Low testosterone levels are predictive for incident atrial fibrillation and ischaemic stroke in men, but protective in women - results from the FINRISK study

Eur J Prev Cardiol. 2018 Jul;25(11):1133-1139. doi: 10.1177/2047487318778346. Epub 2018 May 29.


Background Atrial fibrillation is the most common serious abnormal heart rhythm, and a frequent cause of ischaemic stroke. Recent experimental studies, mainly in orchiectomised rats, report a relationship between sex hormones and atrial electrophysiology and electroanatomy. We aimed to evaluate whether low testosterone levels are predictive for atrial fibrillation and/or ischaemic stroke in men and women. Design and methods The serum total testosterone levels were measured at baseline in a population cohort of 7892 subjects (3876 male, 4016 female), aged 25-74 years, using a commercially available immunoassay. The main outcome measure was atrial fibrillation or ischaemic stroke, whichever came first. Results During a median follow-up of 13.8 years, a total of 629 subjects (8.0%) suffered from incident atrial fibrillation ( n = 426) and/or ischemic stroke ( n = 276). Cox regression analyses, adjusted for age (used as time-scale), geographical region, total cholesterol (log), high-density lipoprotein-cholesterol (log), hypertension medication, known diabetes, smoking status, waist-hip-ratio, and time of blood drawn, documented differential predictive value of low sex-specific testosterone levels for atrial fibrillation and/or ischaemic stroke, in men and in women: Increasing levels were associated with lower risk in men (hazard ratio per one nmol/l increase 0.98 (95% confidence interval 0.93-1.00); p = 0.049). On the other hand, increasing testosterone levels were associated with higher risk in women (hazard ratio per one nmol/l increase 1.17 (95% confidence interval 1.02-1.36); p = 0.031). Conclusion Our study indicates that low testosterone levels are associated with increased risk of future atrial fibrillation and/or ischaemic stroke in men, while they are protective in women.

Keywords: Testosterone; atrial fibrillation; prognosis; stroke; women.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Atrial Fibrillation / blood
  • Atrial Fibrillation / complications*
  • Atrial Fibrillation / epidemiology
  • Biomarkers / blood
  • Brain Ischemia / blood*
  • Brain Ischemia / epidemiology
  • Brain Ischemia / etiology
  • Electrocardiography
  • Female
  • Finland / epidemiology
  • Follow-Up Studies
  • Forecasting*
  • Humans
  • Immunoassay
  • Incidence
  • Male
  • Middle Aged
  • Population Surveillance / methods*
  • Prospective Studies
  • Sex Distribution
  • Sex Factors
  • Testosterone / blood*


  • Biomarkers
  • Testosterone