Testosterone, Dihydrotestosterone, and Incident Cardiovascular Disease and Mortality in the Cardiovascular Health Study

Context:

Low testosterone (T) is associated with prevalent cardiovascular disease (CVD) and mortality. DHT, a more potent androgen, may also be associated with CVD and mortality, but few studies have examined this.

Objective:

The study objective was to examine whether T and DHT are risk factors for incident CVD and mortality.

Design:

In a longitudinal cohort study, we evaluated whether total T, calculated free T (cFT), DHT, and calculated free DHT were associated with incident CVD and mortality in men in the Cardiovascular Health Study (mean age 76, range 66–97 years) who were free of CVD at the time of blood collection.

Main Outcome:

The main outcomes were incident CVD and all-cause mortality.

Results:

Among 1032 men followed for a median of 9 years, 436 incident CVD events and 777 deaths occurred. In models adjusted for cardiovascular risk factors, total T and cFT were not associated with incident CVD or all-cause mortality, whereas DHT and calculated free DHT had curvilinear associations with incident CVD (P < .002 and P = .04, respectively) and all-cause mortality (P < .001 for both).

Conclusions:

In a cohort of elderly men, DHT and calculated free DHT were associated with incident CVD and all-cause mortality. Further studies are needed to confirm these results and to clarify the underlying physiologic mechanisms.