PMID- 19875366
OWN - NLM
STAT- MEDLINE
DCOM- 20100603
LR  - 20131121
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Linking)
VI  - 96
IP  - 7
DP  - 2010 Apr
TI  - Low circulating androgens and mortality risk in heart failure.
PG  - 504-9
LID - 10.1136/hrt.2009.181065 [doi]
AB  - OBJECTIVE: Deficiency of anabolic sex steroids is common in heart failure (HF). 
      The pathophysiological implications of this phenomenon, however, have not been 
      fully elucidated. This clinical study investigated the significance of low serum 
      androgen levels in HF. DESIGN: Prospective cohort study. Patients and Methods In 
      191 consecutively recruited men with HF (mean age 64 years; New York Heart 
      Association (NYHA) class I-IV 24%/35%/35%/6%) and reduced (ejection fraction (EF) 
      <or=40%, n=96) or preserved (EF >40%, n=95) left ventricular function total and 
      free serum testosterone, dehydroepiandrosterone sulfate (DHEAS) and sex hormone 
      binding globulin (SHBG) were measured. The median observation period was 859 
      days. RESULTS: During follow-up 53 patients (28%) died. Whereas total serum 
      testosterone was normal in most patients (91%), free testosterone and DHEAS were 
      reduced in 79% and 23%, respectively. DHEAS and free testosterone, but not total 
      testosterone, were inversely associated with NYHA class (both p<0.01). Lower free 
      testosterone and DHEAS and higher SHBG predicted all-cause mortality risk (hazard 
      ratio (HR) 0.89, 95% CI 0.82 to 0.96 per 1 ng/dl free testosterone, p=0.004; HR 
      0.95, 95% CI 0.89 to 1.00 per 10 microg/dl DHEAS, p=0.058; and HR 1.18, 95% CI 
      1.05 to 1.33 per 10 nmol/l SHBG, p=0.006, respectively; adjusted for age and NYHA 
      class). However, further adjustment for carefully selected confounding factors 
      abolished these associations. CONCLUSION: In male HF patients, low serum levels 
      of androgens are associated with adverse prognosis, but this relation is 
      confounded by indicators of a poor health state. The results suggest that low 
      serum androgens develop as a sequel of this progressive multifaceted systemic 
      disorder.
FAU - Guder, G
AU  - Guder G
AD  - Medizinische Klinik und Poliklinik I - Herz-Kreislaufzentrum, Klinikum der 
      Universitat Wurzburg, Oberdurrbacher Strasse 6, D - 97080 Wurzburg, Germany. 
      stoerk_s@klinik.uni-wuerzburg.de
FAU - Frantz, S
AU  - Frantz S
FAU - Bauersachs, J
AU  - Bauersachs J
FAU - Allolio, B
AU  - Allolio B
FAU - Ertl, G
AU  - Ertl G
FAU - Angermann, C E
AU  - Angermann CE
FAU - Stork, S
AU  - Stork S
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20091028
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
RN  - 0 (Androgens)
RN  - 0 (Sex Hormone-Binding Globulin)
RN  - 3XMK78S47O (Testosterone)
RN  - 57B09Q7FJR (Dehydroepiandrosterone Sulfate)
RN  - WI4X0X7BPJ (Hydrocortisone)
SB  - IM
CIN - Heart. 2010 Apr;96(7):496-7. PMID: 20350986
MH  - Aged
MH  - Androgens/*deficiency
MH  - Cause of Death
MH  - Dehydroepiandrosterone Sulfate/metabolism
MH  - Heart Failure/*mortality
MH  - Humans
MH  - Hydrocortisone/metabolism
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Prospective Studies
MH  - Risk Factors
MH  - Sex Hormone-Binding Globulin/deficiency
MH  - Testosterone/deficiency
EDAT- 2009/10/31 06:00
MHDA- 2010/06/04 06:00
CRDT- 2009/10/31 06:00
PHST- 2009/10/31 06:00 [entrez]
PHST- 2009/10/31 06:00 [pubmed]
PHST- 2010/06/04 06:00 [medline]
AID - hrt.2009.181065 [pii]
AID - 10.1136/hrt.2009.181065 [doi]
PST - ppublish
SO  - Heart. 2010 Apr;96(7):504-9. doi: 10.1136/hrt.2009.181065. Epub 2009 Oct 28.