Introduction: Obesity is an independent cardiovascular (CV) risk factor. Testosterone (T) is inversely related to body mass index (BMI) in males. There is substantial evidence suggesting that low T could play a role as a moderator of CV mortality in men, and so this study is designed to assess the possible interaction between T and obesity in predicting major cardiovascular events (MACE) in a sample of subjects with erectile dysfunction.
Methods: This is an observational prospective cohort study involving a consecutive series of 1687 patients attending our Unit for erectile dysfunction. According to BMI, subjects were divided into normal weight (BMI=18.524.9 kg/m2), overweight (BMI=25.029.9 kg/m2) and obese (BMI≥30.0 kg/m2). Hypogonadism was defined as total T below 10.4 nmol/l. Information on MACE was obtained through the City of Florence Registry Office.
Results: Among the patients studied, 39.8% had normal weight, whereas 44.1 and 16.1% were overweight or obese respectively. Unadjusted analysis in the whole sample showed that, while hypogonadism and obesity were significantly associated with an increased risk of MACE, their interaction term was associated with a protective effect. In a Cox regression model, adjusting for confounders, hypogonadism showed a significant increased risk of MACE in normal weight subjects, whereas it was associated with a reduced risk in obese patients.
Conclusions: Hypogonadism-associated CV risk depends on the characteristics of subjects. Further studies are advisable to clarify if low T in obese patients is a (positive) consequence of a comorbid condition to save energy or if it represents a pathogenetic issue of the same illness.
30 Apr - 04 May 2011
European Society of Endocrinology