Androgen status in non-diabetic elderly men with heart failure

Figures & data

Table 1. Baseline characteristics of elderly men with HF and healthy controls.

	HF patients (N = 73)	Healthy controls (N = 20)	p Value
Clinical assessment
Age (years)	67 ± 7	67 ± 7	0.934
Ischemic/idiopathic dilated CMP, n (%)	60 (82)/13 (18)
NYHA class II/III, n (%)	54 (74)/19 (26)
Smokers, n (%)	10 (14)	5 (25)	0.387
BMI (kg/m^2)	28 ± 5	28 ± 3	0.756
Waist (cm)	99.4 ± 14.2	99.8 ± 7.6	0.895
Waist-to-hip ratio	1.03 ± 0.04	1.01 ± 0.06	0.100
Atrial fibrillation, n (%)	20 (27)
Mean blood pressure (mmHg)	101 ± 12	103 ± 7	0.372
MLHFQ	30 ± 4
Previous myocardial infarction, n (%)	47 (64)
Hypertension, n (%)	45 (62)
Pacemaker, n (%)	7 (10)
Six-minute walking distance (m)	406 ± 83	578 ± 64	<0.001
Grip strength (kg)	95 ± 20	114 ± 19	<0.001
Echocardiography assessment
Left atrial diameter (mm)	48 ± 6	34 ± 3	<0.001
Left atrial volume (ml)	94 ± 41	46 ± 14	<0.001
Left ventricular end-diastolic diameter (mm)	66 ± 9	49 ± 4	<0.001
Left ventricular end-systolic diameter (mm)	54 ± 11	28 ± 4	<0.001
LVMi (g/cm^2)	159 ± 44	81 ± 12	<0.001
LVEF (%)	29 ± 8	65 ± 5	<0.001
dp/dt	710 ± 225	2005 ± 425	<0.001
Tei index	0.61 ± 0.22	0.28 ± 0.12	<0.001
E/Ea	14 ± 6	8 ± 2	<0.001
RVSP (mmHg)^a	46 ± 17	25 ± 2	0.002
DEXA assessment
BMD hip (g/cm^2)	0.88 ± 0.16	0.98 ± 0.18	0.021
BMD L1–L4 (g/cm^2)	1.09 ± 0.18	1.21 ± 0.23	0.012
Fat mass (kg)	22 ± 11	25 ± 7	0.333
Lean mass (kg)	54 ± 9	57 ± 4	0.178
BMC (kg)	2.8 ± 0.5	3.3 ± 0.5	0.001
Blood analysis
TT (ng/ml)	4.79 ± 1.65	4.45 ± 1.68	0.418
SHBG (nmol/l)	64 ± 26	57 ± 20	0.251
eFT (nmol/l)	0.409 ± 0.277	0.350 ± 0.204	0.378
NT-proBNP (pg/ml)	1809 (2742)	68 (74)	<0.001
Leptin (ng/ml)	7.35 ± 6.67	5.93 ± 3.25	0.360
Adiponectin (μg/ml)	16.99 ± 9.42	9.61 ± 2.34	0.001
hs-CRP (mg/l)	2.49 (2.86)	1.72 (2.46)	0.090
Hemoglobin (g/dl)	14.4 ± 1.5	15.0 ± 0.9	0.080
Proteins ( g/l)	75 ± 5	73 ± 4	0.041
Albumine (g/l)	43 ± 3	45 ± 3	0.001
Creatinine clearance (ml/min)	64 ± 22	78 ± 14	0.007
Medication, n (%)
ACE inhibitors	59 (81)
β-Blocker	55 (75)
Loop diuretics	59 (81)
Aldosterone antagonists	40 (55)
Digoxin	21 (29)
Vitamin K antagonist	38 (52)
Aspirin	47 (64)
Statin	20 (27)

Data are expressed as mean ± SD, median (interquartile range), or absolute number (percentage).

ACE: angiotensin-converting enzyme; BMD: bone mineral density; BMI: body mass index; CMP: cardiomyopathy; eFT: estimated free testosterone; hs-CRP: high-sensitivity C-reactive protein; LVEF: left ventricular ejection fraction; LVMi: left ventricular mass index; MLHFQ: Minnesota living with heart failure questionnaire; NT-proBNP: N-terminal pro-brain natriuretic peptide; NYHA: New York Heart Association; RVSP: right ventricular systolic pressure; SHBG: sex hormone-binding globuline; TT: testosterone.

^aRVSP measured in 66/10 of HF patients/controls.

Figure 1. Relationship between serum TT with total fat mass (A) and adiponectin (B) in elderly men with HF.

Figure 2. Relationship between serum TT with NT-proBNP in elderly men with HF.

Table 2. Correlation of TT and eFT with other investigated variables in elderly men with HF.

