Association of testosterone and CRP with the 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), while a positive association was observed between inflammation and CAD in men, but the relationships are 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 CAD 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 STelevation myocardial infarction (STEMI), 103 patients with angiographically-proven CAD, 103 controls without having a history of CAD) were recruited. Serum TT, hs-CRP, lipids, cardiac troponin I (cTnl) 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. Killip classes, TIMI (Thrombolysis In Myocardial Infarction), GRACE (Global Registry of Acute Coronary Events) and modified Sylvester ECG (electrocardiographic) QRS scores were used in assessing the severity of STEM!. Mean basal serum TT in patients with CAD was significantly lower than controls (p = 0.001). Low TT level showed high adjusted (age, BMI, smoking) odds ratio as a risk factor for angiographically proven CAD (p = 0.007, OR = 3.4, Cl = 1.41-8.61) and STEMI (p = 0.001, OR = 5.6, Cl = 2.32-13.84). The mean basal hs-CRP concentration in patients with CAD was significantly higher compared to controls (p = 0.001). TT showed a significant negative correlation with hs-CRP and LDL-Ch, while a significant positive correlation was seen between TT and HDL-Ch. TT levels were not associated with the severity of angiographicallyproven CAD, but hs-CRP levels were associated with the severity. TT level did not show a significant association with the severity of STEMI assessed by clinical risk scores, while hs-CRP level showed a significant positive association with the severity. In conclusion, TT levels were low in patients with CAD compared to controls, while hs-CRP levels were higher in patients compared to controls. TT did not show a significant correlation with the severity of CAD, while hs-CRP did show a significant positive correlation. TT was negatively correlated with hs- CRP. Low levels of TT and inflammation reflected by high levels of hs-CRP play a role in the development of CAD. Dr. Chandima Madhu Wickramatilake, Senior Lecturer, Department o f Biochemistry, conducted her PhD research project on the title o f “Association o f testosterone and CRP with the severity o f coronary) artery disease among male patients: a case-control hospital-based study”. She registered fo r her PhD at University o f Ruhuna, Sri Lanka and. the thesis was defended in May 2014. The results were published as 11 research papers in peer reviewed journals. Further, 20 abstracts were presented in national and international forums. Professor K Rajasooriya oration was delivered at the Annual Academic Sessions o f Ceylon College o f Physicians in 2015, based on the findings o f the study. The publications o f the study received awards such as best oral presentation at Annual Academic Sessions o f Sri Lanka Heart Association 2014 and G. R. Handy Award offered by Sri. Lanka Medical Association fo r best original article published in the field of Cardiovascular Medicine in 2014.