Testosterone and the risk of incident atrial fibrillation in older men: further analysis of the ASPREE study

Cammie Tran; Bu B Yeap; Jocasta Ball; Daniel Clayton-Chubb; Sultana Monira Hussain; Amy Brodtmann; Andrew M Tonkin; Johannes T Neumann; Hans G Schneider; Sharyn Fitzgerald; Robyn L Woods; John J McNeil

doi:10.1016/j.eclinm.2024.102611

Testosterone and the risk of incident atrial fibrillation in older men: further analysis of the ASPREE study

EClinicalMedicine. 2024 Apr 29:72:102611. doi: 10.1016/j.eclinm.2024.102611. eCollection 2024 Jun.

Authors

Cammie Tran¹, Bu B Yeap^{2

3}, Jocasta Ball^{1

4}, Daniel Clayton-Chubb^{5

6}, Sultana Monira Hussain^{1

7}, Amy Brodtmann⁶, Andrew M Tonkin¹, Johannes T Neumann^{8

9}, Hans G Schneider^{1

10}, Sharyn Fitzgerald¹, Robyn L Woods¹, John J McNeil¹

Affiliations

¹ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 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, Victoria, Australia.
⁵ Department of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia.
⁶ Central Clinical School, Monash University, Melbourne, Victoria, Australia.
⁷ Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.
⁸ University Heart and Vascular Center Hamburg, University Medical Center Hamburg - Eppendorf, Hamburg, Germany.
⁹ German Center of Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lubeck, Germany.
¹⁰ Clinical Biochemistry Unit Alfred Pathology Service Alfred Health Melbourne, Victoria, Australia.

Abstract

Background: 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 death but noted more atrial fibrillation (AF) events in testosterone-treated men. We investigated the relationship between endogenous testosterone concentrations with risk of developing AF in healthy older men.

Methods: Post-hoc analysis of 4570 male participants in the ASPirin in Reducing Events in the Elderly (ASPREE) study. Men were aged ≥ 70 years, had no history of cardiovascular disease (including AF), thyroid disease, prostate cancer, dementia, or life-threatening illnesses. Risk of AF was modelled using Cox proportional hazards regression.

Findings: Median (IQR) age was 73.7 (71.6-77.1) years and median (IQR) 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 [17.0 (12.4-21.2) vs 15.7 (12.2-20.0) nmol/L]. There was a non-linear association of baseline testosterone with incident AF. The risk for AF was higher in men with testosterone in quintiles (Q) 4&5 (Q4:Q3, HR = 1.91; 95%CI = 1.29-2.83 and Q5:Q3HR = 1.98; 95%CI = 1.33-2.94). Results were similar after excluding men who experienced MACE or heart failure during follow-up.

Interpretation: Circulating testosterone concentrations within the high-normal range are independently associated with an increased risk of incident AF amongst healthy older men. This suggests that AF may be an adverse consequence of high-normal total testosterone concentrations.

Funding: National Institute on Aging and National Cancer Institute at the National Institutes of Health; Australian Government (NHMRC, CSIRO); Monash University; and AlfredHealth.

Keywords: Ageing; Arrhythmia; Atrial fibrillation; Epidemiology; Gerontology; Testosterone.