Endocrine Abstracts

JOINT1556

Introduction: Sex hormones are believed to be responsible for gender difference in cardiovascular disease incidence and morbidity. The ratio between testosterone (T) and estradiol (E2) in men is associated with some health outcomes and behavioral traits.

Aim: We decided to investigate the ratio between T and E2 in the acute period after the onset of the acute coronary syndrome (ACS). It was hypothesized that the T to E2 ratio rather than the separate values alone may better reflect the severity of the cardiovascular event or relate to established risk factors.

Methods: For a period of three years 72 male patients with ACS, mean age 56.75, and 35 controls, mean age 54.22, were recruited. Student t-test, Mann-Whitney U-test and correlation analysis in SPSS v24 were applied.

Results: Lower values of both total and free T were found in the ACS group compared to controls (8.97 vs. 10.98 nmol/l, p=.001 for total T and 0.189 vs. 0.223 nmol/l, p=.006 for free T). Patients with myocardial infarction with ST-elevation (STEMI) had significantly lower T fractions compared to ACS without ST-elevation (NSTEMI). E2 values did not differ in both groups (P >.05) The T to E2 ratio on the other hand was significantly lower in the ACS group compared to the control subjects. The patient group had a more estrogenic hormonal environment with a mean value of T to E2 ratio 51.7 compared to 71.7 in the controls. (P <.001). The same tendency is valid when comparing ACS with ST-elevation to ACS without ST-elevation with lower value in the STEMI subgroup (T/E2: 46.9 vs. 64.1, p=.014). In the ACS group higher body mass index was associated with higher T/E2 ratio (r=-.277, p=.024). Free T was associated with GRACE risk and mortality risk score after adjusting for age (r=-.25, p=.043) but not T/E2 ratio (p=.97) or total T (p=.49).

Conclusion: Lower T/E2 ratio (more estrogenic environment) is observed in patients with ACS. Decrease in the substrate for Е2 production as well as an increase in aromatization are possible mechanisms. Comparable to the decrease of T in ACS this may represent an adaptive response, but the significance of this finding is unclear. Free Т on the other hand correlates with the cardiovascular risk even after correction for age. These results are in favor of sex hormones interrelation with the onset of acute cardiovascular events.

Keywords: acute coronary syndrome, testosterone, estradiol, ratio.