Deficiencies in Circulating Testosterone, and Depression in Men With HF
Deficiencies in Circulating Testosterone, and Depression in Men With HF
Aims 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).
Methods and results Serum total testosterone (TT) and dehydroepiandrosterone sulphate (DHEAS) were measured using immunoassays in 163 men with stable systolic CHF [age: 60 ± 10 years, NYHA class (I/II/III/IV): 27/84/46/6] and 316 healthy men. Depression was assessed using Beck Depression Inventory (BDI) and defined as BDI ≥16 points. In men with CHF, reduced TT and DHEAS, advanced NYHA class, elevated N-terminal pro-B type natriuretic peptide (NT-proBNP), reduced glomerular filtration rate, and reduced haemoglobin independently predicted severity of depressive symptoms (all P < 0.05). Depression was present in 20, 37 and 77% of men with no androgen deficiency, either TT or DHEAS deficiency, and both androgen deficiencies, respectively (P < 0.0001). During follow-up (median: 28 months), there were 87 (53%) cardiovascular deaths or unplanned hospitalizations. TT and DHEAS deficiencies (defined as ≤ the 10th percentile of serum androgen levels in healthy controls) and BDI ≥16 points independently predicted unfavourable outcome (all P < 0.05).
Conclusion TT and DHEAS deficiencies predict severity of depression in men with CHF. Depression and combined androgen deficiencies are independently related to poor outcome in these patients.
Deficiencies in circulating gonadal and adrenal androgens are prominent features of male ageing. Depleted testosterone and dehydroepiandrosterone sulphate (DHEAS) levels are linked to both impaired somatic health and worsened psyche of elderly men in a general population. Markedly reduced circulating levels of these androgens are also seen in men at advanced stages of chronic diseases, including the syndrome of chronic heart failure (CHF). In male patients with CHF, depleted anabolic axes are related to impaired exercise capacity, changes in body composition, and increased cardiovascular mortality.
Only recently it has become evident that elderly men with androgen deficiency are prone to develop depressive symptoms, as androgens directly modify functioning of central nervous system structures involved in the regulation of human psyche and mood. Depressive symptoms are common in patients with CHF, negatively affecting their quality of life and long-term survival. Among numerous pathophysiological mechanisms explaining the high prevalence of depression in CHF (MOOD-HF), the impact of androgen deficiencies has not been evaluated.
Therefore, we investigated links between deficiencies in circulating androgens and depressive symptoms, and their combined impact on outcome in men with CHF.
Abstract and Introduction
Abstract
Aims 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).
Methods and results Serum total testosterone (TT) and dehydroepiandrosterone sulphate (DHEAS) were measured using immunoassays in 163 men with stable systolic CHF [age: 60 ± 10 years, NYHA class (I/II/III/IV): 27/84/46/6] and 316 healthy men. Depression was assessed using Beck Depression Inventory (BDI) and defined as BDI ≥16 points. In men with CHF, reduced TT and DHEAS, advanced NYHA class, elevated N-terminal pro-B type natriuretic peptide (NT-proBNP), reduced glomerular filtration rate, and reduced haemoglobin independently predicted severity of depressive symptoms (all P < 0.05). Depression was present in 20, 37 and 77% of men with no androgen deficiency, either TT or DHEAS deficiency, and both androgen deficiencies, respectively (P < 0.0001). During follow-up (median: 28 months), there were 87 (53%) cardiovascular deaths or unplanned hospitalizations. TT and DHEAS deficiencies (defined as ≤ the 10th percentile of serum androgen levels in healthy controls) and BDI ≥16 points independently predicted unfavourable outcome (all P < 0.05).
Conclusion TT and DHEAS deficiencies predict severity of depression in men with CHF. Depression and combined androgen deficiencies are independently related to poor outcome in these patients.
Introduction
Deficiencies in circulating gonadal and adrenal androgens are prominent features of male ageing. Depleted testosterone and dehydroepiandrosterone sulphate (DHEAS) levels are linked to both impaired somatic health and worsened psyche of elderly men in a general population. Markedly reduced circulating levels of these androgens are also seen in men at advanced stages of chronic diseases, including the syndrome of chronic heart failure (CHF). In male patients with CHF, depleted anabolic axes are related to impaired exercise capacity, changes in body composition, and increased cardiovascular mortality.
Only recently it has become evident that elderly men with androgen deficiency are prone to develop depressive symptoms, as androgens directly modify functioning of central nervous system structures involved in the regulation of human psyche and mood. Depressive symptoms are common in patients with CHF, negatively affecting their quality of life and long-term survival. Among numerous pathophysiological mechanisms explaining the high prevalence of depression in CHF (MOOD-HF), the impact of androgen deficiencies has not been evaluated.
Therefore, we investigated links between deficiencies in circulating androgens and depressive symptoms, and their combined impact on outcome in men with CHF.