Monika Lopuszanska

Anabolic Deficiency in Men With Chronic Heart Failure: Prevalence and Detrimental Impact on Survival

Background— The age-related decline of circulating anabolic hormones in men is associated with increased morbidity and mortality. We studied the prevalence and prognostic consequences of deficiencies in circulating total testosterone (TT) and free testosterone, dehydroepiandrosterone sulfate (DHEAS), and insulin-like growth factor-1 (IGF-1) in men with chronic heart failure (CHF). Methods and Results— Serum levels of TT, DHEAS, and IGF-1 were measured with immunoassays in 208 men with CHF (median age 63 years; median left ventricular ejection fraction 33%; New York Heart Association class I/II/III/IV, 19/102/70/17) and in 366 healthy men. Serum levels of free testosterone were estimated (eFT) from levels of TT and sex hormone binding globulin. Deficiencies in DHEAS, TT, eFT, and IGF-1, defined as serum levels at or below the 10th percentile of healthy peers, were seen across all age categories in men with CHF. DHEAS, TT, and eFT were inversely related to New York Heart Association class irrespective of cause (all P<0.01). DHEAS correlated positively with left ventricular ejection fraction and inversely with N-terminal pro-brain natriuretic peptide (both P<0.01). Circulating TT, eFT, DHEAS, and IGF-1 levels were prognostic markers in multivariable models when adjusted for established prognostic factors (all P<0.05). Men with CHF and normal levels of all anabolic hormones had the best 3-year survival rate (83%, 95% CI 67% to 98%) compared with those with deficiencies in 1 (74% survival rate, 95% CI 65% to 84%), 2 (55% survival rate, 95% CI 45% to 66%), or all 3 (27% survival rate, 95% CI 5% to 49%) anabolic endocrine axes (P<0.0001). Conclusions— In male CHF patients, anabolic hormone depletion is common, and a deficiency of each anabolic hormone is an independent marker of poor prognosis. Deficiency of >1 anabolic hormone identifies groups with a higher mortality.

Deficiencies in circulating testosterone and dehydroepiandrosterone sulphate, and depression in men with systolic chronic heart failure

Elderly men with androgen deficiencies are prone to develop late‐onset depression. We investigated links between circulating androgens and depression, and their combined impact on outcome in men with chronic heart failure (CHF).

The negative health consequences of unemployment: The case of Poland

In the 1990s Poland began to make a transition to a free-market economy: a transition accompanied by a variety of negative socio-economic developments, most notably a rise in unemployment. The aim of this study is to shed light on the relationship between occupational status (including unemployment) and the risk of cardiovascular disease (CVD), by examining the experience of 542 men and 572 women between the ages of 40 and 50 of the town of Wroclaw in 2006. The Framingham Risk Score (FRS), which uses certain health and life-style parameters to predict the risk of major coronary problems over a 10-year period, was calculated, and the effect of occupational status on the FRS was assessed. The results showed that the FRS varied according to sex and to occupational status, with the highest FRS rating among unemployed men. Thus governmental policies to counter the adverse effects of unemployment should be developed to remedy the problem.

Could gonadal and adrenal androgen deficiencies contribute to the depressive symptoms in men with systolic heart failure

Abstract Background: Testosterone (TT) and dehydroepiandrosterone sulphate (DHEAS) are neurosteroids and their deficiencies constitute the hormone risk factors promoting the development of depression in elderly otherwise healthy men. We investigated the link between hypogonadism and depression in accordance with age and concomitant diseases in men with systolic HF using the novel scale previously dedicated for elderly population. Methods: We analysed the prevalence of depression and severity of depressive symptoms in population of 226 men with systolic HF (40–80 years) compared to 379 healthy peers. The severity of depression was assessed using the Polish long version of Geriatric Depression Scale (GDS). Results: In men aged 40–59 years the severity of depressive symptoms was greater in NYHA classes III–IV compared to NYHA classes I–II and reference group. In men aged 60–80 years depressive symptoms were more severe in NYHA class III-IV compared to controls (all p ≤ 0.001). In multivariate logistic regression model in men aged 40–59 years advanced NYHA class was associated with higher prevalence of mild depression (OR = 2.14, 95%CI: 1.07–4.29) and chronic obstructive pulmonary disease (COPD) with higher prevalence of severe depression (OR = 69.1, 95%CI: 2.11–2264.3). In men aged 60–80 years advanced NYHA class and TT deficiency were related to higher prevalence of mild depression (respectively: OR = 2.9, 95%CI: 1.3–6.4; OR = 3.6, 95%CI: 1.2–10.63). Conclusion: TT deficiency, COPD and advanced NYHA class were associated with higher prevalence of depression in men with systolic HF.

