Επίπεδα τεστοστερόνης σε υπερτασικούς ασθενείς με ασυμπτωματική βλάβη οργάνου-στόχου N. Iωακειμίδης, Χ. Βλαχόπουλος, Α. Αγγελής, Π. Πιέτρη, Δ. Τερεντές-Πρίντζιος, Μ. Αμπντελρασούλ, Ι. Γουργούλη, Χ. Στεφανάδης Moνάδα Υπέρτασηs και Μονάδα Καρδιαγγειακών Νοσημάτων και Σεξουαλικήs Υγείαs Α Πανεπιστημιακή Καρδιολογική Κλινική και Ομώνυμο Εργαστήριο
IMT, LVH and CVD prediction cimt is a strong predictor of future vascular events including stroke and MI Lorenz et al Circulation 2007 when cimt information was added to traditional risk prediction models, a significant number of patients were reclassified to higher or lower risk categories Lorenz et al Eur Heart 2010 9.9% NRI Nambi et al J Am CollCardiol 2010 (ARIC substudy) 5-yr NRI =11.6% LVH is associated with CV morbidity and mortality Cuspidi C J Hypertens 2002
Risk prediction is improved by adding markers of subclinical organ damage to SCORE LVM, atherosclerotic plaques in the carotid arteries, PWV, urine albumin/creatinine ratio Subclinical organ damage predicted cardiovascular death independently of SCORE and the combination may improve risk prediction. Sehestedt T et al., Eur Heart J 2010
Testosterone in Hypertension testosterone levels in HTN pts LOW testo Svartberg J et al. Eur J Endocrinol 2004 Tromso Study Jaffe A et al Hypertension 1996 Hughes GS et al J Hypertens 1989 Khaw KT et al. J Hypertens 1988 Messerli FH et al. Ann Intern Med 1987 Fogari R et al. Am J Hypertens 2002 Fogari R et al. Hypertens Res 2005 Torkler S et al. Aging Male 2010 No difference Dai WS Am J Epidemiol 1981 Labropoulos et al Cardiology 1982 Most studies show low testosterone in HTN pts No study shows increased testosterone!
Tivesten A et al, J Am Coll Cardiol 2005 Vlachopoulos et al. Atherosclerosis 2014 Testosterone and organ damage IMT LVH Muller M et al Circulation 2004 Makinen J et al J Am Coll Cardiol 2005 ABI Svartberg J et al. Eur J Endocrinol 2004 Tromso Study
Εισαγωγή-Σκοπός: Σκοπός της παρούσας μελέτης είναι να διερευνηθεί η συσχέτιση της παρουσίας ασυμπτωματικής βλάβης οργάνου-στόχου με τα επίπεδα τεστοστερόνης σε υπερτασικούς ασθενείς.
Πληθυσμόs Μελέτηs 116 consecutive patients (30 69 years old, mean±sd=56±9 years) with essential hypertension. Diagnosis of hypertension was set if blood pressure was >140/90 mmhg in 3 consecutive recordings at rest, or when taking antihypertensive drugs. Men with obesity/metabolic syndrome/diabetes were excluded from the study. Men who have a history or a clinical presentation of current cardiovascular disease (CAD, stroke/tia and PAD) were also excluded from the study. Malignancy, overt endocrine disease and use of steroid hormones were excluded, because these conditions may have a significant influence on both plasma sex hormones and clinical outcome.
Estimation of carotid IMT
Estimation of left ventricular mass index Devereux s formula LVM=1.04 [(LVID+PWT+IVST)³-LVID³]x0.8+0.6 LVID: internal dimension; PWT: posterior wall thickness; IVST: interventricular septal thickness; 1.04: specific gravity of the myocardium; 0.8 : correction factor
Αποτελέσματα Table 1. Baseline characteristics of patients with a MACE and subjects without MACE Age (years) 55±8 BMI (Kgr/m 2 ) 27.7±4.0 Systolic BP, mmhg 137±16 Diastolic BP, mmhg 84±9 Pulse Pressure, mmhg 52±13 Mean Pressure, mmhg 102±11 Total cholesterol, mg/dl 209±34 HDL cholesterol, mg/dl 44±9 Triglycerides, mg/dl 106 (86-127) Glucose, mg/dl 107 (91 121) hscrp, mg/l 1.9 (1.5-2.2) Total testosterone, ng/ml 4.6±1.2 Hypogonadism, n (%) 35 (30) Hypercholesterolemia, n (%) 78 (67) Smoking, n (%) 65 (56) FRS >20%, n (%) 31 (27) Drug Therapy, n (%) Antihypertenive therapy 66 (57) β-blockers 20 (17) ACE inhibitors/arbs 49 (42) Calcium antagonists 22 (19) Diuretics 28 (24) Statins 23 (20)
Τεστοστερόνη και ΙΜΤ r=-0.407 P<0.001
Τεστοστερόνη και LVMindex r=-0.345 P<0.001
Table. Stepwise regression models evaluating the association of total testosterone (TT) with left ventricular mass index (LVMi) and intima-media thickness (IMT) as dependent variables (Models 1 and 2, respectively) Unstandardized coefficient Standardized coefficient P value Model 1 (LVMi) Age (years) 0.003 0.265 <0.001 Systolic pressure (mm Hg) 0.007 0.315 <0.001 TT (ng/ml) -0.047-0.255 <0.01 Adjusted R 2 of model = 0.266 Model 2 (IMT) Age (years) 0.009 0.385 < 0.001 Systolic pressure (mg/dl) 0.005 0.244 <0.01 LDL (mg/dl) 0.062 0.193 <0.05 TT (ng/ml) 0.064 0.308 <0.001 Adjusted R 2 of model = 0.329 In all models, age, systolic pressure, body mass index, total triglycerides, low-density lipoprotein (LDL), blood glucose, smoking status and high sensitivity C-reactive protein were introduced as covariates.
Τεστοστερόνη και βλάβη στιs Καρωτίδεs P<0.001 F=10.115, P<0.001
Τεστοστερόνη και Υπερτροφία αριστερήs κοιλίαs P<0.001
F=5.678 P=0.006
Bλάβη οργάνου στόχου και Υπογοναδισμόs* (%) Normal cimt High cimt Normal LVMi 12 21 LVH 19 47 * TT<3.4 ng/ml x²=12.39 P=0.006
Predictive value of low testosterone Hypertensive patients 228 male hypertensive patients (mean age 56 years) CVD pts and men with CVD were excluded from analysis mean follow-up of 44 months Vlachopoulos C et al. Am J Hypertens 2013 A TT plasma level of 5.04 ng/ml was associated with a negative predictive value (ability to rule out MACE) of 97.2%.
Vlachopoulos C et al. Eur Heart J 2013
Συμπεράσματα Τα επίπεδα τεστοστερόνης στο πλάσμα είναι μειωμένα στους υπερτασικούς ασθενείς με ασυμπτωματική βλάβη οργάνου στόχου. Απαιτείται περαιτέρω έρευνα προκειμένου να διερευνηθεί εάν η σχέση είναι αιτιολογική και κατά πόσο αυτή επηρεάζει τον κίνδυνο για μελλοντικά καρδιαγγειακά συμβάματα.