associated with claudication (per 1 SD increase, OR = 0·96, 95% CI = 0·83–1·11, P = 0·565; Q4/Q1, OR = 0·88, 95% CI = 0·60–1·29). Conclusions Lower T or DHT levels, but not E 2, are associated with symptoms of intermittent claudication in older men. Reduced exposure to androgens may represent a causal factor or biomarker for symptomatic peripheral arterial disease. Further studies are needed to examine underlying mechanisms and evaluate therapeutic options in ageing men.