Association between serum testosterone concentration and coronary heart disease

Sathesh Kumar, K (2014) Association between serum testosterone concentration and coronary heart disease. Masters thesis, Stanley Medical College, Chennai.

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Abstract

INTRODUCTION : Acute coronary syndrome includes unstable angina and non-ST elevated myocardial infarction and is defined as a spectrum of disease characterized by either: 1. New onset angina, 2. Angina at rest, 3. Progression of angina of increasing frequency or severity, 4. Angina in response to lower levels of exertion, 5. STEMI. Acute coronary syndrome most often represents acute atherosclerotic plaque rupture with exposure of thrombogenic sub-endothelial matrix. Coronary atheroma occurs as a result of inflammatory process. Cellular inflammation and local inflammation in the arterial wall occurs as a result of cytokines, which can further progress to cause vascular smooth muscle apoptosis, degradation of the fibrin cap and plaque rupture. Clinically patient can have unstable angina or progressed to myocardial infarction as a consequence of thrombus formation due to platelet aggregation. Cytokines have pivotal role in pathogenesis of atheroma formation. Proinflammatory cytokines are suppressed by testosterone which shows immunemodulating effect. Men with low testosterone levels are at increase risk of developing acute coronary syndrome. AIMS AND OBJECTIVES : 1. To estimate the level of free testosterone level in male patient suffering acute coronary syndrome. 2. To correlate free testosterone level with mortality and morbidity in male patients presenting with acute coronary syndrome. 3. To correlate free testosterone level in male patients of acute coronary syndrome with other parameters e.g. BMI, lipid abnormality & ECG changes. MATERIALS AND METHODS : For the study, male subjects presenting with acute coronary syndrome and those patients who have recovered from a recent acute coronary event attending Medicine OPD were taken as cases. Age & sex matched healthy control were taken from the medical ward. Study was done between October 2012 and November 2013. Number of cases – 50. Number of controls – 25. Inclusion criteria : All male patients presenting with acute coronary syndrome between the age group of 35-74 years. Exclusion criteria : • Patient with liver disease. • Patient with renal parenchymal disease. • Patient with diabetes mellitus. 50 male patients with acute coronary syndrome were studied based on the history, ECG changes, estimation of serum free testosterone and estimation of cardiac markers wherever required. SUMMARY : The present study included 50 patients who presented with acute coronary syndrome and 25 patients of age matched controls without evidence of CAD. In the study group, the mean age of presentation was 53.3 yrs. The commonest presenting symptom was chest pain followed by palpitation. Hypertension present in 34% of cases and 28% of controls. Smoking incidence was 46% in cases and 20% in controls. Higher levels of total cholesterol, triglyceride and LDL cholesterol and lower level of HDL cholesterol were seen in cases. They significantly differ in comparison to controls. Of the cases studied, about 86% had STEMI and 14% had NSTEMI. The mean serum free testosterone was significantly lower in patients with ACS. Serum free testosterone level was also significantly lower in patients with hypertension and smokers. Mean serum free testosterone level did not relate to the number of cardiovascular risk factors. Most of the patients (48%) presented with AWMI followed by IWMI (32%). Mean serum free testosterone level was lowest in patient who had IWMI+AWMI as compared with other patterns of ACS. Of the 50 cases studied, 2 patients died (percentage of mortality - 4%). Mean serum free testosterone level was inversely related to hypertension, dyslipidemia, smokers and BMI. CONCLUSION : The serum free testosterone was found to be lower in patients with acute coronary syndrome as compared to controls. The difference between cases and controls was statistically significant. The serum free testosterone level was lowest in patients who presented with AWMI+IWMI as compared with other patterns of ACS. There was an inverse correlation found between serum free testosterone level and mortality and morbidity in patients with acute coronary syndrome. The serum free testosterone level was found to be lower in cases with traditional risk factors like smoking, hypertension, dyslipidemia and BMI.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Association ; serum testosterone concentration ; coronary heart disease.
Subjects: MEDICAL > General Medicine
Depositing User: Pushparaj A
Date Deposited: 12 Jul 2017 05:44
Last Modified: 04 Feb 2018 01:52
URI: http://repository-tnmgrmu.ac.in/id/eprint/1454

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