Myocardial infarction in young men: androgen levels and predictors of post-hospital adverse cardiovascular events


DOI: https://dx.doi.org/10.18565/therapy.2023.4.22-29

Tkachenko V.V., Tuev A.V., Karpunina N.S., Shishkina E.A.

Academician E.A. Wagner Perm State Medical University of the Ministry of Healthcare of the Russia
Abstract. Myocardial infarction (MI) remains one of the leading causes of morbidity and mortality worldwide, including in young men.
The aim of the study was to determine the risk factors for recurrent MI in young men with normal and reduced testosterone levels, taking into account the angiographic patterns.
Material and methods. The total amount is of 99 men aged 25 to 44 years, group I includes 60 patients with STEMI and the phenomenon of slow coronary blood flow (SFC), group II includes 39 patients with STEMI and atherotrombotic occlusion of the coronary artery. During the admission together with the routine examination, the levels of testosterone, cortisol, sex steroid-binding globulin and free testosterone were measured. To evaluate the long-term outcomes after index MI (12 months after) multivariate prognostic models were used.
Results. A year after the index MI, there was a failure to achieve the target blood pressure in 45,6% and 51,7% in both groups, the target LDL level in 40,4% and 72,4%, respectively. There were no deaths in the groups, a new MI was registered in 10 and 16 men from groups 1 and 2. It was found that for men with normal testosterone levels, regardless of the angiographic pattern, the risk of MI increased with a decline in cortisol levels, with neutrophil-lymphocyte ratio (NLR) growth and the number of affected arteries, CI: 0,69–0,94, model sensitivity – 86,4%, specificity – 87,5%, p=0,004. The risk of MI for men with low testosterone levels increased with ejection fraction reducing and with an increase in NLR and LDL cholesterol, CI: 0,53–0,83, sensitivity – 67%, specificity – 38%, p=0,001.
Conclusion. As with the saved and with a reduced level of testosterone, the predictors of adverse cardiac events (a new MI) made a combination of atherogenic dyslipidemia with the activity of latent inflammation. In addition, the need to improve further work to achieve the target values of blood pressure and LDL in patients with STEMI has been highlighted.
Keywords: androgen level, post-hospital adverse events, young men, myocardial infarction
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About the Autors

Vyacheslav V. Tkachenko, applicant at the Department of hospital therapy and cardiology, Academician E.A. Wagner Perm State Medical University of the Ministry of Healthcare of the Russia. Address: 614000, Perm, 85 Pushkina Str. E-mail: vvtkachenko@heart-perm.ru
Alexander V. Tuev, MD, professor, professor of the Department of hospital therapy and cardiology, Academician
E.A. Wagner Perm State Medical University of the Ministry of Healthcare of the Russia. Address: 614000, Perm, 85 Pushkina Str. E-mail: olgakhlynova@mail.ru. ORCID: https://orcid.org/0000-0002-1336-1054
Natalia S. Karpunina, MD, associate professor, professor of the Department of hospital therapy and cardiology, Academician E.A. Wagner Perm State Medical University of the Ministry of Healthcare of the Russia. Address: 614000, Perm, 85 Pushkina Str. E-mail: karpuninapsma@mail.ru. ORCID: https://orcid.org/0000-0003-3127-1797
Ekaterina A. Shishkina, MD, associate professor of the Department of hospital therapy and cardiology, Academician E.A. Wagner Perm State Medical University of the Ministry of Healthcare of the Russia. Address: 614000, Perm, 85 Pushkina Str. E-mail: doctor.shishkina@yandex.ru. ORCID: https://orcid.org/0000-0001-6965-7869


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