Testosterone and dihydrotestosterone and incident ischaemic stroke in men in the Cardiovascular Health Study

Molly M. Shores, Alice M. Arnold, Mary L. Biggs, W. T. Longstreth, Nicholas L. Smith, Jorge Kizer, Anne R. Cappola, Calvin H. Hirsch, Brett T. Marck, Alvin M. Matsumoto

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Measurements Adjudicated ischaemic stroke. Results Among 1032 men (mean age 76, range 66-97), followed for a median of 10 years, 114 had an incident ischaemic stroke. Total T and free T were not significantly associated with stroke risk, while DHT had a nonlinear association with incident stroke (P = 0·006) in analyses adjusted for stroke risk factors. The lowest risk of stroke was at DHT levels of 50-75 ng/dl, with greater risk of stroke at DHT levels above 75 ng/dl or below 50 ng/dl.

Results were unchanged when SHBG was added to the model. Calculated free DHT had an inverse linear association with incident ischaemic stroke with HR 0·77 (95% CI, 0·61, 0·98) per standard deviation in analyses adjusted for stroke risk factors.

Conclusions Dihydrotestosterone had a nonlinear association with stroke risk in which there was an optimal DHT level associated with the lowest stroke risk. Further studies are needed to confirm these results and to clarify whether there is an optimal androgen range associated with the least risk of adverse outcomes in elderly men.

Objective Ischaemic stroke is a major cause of morbidity and mortality in elderly men. Our main objective was to examine whether testosterone (T) or dihydrotestosterone (DHT) was associated with incident ischaemic stroke in elderly men.

Design Cohort study.

Participants Elderly men in the Cardiovascular Health Study who had no history of stroke, heart disease or prostate cancer as of 1994 and were followed until December 2010.

Original languageEnglish (US)
Pages (from-to)746-753
Number of pages8
JournalClinical Endocrinology
Volume81
Issue number5
DOIs
StatePublished - Nov 1 2014

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Dihydrotestosterone
Testosterone
Stroke
Health
Heart Neoplasms
Androgens
Heart Diseases
Prostatic Neoplasms

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Medicine(all)

Cite this

Shores, M. M., Arnold, A. M., Biggs, M. L., Longstreth, W. T., Smith, N. L., Kizer, J., ... Matsumoto, A. M. (2014). Testosterone and dihydrotestosterone and incident ischaemic stroke in men in the Cardiovascular Health Study. Clinical Endocrinology, 81(5), 746-753. https://doi.org/10.1111/cen.12452

Testosterone and dihydrotestosterone and incident ischaemic stroke in men in the Cardiovascular Health Study. / Shores, Molly M.; Arnold, Alice M.; Biggs, Mary L.; Longstreth, W. T.; Smith, Nicholas L.; Kizer, Jorge; Cappola, Anne R.; Hirsch, Calvin H.; Marck, Brett T.; Matsumoto, Alvin M.

In: Clinical Endocrinology, Vol. 81, No. 5, 01.11.2014, p. 746-753.

Research output: Contribution to journalArticle

Shores, MM, Arnold, AM, Biggs, ML, Longstreth, WT, Smith, NL, Kizer, J, Cappola, AR, Hirsch, CH, Marck, BT & Matsumoto, AM 2014, 'Testosterone and dihydrotestosterone and incident ischaemic stroke in men in the Cardiovascular Health Study', Clinical Endocrinology, vol. 81, no. 5, pp. 746-753. https://doi.org/10.1111/cen.12452
Shores, Molly M. ; Arnold, Alice M. ; Biggs, Mary L. ; Longstreth, W. T. ; Smith, Nicholas L. ; Kizer, Jorge ; Cappola, Anne R. ; Hirsch, Calvin H. ; Marck, Brett T. ; Matsumoto, Alvin M. / Testosterone and dihydrotestosterone and incident ischaemic stroke in men in the Cardiovascular Health Study. In: Clinical Endocrinology. 2014 ; Vol. 81, No. 5. pp. 746-753.
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AU - Shores, Molly M.

AU - Arnold, Alice M.

AU - Biggs, Mary L.

AU - Longstreth, W. T.

AU - Smith, Nicholas L.

AU - Kizer, Jorge

AU - Cappola, Anne R.

AU - Hirsch, Calvin H.

AU - Marck, Brett T.

AU - Matsumoto, Alvin M.

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N2 - Measurements Adjudicated ischaemic stroke. Results Among 1032 men (mean age 76, range 66-97), followed for a median of 10 years, 114 had an incident ischaemic stroke. Total T and free T were not significantly associated with stroke risk, while DHT had a nonlinear association with incident stroke (P = 0·006) in analyses adjusted for stroke risk factors. The lowest risk of stroke was at DHT levels of 50-75 ng/dl, with greater risk of stroke at DHT levels above 75 ng/dl or below 50 ng/dl.Results were unchanged when SHBG was added to the model. Calculated free DHT had an inverse linear association with incident ischaemic stroke with HR 0·77 (95% CI, 0·61, 0·98) per standard deviation in analyses adjusted for stroke risk factors.Conclusions Dihydrotestosterone had a nonlinear association with stroke risk in which there was an optimal DHT level associated with the lowest stroke risk. Further studies are needed to confirm these results and to clarify whether there is an optimal androgen range associated with the least risk of adverse outcomes in elderly men.Objective Ischaemic stroke is a major cause of morbidity and mortality in elderly men. Our main objective was to examine whether testosterone (T) or dihydrotestosterone (DHT) was associated with incident ischaemic stroke in elderly men.Design Cohort study.Participants Elderly men in the Cardiovascular Health Study who had no history of stroke, heart disease or prostate cancer as of 1994 and were followed until December 2010.

AB - Measurements Adjudicated ischaemic stroke. Results Among 1032 men (mean age 76, range 66-97), followed for a median of 10 years, 114 had an incident ischaemic stroke. Total T and free T were not significantly associated with stroke risk, while DHT had a nonlinear association with incident stroke (P = 0·006) in analyses adjusted for stroke risk factors. The lowest risk of stroke was at DHT levels of 50-75 ng/dl, with greater risk of stroke at DHT levels above 75 ng/dl or below 50 ng/dl.Results were unchanged when SHBG was added to the model. Calculated free DHT had an inverse linear association with incident ischaemic stroke with HR 0·77 (95% CI, 0·61, 0·98) per standard deviation in analyses adjusted for stroke risk factors.Conclusions Dihydrotestosterone had a nonlinear association with stroke risk in which there was an optimal DHT level associated with the lowest stroke risk. Further studies are needed to confirm these results and to clarify whether there is an optimal androgen range associated with the least risk of adverse outcomes in elderly men.Objective Ischaemic stroke is a major cause of morbidity and mortality in elderly men. Our main objective was to examine whether testosterone (T) or dihydrotestosterone (DHT) was associated with incident ischaemic stroke in elderly men.Design Cohort study.Participants Elderly men in the Cardiovascular Health Study who had no history of stroke, heart disease or prostate cancer as of 1994 and were followed until December 2010.

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