Androgen activity, ischaemic heart disease and risk factors among men in NHANES III

Eur J Clin Invest. 2013 Dec;43(12):1273-81. doi: 10.1111/eci.12174. Epub 2013 Oct 7.


Aim: Observationally, low serum testosterone among men is associated with cardiovascular diseases and its risk factors, but it is unclear whether raising endogenous androgens would be protective. To clarify the role of androgens, the association of two different androgen biomarkers (serum testosterone and androstanediol glucuronide) with cardiovascular disease risk factors and mortality was examined in a nationally representative sample of US men.

Research design and methods: Multivariable linear and proportion hazards regression were used to examine the adjusted associations of serum testosterone and androstanediol glucuronide with cardiovascular disease risk factors and death from major cardiovascular diseases in 1460 men from NHANES III phase 1 (1988-1991) followed-up through 2006.

Results: Serum testosterone and androstanediol glucuronide were weakly correlated (0·13). Serum testosterone was associated with healthier values of most cardiovascular disease risk factors but not with death from ischaemic heart disease or stroke, adjusted for age, education, race/ethnicity, smoking and alcohol use. Similarly adjusted, androstanediol glucuronide was associated with unhealthier values of some cardiovascular risk factors and death from ischaemic heart disease (hazard ratio 1·16, 95% confidence interval 1·003-1·33 per standard deviation).

Conclusions: Androgen biomarkers had inconsistent associations with cardiovascular disease risk factors and ischaemic heart disease. Androstanediol glucuronide, rather than serum testosterone, had associations with cardiovascular disease risk factors more similar to those seen in randomized controlled trials of testosterone therapy, with corresponding implications for raising androgens.

Keywords: Androgens; cardiovascular; death; ischaemic heart disease; men; risk factors.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Analysis of Variance
  • Androstane-3,17-diol / analogs & derivatives*
  • Androstane-3,17-diol / metabolism
  • Biomarkers / metabolism
  • Body Mass Index
  • Cardiovascular Diseases / mortality
  • Cholesterol, HDL / metabolism
  • Cholesterol, LDL / metabolism
  • Diabetic Angiopathies / mortality
  • Glycated Hemoglobin A / metabolism
  • Hemoglobins / metabolism
  • Humans
  • Hypertension / complications
  • Hypertension / mortality
  • Male
  • Middle Aged
  • Myocardial Ischemia / mortality*
  • Prospective Studies
  • Risk Factors
  • Stroke / mortality
  • Testosterone / metabolism*
  • United States / epidemiology
  • Waist Circumference
  • Young Adult


  • Biomarkers
  • Cholesterol, HDL
  • Cholesterol, LDL
  • Glycated Hemoglobin A
  • Hemoglobins
  • Androstane-3,17-diol
  • androstane-3,17-diol glucuronide
  • Testosterone