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Combination of low free testosterone and low vitamin D predicts mortality in older men referred for coronary angiography
Author(s) -
Lerchbaum Elisabeth,
Pilz Stefan,
Boehm Bernhard O.,
Grammer Tanja B.,
ObermayerPietsch Barbara,
März Winfried
Publication year - 2012
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/j.1365-2265.2012.04371.x
Subject(s) - medicine , quartile , testosterone (patch) , hazard ratio , endocrinology , vitamin d and neurology , sex hormone binding globulin , proportional hazards model , vitamin d deficiency , confidence interval , hormone , androgen deficiency , cohort , androgen
Summary Context Low levels of 25‐hydroxyvitamin D [25( OH ) D ] and free testosterone ( FT ) are both associated with increased mortality. Experimental studies show a complex interplay of vitamin D and androgen metabolism suggesting that a deficiency of both hormones may be associated with a particularly adverse clinical outcome. Objective To evaluate the impact of parallel FT and 25( OH ) D deficiency in a large cohort of older men. Design We measured total testosterone ( TT ), sex hormone‐binding globulin and 25( OH ) D levels in 2069 men who were routinely referred for coronary angiography (1997–2000). Main outcome measures Cox proportional hazard ratios ( HR s) (with 95% confidence intervals) for mortality from all causes, cardiovascular and noncardiovascular causes according to combined deficiency of FT and 25( OH ) D . Results In multivariate‐adjusted analyses, we found an increased risk for all‐cause mortality, cardiovascular and noncardiovascular mortality for men in the lowest FT [ HR 1·26 (1·03–1·54), 1·24 (0·96–1·60) and 1·39 (1·00–1·93), respectively] and 25( OH ) D quartile [ HR 1·77 (1·47–2·13), 1·65 (1·29–2·10) and 1·89 (1·38–2·60) respectively] compared with men in higher FT and 25( OH ) D quartiles. There was no independent association of TT levels with mortality. Multivariate‐adjusted HR s progressively increased with the number of hormones ( FT and 25( OH ) D ) in the lowest quartile [0 vs 2 hormone deficiencies: 2·11 (1·60–2·79) for all cause, 1·77 (1·23–2·55) for cardiovascular and 2·33 (1·45–3·47) for noncardiovascular mortality, respectively]. Conclusion A combined deficiency of FT and 25( OH ) D is significantly associated with fatal events in a large cohort of men referred for coronary angiography.