Testosterone is positively associated with coronary artery calcium in a low cardiovascular disease risk population

Trumble B.C.; Negrey J.; Koebele S.V.; Thompson R.C.; Wann L.S.; Allam A.H.; Beheim B.; Sutherland M.L.; Sutherland J.D.; Rodriguez D.E.; Michalik D.E.; Rowan C.J.; Lombardi G.P.; Garcia A.R.; Cummings D.K.; Seabright E.; Alami S.; Kraft T.S.; Hooper P.; Buetow K.; Irimia A.; Gatz M.; Stieglitz J.; Gurven M.D.; Kaplan H.; Thomas G.S. · Evolution, Medicine and Public Health (2023) · DOI: 10.1093/emph/eoad039

Resumen

Background: In industrialized populations, low male testosterone is associated with higher rates of cardiovascular mortality. However, coronary risk factors like obesity impact both testosterone and cardiovascular outcomes. Here, we assess the role of endogenous testosterone on coronary artery calcium in an active subsistence population with relatively low testosterone levels, low cardiovascular risk and low coronary artery calcium scores. Methodology: In this cross-sectional community-based study, 719 Tsimane forager-horticulturalists in the Bolivian Amazon aged 40+ years underwent computed tomography (49.8% male, mean age 57.6 years). Results: Coronary artery calcium levels were low; 84.5% had no coronary artery calcium. Zero-inflated negative binomial models found testosterone was positively associated with coronary artery calcium for the full sample (Incidence Rate Ratio [IRR] = 1.477, 95% Confidence Interval [CI] 1.001–2.170, P = 0.031), and in a male-only subset (IRR = 1.532, 95% CI 0.993–2.360, P = 0.053). Testosterone was also positively associated with clinically relevant coronary atherosclerosis (calcium >100 Agatston units) in the full sample (Odds Ratio [OR] = 1.984, 95% CI 1.202–3.275, P = 0.007) and when limited to male-only sample (OR = 2.032, 95% CI 1.118–4.816, P = 0.024). Individuals with coronary artery calcium >100 had 20% higher levels of testosterone than those with calcium <100 (t = –3.201, P = 0.007). Conclusions and Implications: Among Tsimane, testosterone is positively associated with coronary artery calcium despite generally low normal testosterone levels, minimal atherosclerosis and rare cardiovascular disease (CVD) events. Associations between low testosterone and CVD events in industrialized populations are likely confounded by obesity and other lifestyle factors. LAY SUMMARY In sedentary urban male participants, low testosterone is associated with coronary heart disease. However, obesity can confound this association, resulting in lower testosterone and more heart disease. Among the physically active Tsimane of Bolivia, heart disease and obesity are rare, and male participants with higher testosterone had more atherosclerosis of their coronary arteries. © The Author(s) 2023. Published by Oxford University Press on behalf of the Foundation for Evolution, Medicine, and Public Health. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

Instituciones: Universidad Peruana Cayetano Heredia