News and Announcements
BMC Public Health. 2010; 10: 712. Published online 2010 November 19.
Doing masculinity, not doing health? a qualitative study among Dutch male employees about health beliefs and workplace physical activity
Petra Verdonk, Hannes Seesing, and Angelique de Rijk.
International Journal of Clinical Practice. 2010 Dec;64(13):1754-62.
Erectile dysfunction and testosterone screening with prostate specific antigen screening at age 40: are these three gender specific determinants additive for overall men's heath and do they improve traditional non-gender specific determinants to lessen cardiovascular risk and all-cause mortality?
The Miriam Hospital, Warren Alpert School of Medicine, Brown University, Providence, RI, USA. martin_miner@brown.edu
Heart. 2010 Nov;96(22):1821-5. Epub 2010 Oct 19.
Low serum testosterone and increased mortality in men with coronary heart disease.
Malkin CJ, Pugh PJ, Morris PD, Asif S, Jones TH, Channer KS.
Department of Cardiology, M131, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK; kevin.channer@sth.nhs.uk
The response by Dr. Richard Bebb follows:
The article by Malkin et al regarding low serum testosterone and coronary artery disease adds more evidence to the growing body of literature that has correlated low testosterone levels with increased mortality in men.
In this study, men presenting with coronary artery disease were screened for low testosterone and then followed prospectively to determine if the low testosterone would adversely affect their survival.
The incidence of hypogonadism was roughly 24%, a number not dissimilar to the expected prevalence of hypogonadism in men aged 60yrs. However, when this group of almost 1,000 men were followed over a period of approximately 7 years, there was an increased mortality in those men with low testosterone levels. This increased mortality persisted when the prevalence of associated risk factors like obesity and diabetes were corrected for.
The biological explanation for this may lie in one or more of the following explanations:
1) There may be a direct negative effect of testosterone deficiency on the development of coronary artery disease.
2) There may be an indirect negative effect of testosterone deficiency on the development of coronary artery disease. Such as a greatly propensity to develop the metabolic syndrome or diabetes.
3) Low testosterone may be serving as a "marker" or barometer of general ill health.
Or
4) Men with low testosterone levels may be less likely or less able to
complete meaningful cardiac rehabilitation after coronary events, thereby increasing their risk of having further cardiovascular events.
To date, no prospective studies have looked at this important issue. While a randomized, placebo controlled study of testosterone therapy and heart disease in older men with low testosterone and no pre-existing heart disease is presently underway in multiple sites in the United States, it will be a number or years before the results are available. It would seem logical, and clinically very relevant, to prospectively study whether testosterone administration in men with low testosterone and coronary heart disease will reduce mortality as this group of men have such a high rate of coronary events that less subjects and study duration would be required to produce a statistically significant result.
Richard Bebb MD, ABIM, FRCPC October 24, 2010.
