Abstract

PURPOSE: Male ageing is associated with increased incidence of cardiovascular disease (CVD) and lower circulating testosterone (T). However, whether physical activity (PA) interacts with hormones to modify CVD risk is unclear. We assessed whether PA and sex hormone concentrations were independently associated with measures of CVD risk in 1649 men. METHODS: Leisure, home, work and total PA were ascertained via questionnaire. At baseline, serum T, dihydrotestosterone (DHT) and estradiol (E2) were assayed. Men were stratified into high PA+high hormone (H/H); low PA+high hormone (L/H); high PA+low hormone (H/L) and low PA+low hormone (L/L) groups. RESULTS: Mean age was 49.8 years at outset with 415 CVD events and 127 CVD deaths occurring during 20-year follow-up. Men with higher PA and higher T or DHT had lower odds of metabolic syndrome (leisure H/H vs L/L odds ratio [OR] 0.17 p<0.001 for T, 0.26 p<0.001 for DHT). Men with higher PA and E2 had lower risk of metabolic syndrome (leisure PA H/H vs L/L OR 0.51, p=0.001). Men with higher leisure PA and higher DHT had the lowest risk of CVD events (H/H hazard ratio [HR] 0.72 vs L/L, p=0.016) and CVD death (H/H HR 0.52 vs L/L, p=0.015). Men with low leisure PA and higher E2 were at greater risk of CVD death (L/H vs L/L HR 1.67, p=0.022). CONCLUSIONS: Considering PA levels in the context of T, DHT and E2 better informs consideration of cardiovascular risk. A 2x2 factorial RCT assessing PA and T would illuminate the scope for preventing CVD in men.

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