Novel risk factors for coronary artery disease – role of testosterone and high-sensitivity CRP in Sri Lankan males

Abstract

Coronary artery disease (CAD) is multi-factorial in origin and develops as a result of both genetic and environmental factors. Traditional risk factors (generally smoking, hypertension, raised lipids, and diabetes mellitus) do not explain all of the risk for coronary disease events. There remain several other factors that contribute to the overall risk. Various new or emerging risk factors have been studied to improve global risk assessment for CAD. Inflammation indicated by markers as Creactive protein and low androgen (testosterone) status in males are among the emerging risk factors. In the local setting, the association of testosterone with CAD has not been explored, although this relationship has been well-studied in the Western population. Therefore we investigated, whether serum levels of total testosterone (TT) and high sensitivity C-reactive protein (hs-CRP) differ in men with CAD from those without CAD and to evaluate the relationship of serum TT and hs-CRP with the severity of CAD. Three hundred and nine males (103 patients with ST-elevation myocardial infarction (STEMI), 103 patients with angiographically-proven CAD, 103 controls without having a history of CAD) were studied. Serum TT, hs-CRP, lipids, cardiac troponin I (cTnI) and plasma glucose were estimated. Three angiogram-based severity scores were used in the severity assessment of angiographically-proven CAD. In STEMI patients, clinical risk scores and modified Selvester ECG QRS score were used in assessing the severity of myocardial infarction. We showed that low levels of total testosterone, high levels of hs-CRP, abnormal lipid profile and raised plasma glucose contribute to an atherogenic milieu. Low levels of total testosterone and high level of hs-CRP can be perceived as risk factors of coronary artery disease.