Secular trends in body height and body mass in 19-year-old Polish men based on six national surveys from 1965 to 2010.

The aim was to determine whether an intergenerational trend toward increased stature is slowing down, and whether body weight has recently increased among young men in Poland, as it has in Western European countries.

Decrease in sex difference in premature mortality during system transformation in Poland.

In recent years, sex differences in mortality have followed diverse patterns of change in developed countries. As there is no analogous evidence from Poland, the aim of this study was to describe the pattern of change in excess male mortality among Polish inhabitants aged 35-64 during 1995-2002, when the major socioeconomic transformation occurred, and compare it with sex differences in mortality observed in the late 1980s. During the study period, excess male mortality decreased significantly, independently of age and educational level. The reduction in mortality was observed in both sexes, but its magnitude was greater in men. These changes resulted mainly from a reduction in mortality rates due to cardiovascular disease and lung cancer in males and a concomitant increase in mortality rates due to lung cancer and suicides in females. Although, in general, excess male mortality decreased, social gradients related to this phenomenon increased. Subjects (in particularly men) who had graduated from university benefited the most, their magnitude of reduction in mortality rates being the greatest. Changes in social environment during the transformation period in Poland are suggested as major determinants of these changes, but further studies are needed.

The effects of sex steroids and some elements of lifestyle on the normal variation of bone mineral content in younger versus older healthy Polish males

