New study establishes the importance of androgens in older women for cardiovascular health

The protective effects of estrogen on cardiovascular health have long been reported, but what about testosterone? Research published in THE LANCET Healthy Longevity this month by Rakibul Islam and colleagues challenges previous assumption that androgens exert harmful cardiovascular effects in older women.

This study is the largest prospective longitudinal study of women aged 70+ years, which measures sex hormones and adverse cardiovascular events. While previous studies have reported that postmenopausal women with low serum testosterone were at increased risk of cardiovascular disease, methodological limitations of these studies have questioned the robustness of their findings. Rakibul Islam’s study is the first to demonstrate a significant association between a relatively low concentration of testosterone in the blood and an increased risk of ischaemic cardiovascular disease events.

Eligible participants were taken from the ASPREE trial and were over 5000 healthy Australian women aged 70 years with unimpaired cognition, no previous cardiovascular events, and a life expectancy of at least 5 years.

5535 women were included in the final analysis, and they were followed up for 4-6 years. Their risk of cardiovascular events and all-cause mortality were assessed using Cox proportional hazards regression that included age, body-mass index, smoking status, alcohol consumption, diabetes, hypertension, dyslipidaemia, impaired renal function, and treatment allocation in the ASPREE trial (aspirin vs placebo).

Results showed that blood concentrations of testosterone and DHEA above the lowest quartile were associated with nearly half the risk of a major adverse cardiovascular event, independent of traditional risk factors for cardiovascular disease.

The authors conclude:

“In healthy women from Australia aged 70 years and older, having blood testosterone and DHEA concentrations above the lowest quartile appears to be cardioprotective. Replication of these findings would justify the consideration of trials investigating testosterone therapy for the primary prevention of ischaemic cardiovascular disease events in older women with low circulating concentrations of testosterone.”

Dr Louise Newson, Chair of Newson Health Menopause Society responds:

“Testosterone is an important female hormone but has been neglected for too many years. This study highlights how important it is to undertake more research in testosterone and cardiovascular health, as well as testosterone’s potential role in improving bone and brain health.”

There is clearly a need for research to now focus on the effects of transdermal testosterone therapy for cardiovascular health, to continue to improve our understanding of the role of hormones in protecting our future health.