Association of Testosterone and CRP with severity of coronary artery disease among male patients : A Case control hospital based study

Abstract

Epidemiological studies have found an inverse association between testosterone and coronary artery disease {CAD}in men, but the relationship is inconsistent. the study aimed to investigate, whether serum levels of total testosterone {TT} and high sensitivity C-reactive protein {hs-CRP} differ in men with coronary disease from those without CAD and to evaluate the relationship of serum TT and hs -CRP with the severity of CAD . Three hundred and nine males {103 patients with ST-elevation myocardial infarction {SAEMI}, 103 patients with angiographically-proven CAD, 103 controls without having a history of CAD} were recruited . serum TT, hs-CRP, lipids, cardiac troponin I {cTnI }and plasma glucose were estimated. Three angiogram-based severity scores { Gensini, Leaman and vessel score } were used in the severity assessment of angiographically-proven CAD. In STEMI patients, Killip classes, TIMI {Thrombolysis in Myocardial Infarction}, GRACE {Global Registry of Acute coronary Events} and modified Silvester ECG {electrocardiographic} QRS scores were used in assessing the severity of myocardial infarction. Mean basal serum TT in patients with angiographically-proven CAD was significantly lower than controls {P =0.001} and mean basal {on admission} serum TT in STEMI patients was significantly lower than controls {P =0.001}. The difference remained statistically significant after adjustment for confounding variables. Serum TT was found to be an independent predictor of both angiographically-proven CAD {p=0.001, OR=0.68, CI=0.58-0.79} and STEMI {P=0.001,OR=0.75,CI0.66-0.85} . low testosterone level showed high adjusted {age, BMI, smoking} odds ratio as a risk factor for angiographically-proven CAD {P=0.007,OR=3.4,CI=1.41-8.61}and STEMI {P=0.001,OR=5.6,CI=2.32-13.84}. The mean basal ha-CRV concentration in patients with angiographically-proven CAD was significantly higher compared to controls {P=0.001}and mean basal {on admission} hs-CRP concentration in STEMI patients was significantly higher compared to controls {p=0.001}. Total testosterone showed a significant negative correlation with hs-CRP and LDL-Ch, while a significant positive correlation was seen between TT and HDL-Ch. In angiographically-proven CAD patients, the TT levels were not significantly different according to the severity categories of vessel score {P=0.373}, Leaman score { P=0.694}and Gensini score {P=0.329} ,but hs-CRP level showed a significant difference among the severity categories estimated by the respective scores {p=0.001,p=0.028,p=0.015}.in STEMI patients the TT level did not show a significant association with the severity of STEMI assessed by cTnI {p=0.129},Killip classes {p=0.864},TIMI {P=0.783},DRACE {P=0.342}and ECG score {P=0.659},but it showed a significant association with left ventricular ejection fraction{p=0.049}.however , hs-CRP level showed a significant positive association with the severity assessed by Killip classes {{p=0.025}TIMI {P=0.017},GRACE {P=0.002}and ECG score {p=0.044}. In conclusion TT levels were low in patients with angiographically-proven CAD and in patients with STEMI compared to controls, while hs-CRP levels were higher in both group of patients compared to controls. Testosterone was an independent predictor of CAD and low TT concentration was a risk factor of CAD. Total testosterone did not show a significant correlation with the angiographic severity of CAD, while hs-CRP did show a significant positive correlation. Severity of myocardial infarction graded by clinical risk scores and ECG score was not correlated with the testosterone concentration, but positively correlated with hs-CRP. Total testosterone was negatively correlated with hs-CRP. A significant positive association was found between testosterone and HDL-Ch, while a negative association was found between testosterone, high levels of hs-CRP and abnormal lipid profile play a role in the development of coronary artery disease. The precise mechanisms underlying underlying these observation and any clinical applications require further studies.