Meta-Analysis:
Circulating androgen and the risk of mortality in male patients with chronic heart failure: a metaanalysis of prospective cohort studies
Yunwei Li1,*, Xiaoming Zhong1,*, Guanchang Cheng1, Cuihua Zhao1, Lei Zhang1, Yan Hong1, Qilin Wan1, Ruili He1 and Zhizhong Wang1
1Department of Cardiovascular Medicine, Huaihe Hospital of Henan University, Kaifeng 475000, China
*These authors contributed equally to this work
Correspondence to:
Guanchang Cheng, email: [email protected]
Keywords: androgen deficiency; testosterone; sex hormone-binding globulin; chronic heart failure; mortality
Received: August 09, 2017 Accepted: September 23, 2017 Published: March 01, 2018
ABSTRACT
Background: Androgen deficiency is correlated with the severity of chronic heart failure (CHF). However, whether circulating androgen, including total testosterone (TT), dehydroepiandrosterone sulfate (DHEAS), free testosterone (FT), as well as higher sex hormone-binding globulin (SHBG), are predictive of the mortality in CHF remain to be determined.
Results: Six cohort studies including 1342 CHF patients were included. With a mean follow-up between 2.2 to 3.5 years, 456 mortality cases occurred. Results of the meta-analyses showed that higher circulating TT (hazard ratio [HR] per 1 ng/ml increment = 0.87, p < 0.001), DHEAS (HR per 100 ng/ml increment = 0.93, p = 0.006), and FT (HR per 10 pg/ml increment = 0.93, p < 0.001) were independently associated with lower mortality risk, while higher SHBG (HR per increment of 1 nmol/L = 1.05, p < 0.001) was independently associated with higher mortality risk in CHF. Results of subgroup analyses according to the study outcome suggested that the predictive efficacies of TT, DHEAS, FT and SHBG were similar for both the outcomes of all-cause mortality and cardiovascular mortality (p for subgroup difference all < 0.05).
Materials and Methods: A meta-analysis of prospective cohort study was performed to evaluate the association between androgen at baseline and the mortality risk in CHF. Relevant studies were identified by systematic searching of PubMed and Embase. A random effect model was used to combine the results to incorporate the potential heterogeneities.
Conclusions: Androgen deficiency may be independently associated with higher mortality risk in male CHF patients.