ABSTRACT
Historically androgens have been considered a risk factor for coronary artery disease in men, since postmenopausal women have a lower incidence of coronary heart disease and myocardial infarction than men of a similar age. However, there has been no direct evidence linking physiologic concentrations of androgens to an increased incidence of coronary heart disease and myocardial infarction, and recent evidence suggests that the reverse may be true. In a study examining the effect of risk factors (including estradiol and testosterone) on predicting myocardial infarction in males who had not had a previous myocardial infarction, Phillips and coworkers1
raised the possibility that hypotestosteronemia in men may be a risk factor for coronary atherosclerosis. Serum total and free testosterone levels were negatively correlated with degree of risk of coronary artery disease and with risk factors for myocardial infarction. These findings have been confirmed by other studies.2,3 Decreased total and free testosterone levels have been shown to be associated with ischemic stroke in men,4 further implicating testosterone in the pathophysiology of vascular diseases. Declining levels of the androgen dehydroepiandrosterone sulfate (DHEAS) have been associated with an increased risk of vascular disease.5 Confusion arises from data concerning the use of high doses of androgens (anabolic steroids) to increase muscle mass and athletic performance, where there is a well-documented increase in incidence of cardiovascular events.6