	TT	eFT
Age r (p)	−0.254 (0.038)	−0.278 (0.017)
Waist r (p)	−0.386 (0.001)	−0.267 (0.022)
Hip r (p)	−0.395 (0.001)	−0.295 (0.014)
Waist-to-hip ratio r (p)	−0.254 (0.038)	−0.112 (0.347)
BMI r (p)	−0.404 (<0.001)	−0.275 (0.018)
Total fat mass r (p)	−0.413 (<0.001)	−0.304 (0.009)
Total lean mass r (p)	−0.120 (0.311)	−0.009 (0.938)
BMD hip total r (p)	−0.229 (0.052)	−0.131 (0.269)
Mean blood pressure r (p)	−0.278 (0.017)	−0.311 (0.007)
NT-proBNP (log-transformed) r (p)	0.371 (0.001)	0.367 (0.001)
Leptin r (p)	−0.272 (0.020)	−0.165 (0.162)
Adiponectin r (p)	0.349 (0.002)	0.364 (0.002)
hs-CRP (log-transformed) r (p)	0.178 (0.131)	0.319 (0.006)
CrCl r (p)	−0.242 (0.039)	−0.115 (0.334)
LAD r (p)	0.077 (0.515)	0.231 (0.049)
LVEDD r (p)	0.143 (0.228)	0.252 (0.032)
LVESD r (p)	0.181 (0.126)	0.243 (0.038)
LVEF r (p)	−0.117 (0.322)	−0.242 (0.039)
LVMi r (p)	0.226 (0.055)	0.291 (0.012)
dp/dt r (p)	−0.257 (0.033)	−0.270 (0.025)
Tei index r (p)	0.266 (0.023)	0.334 (0.004)
Grip strength r (p)	0.062 (0.600)	0.124 (0.296)
6-min walking distance r (p)	−0.025 (0.835)	−0.016 (0.891)

BMD: bone mineral density; CrCl: creatinine clearance; eFT: estimated free testosterone; hs-CRP: high-sensitivity C-reactive protein; LAD: left atrial diameter; LVEDD: left ventricular end-diastolic diameter; LVEF: left ventricular ejection fraction; LVESD: left ventricular end-sytolic diameter; LVMi: left ventricular mass index; NT-proBNP: N-terminal pro-brain natriuretic peptide; TT: total testosterone.

Table 3. Multivariate regression analysis (stepwise model) with TT and eFT as dependent variables in elderly men with HF.

	B	p	F(p)
TT (Constant)
Age	8.636
Total fat mass	−0.049	0.035	9.118
Adiponectin	−0.059	0.001	(<.001)
R^2 = 0.284	0.046	0.015
eFT (Constant)
Age	1.051
Total fat mass	−0.011	0.005
Adiponectin	−0.007	0.007	9.981
hs-CRP	0.009	0.002	(<0.001)
R^2 = 0.370	0.177	0.005

ACE: angiotensin-converting enzyme; BMD: bone mineral density; BMI: body mass index; CMP: cardiomyopathy; eFT: estimated free testosterone; hs-CRP: high-sensitivity C-reactive protein; LVEF: left ventricular ejection fraction; LVMi: left ventricular mass index; MLHFQ: Minnesota living with heart failure questionnaire; NT-proBNP: N-terminal pro-brain natriuretic peptide; NYHA: New York Heart Association; RVSP: right ventricular systolic pressure; SHBG: sex hormone-binding globuline; TT: testosterone.

Figure 3. Kaplan–Meier survival analysis for TT deficiency in elderly men with HF.

Table 4. Univariate and multivariate Cox regression analysis on predictors of all-cause mortality in elderly men with HF.

	Univariate			Multivariate
	HR	95% CI	p Value	HR	95% CI	p Value
Age	1.034	1.003–1.096	0.037
BMI	0.948	0.884–1.018	0.140
CrCl	0.976	0.960–0.992	0.002
NT-proBNP (log)	3.698	1.927–7.095	<0.001	2.228	1.116–4.446	0.023
6-MWT	0.989	0.985–0.993	<0.001	0.991	0.986–0.995	<0.001
LVEF	0.956	0.920–0.993	0.019
Adiponectin	1.029	1.004–1.055	0.025
Total testosterone	1.029	0.850–1.245	0.771
Loop diuretics	2.837	1.009–7.978	0.048

ACE: angiotensin-converting enzyme; BMD: bone mineral density; BMI: body mass index; CMP: cardiomyopathy; eFT: estimated free testosterone; hs-CRP: high-sensitivity C-reactive protein; LVEF: left ventricular ejection fraction; LVMi: left ventricular mass index; MLHFQ: Minnesota living with heart failure questionnaire; NT-proBNP: N-terminal pro-brain natriuretic peptide; NYHA: New York Heart Association; RVSP: right ventricular systolic pressure; SHBG: sex hormone-binding globuline; TT: testosterone.