Poster Presentation ESA-SRB 2023 in conjunction with ENSA

Testosterone and the risk of incident atrial fibrillation in older men: the ASPREE study (#277)

Cammie Tran 1 , Bu B Yeap 2 3 , Jocasta Ball 1 4 , Daniel Clayton-Chubb 1 5 , S Monira Hussain 1 6 , Amy Brodtmann 1 7 , John J McNeil 1
  1. School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
  2. Medical School, University of Western Australia, Perth, Western Australia, Australia
  3. Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia
  4. Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
  5. Department of Gastroenterology, Alfred Hospital, Melbourne, VIC, Australia
  6. Department of Medical Education, The University of Melbourne, Melbourne, VIC, Australia
  7. Central Clinical School, Monash University, Melbourne, VIC, Australia

Background: Whether testosterone influences cardiovascular risk in older men remains uncertain. A cardiovascular safety trial of testosterone in men with cardiovascular risk factors or disease found no difference in rates of major adverse cardiovascular events (MACE) or deaths, but noted more atrial fibrillation (AF) events in testosterone-treated men.

 

Aim: To investigate whether endogenous testosterone concentrations are associated with risk of developing AF in healthy older men.

 

Methods: Post-hoc analysis of 4,570 male participants in the Aspirin in Reducing Events in the Elderly (ASPREE) study. Men had no history of cardiovascular disease (including AF), thyroid disease, prostate cancer, dementia, or life-limiting illnesses. Total testosterone was measured at baseline using chemiluminescence immunoassay. Incident AF during follow-up was ascertained using self-reported diagnosis, prescription medication and/or medical records. Risk of AF was modelled using restricted cubic splines and Cox proportional hazards regression.

 

Results: Mean age±SD was 75.0±4.2 years and median (IQR) of follow-up 4.4 (3.3-5.5) years, during which 286 men developed AF (15.3 per 1000 participant-years). Baseline testosterone was higher in men who developed incident AF compared men who did not (17.3±6.7 vs 16.5±6.3 nmol/L). There was a non-linear association of baseline testosterone with incident AF. Higher baseline testosterone was associated with an increased risk of AF (per 1SD increase: fully-adjusted hazard ratio [HR]=1.17; 95% Confidence Interval [CI]=1.05-1.32). Risk of AF was similar across the lowest three quintiles of testosterone values, but higher in men with testosterone in quintiles (Q) 4&5 (Q4:Q3, HR=1.91; CI=1.29-2.83 and Q5:Q3HR=1.98; CI=1.33-2.94). Results were similar after excluding men who had MACE or heart failure during follow-up.

 

Conclusion: Serum total testosterone is independently associated with higher risk of incident AF in relatively healthy community-dwelling older men. Screening for AF should be considered when assessing testosterone results or testosterone treatment in older men.