Androgens in Health and Disease.pdf - E Library

Chapter 10/Androgens and Coronary Artery Disease 191
10
Androgens and Coronary
Artery Disease
Fredrick C. W. Wu, MD
and Arnold von Eckardstein, MD
CONTENTS
INTRODUCTION
RELATIONSHIPS BETWEEN SERUM LEVELS OF T AND CAD:
OBSERVATIONAL STUDIES
RELATIONSHIPS BETWEEN SERUM LEVELS OF T AND CAD:
INTERVENTIONAL CLINICAL STUDIES
RELATIONSHIPS BETWEEN SERUM LEVELS OF T AND CAD:
ANIMAL STUDIES
EFFECTS OF T ON CARDIOVASCULAR RISK FACTORS
EFFECTS OF ANDROGENS ON CELLS OF THE ARTERIAL WALL
AND VASCULAR FUNCTION
DHEA-S AND CAD IN MEN AND WOMEN
ESTROGENS AND CARDIOVASCULAR DISEASE IN MEN
SUMMARY AND CONCLUSION
REFERENCES
INTRODUCTION
Coronary artery disease (CAD) is one of the leading causes of mortality in men and
women. Age-adjusted morbidity and mortality rates from CAD are 2.5-fold to 4.5-fold
higher in men than in women (1). This male preponderance is remarkably consistent
across 52 countries with hugely divergent rates of CAD mortality and lifestyles (2). Sex
hormones can influence a multitude of factors implicated in the pathogenesis of atherosclerosis
and coronary artery disease—the traditional view being that androgens are
harmful and estrogens beneficial. However, the gender disparity in CAD may involve
diverse mechanisms ranging from in utero sex hormone imprinting, gender-specific
behavior, distribution of visceral body fat to vascular and myocardial structural/functional
adaptation to aging, pressure overload, and disease (3). As the therapeutic indications
for androgen therapy widen to “non-classical” indications (4), including male
From: Contemporary Endocrinology: Androgens in Health and Disease
Edited by: C. Bagatell and W. J. Bremner © Humana Press Inc., Totowa, NJ
191