The aim of the study was to evaluate the independent ‘net’ effects of hormonal variables (estradiol, free testosterone and dehydroepiandrosterone sulfate (DHEAS) levels) and lifestyle variables (alcohol consumption, coffee drinking, cigarette smoking, physical activity and muscle strength) on trabecular, cortical and total bone mineral content (BMC) in a group of 236 healthy males, aged 22–67 years. The men were occupationally active inhabitants of the city of Wroclaw, Lower Silesia, Poland. Trabecular, cortical and total bone mineral content, at the distal radius of the non-dominant hand, were assessed by peripheral quantitative computed tomography (pQCT) using the Stratec 960 apparatus. Sex steroids levels were measured using standard immunoassays. Data on lifestyle variables (alcohol consumption, cigarette smoking, coffee drinking and physical activity) were obtained through a questionnaire. Hand-grip strength of the dominant hand was assessed using a standard dynamometer. All statistical analyses were made separately in two subgroups, younger males (aged 22–39 years) and older males (aged 40 years and over). The impact of a particular independent variable on BMC and the extent of determination on BMC by the complex of chosen variables were evaluated using a path analysis. In younger males, the effects of physical activity and muscle strength were the most important among all the factors that influenced BMC, as they contributed to 16.2%, 16.9% and 16.5% of the variability of trabecular, cortical and total BMC, respectively. Taking into consideration cigarette smoking, alcohol and coffee drinking together, the coefficients of determination of the variability in trabecular, cortical and total BMC were 10.6%, 11.3% and 16.1%, respectively. The variances in trabecular, cortical and total BMC levels were determined in only 5.8%, 11.5% and 13.0% by sex steroids, respectively. The influence of free testosterone on trabecular BMC was greater compared with that of dehydroepiandrosterone sulfate (DHEAS) and estradiol; for cortical BMC, the impacts of estradiol and DHEAS were similar and greater than that of free testosterone, and the variability of total BMC was affected mainly by estradiol. In contrast, in older men the effects of physical activity and muscular strength were the least important among all the complexes of independent variables, as they contributed to 4.5%, 7.8% and 7.0% of the variability in trabecular, cortical and total BMC, respectively. Taking into consideration the influences of cigarette smoking, alcohol and coffee drinking, the coefficients of determination of the variability in trabecular, cortical and total BMC were 16.5%, 14.8% and 17.4%, respectively. Among the older men, the variances in trabecular, cortical and total BMC were determined in only 9.4%, 6.3% and 13.6% by sex steroid levels, respectively. The influence of DHEAS on trabecular BMC was greater when compared with that of estradiol and free testosterone, whereas the variability of both cortical and total BMC in older men was affected mainly by estradiol. It is quite striking that, in younger healthy subjects, both physical activity and muscle strength contributed to a greater extent to BMC variance when compared with sex steroids levels, whereas, in older men, physical activity and muscular strength were less important than androgen- estrogen activity in determining the variability of BMC. This may suggest that the tropic effect of mechanical force influences bone structure mainly in younger men; probably male bone tissue becomes less prone to mechanical stimuli during aging. It is astonishing that both in younger and older men the coefficients of determination of physical activity and muscle strength were the highest for cortical BMC, which would indicate the greatest response of that part of the bone tissue to mechanical force. It is worth noting that the coefficients of determination of the complex of lifestyle factors (alcohol consumption, cigarette smoking and coffee drinking) were higher in older men compared to younger Polish males. This can be explained by the longer exposure of male bone to environmental influences (ethanol, nicotine, caffeine) during a lifetime. Our study revealed that all the evaluated variables were related to the variability in BMC in healthy Polish men, but the coefficients of determination differed depending on the age of the examined subject and on the BMC of a particular bone component. This suggests that the responsiveness of male bone tissue to environmental factors changes with age, and that these effects vary significantly between particular parts of the male bone structure.

Response to Letter Regarding Article, “Anabolic Deficiency in Men With Chronic Heart Failure: Prevalence and Detrimental Impact on Survival”

BACKGROUND The age-related decline of circulating anabolic hormones in men is associated with increased morbidity and mortality. We studied the prevalence and prognostic consequences of deficiencies in circulating total testosterone (TT) and free testosterone, dehydroepiandrosterone sulfate (DHEAS), and insulin-like growth factor-1 (IGF-1) in men with chronic heart failure (CHF). METHODS AND RESULTS Serum levels of TT, DHEAS, and IGF-1 were measured with immunoassays in 208 men with CHF (median age 63 years; median left ventricular ejection fraction 33%; New York Heart Association class I/II/III/IV, 19/102/70/17) and in 366 healthy men. Serum levels of free testosterone were estimated (eFT) from levels of TT and sex hormone binding globulin. Deficiencies in DHEAS, TT, eFT, and IGF-1, defined as serum levels at or below the 10th percentile of healthy peers, were seen across all age categories in men with CHF. DHEAS, TT, and eFT were inversely related to New York Heart Association class irrespective of cause (all P<0.01). DHEAS correlated positively with left ventricular ejection fraction and inversely with N-terminal pro-brain natriuretic peptide (both P<0.01). Circulating TT, eFT, DHEAS, and IGF-1 levels were prognostic markers in multivariable models when adjusted for established prognostic factors (all P<0.05). Men with CHF and normal levels of all anabolic hormones had the best 3-year survival rate (83%, 95% CI 67% to 98%) compared with those with deficiencies in 1 (74% survival rate, 95% CI 65% to 84%), 2 (55% survival rate, 95% CI 45% to 66%), or all 3 (27% survival rate, 95% CI 5% to 49%) anabolic endocrine axes (P<0.0001). CONCLUSIONS In male CHF patients, anabolic hormone depletion is common, and a deficiency of each anabolic hormone is an independent marker of poor prognosis. Deficiency of >1 anabolic hormone identifies groups with a higher mortality.