Whether exercises and testosterone replacement therapy support a treatment for cardiovascular and atherosclerotic patients with iliac artery stenosis and low total testosterone and high-density lipoprotein cholesterol after endovascular procedure?
DOI:
https://doi.org/10.14739/2310-1210.2023.2.268513Keywords:
exercise, testosterone replacement therapy, critical iliac stenosis II A and B, serum testosteroneAbstract
Serum levels of testosterone (ST) and high-density lipoprotein (HDL) are generally associated with atherosclerosis in male patients over 50 years with critic iliac stenosis (TASC II A and B) and cardiovascular disease with significant changes in HDL and low-density lipoprotein (LDL). In addition to the standard therapy, combined medicamentous therapy and adequate model of exercise are also important factors as medicines can improve HDL levels and primary bypass and endovascular potency impacting positively on improvement of ST or it can be the following testosterone replacement therapy (TRT) comprising cardiovascular disease prevention and vascular treatment as adjunct therapy options after endovascular and vascular surgical procedures.
The aim of the study is to identify the association between HDL and ST after surgical and endovascular intervention on the iliac segment (TASCII A and B), as well as cardiovascular risk factors with modified medium activity (MET) <6 with short interval increase over >6 (MET), with total duration of 30–60 minutes. It also attempts to remodel a patient behavioral pattern, optimize ST levels and link them to outcomes and patency of vascular procedures on the iliac segment.
Materials and methods. 108 selected male patients with cardiovascular disease combined with metabolic syndrome and critical iliac artery stenosis (TASC II A and B) were examined during 2014–2018, 4 years after invasive and minimal invasive treatment (54 patients were treated with surgical Dacron reconstruction and 54 patients – with endovascular treatment on short segment of critical iliac artery stenosis (TASC II A and B).
Results. In the total population, no difference was observed in changes of constraint-induced movement therapy between the standard exercise group and the control one after 4 years from baseline. However, there was no significant interaction between the effect of exercise trainings and primary bypass potency within 4 years.
Conclusions. Primary effects of endovascular procedure and Dacron bypass revascularization raise the risk of elevated testosterone levels after 4 years of group training but does not provide adequate answers to questions as to whether higher levels of ST have any major influence on primary bypass potency preventing further progression of cardiovascular disease and general symptomatic and asymptomatic atherosclerosis. However, exercise and TRT can be potential adjunctive therapeutic options for a future supporting postsurgical and endovascular illiac treatment in cardiovascular patients with low testosterone levels.
References
Araujo, A. B., Dixon, J. M., Suarez, E. A., Murad, M. H., Guey, L. T, & Wittert, G. A. (2011). Clinical review: Endogenous testosterone and mortality in men: a systematic review and meta-analysis. The Journal of Clinical Endocrinology & Metabolism, 96(10), 3007-3019. https://doi.org/10.1210/jc.2011-1137
Basaria, S. (2010). Androgen abuse in athletes: detection and consequences. The Journal of Clinical Endocrinology & Metabolism, 95(84), 1533-1543. https://doi.org/10.1210/jc.2009-1579
Baillargeon, J., Urban, R. J., Kuo, Y. F., Ottenbacher, K. J., Raji, M. A., Du, F., Lin, Y. L., & Goodwin, J. S. (2014). Risk of Myocardial Infarction in Older Men Receiving Testosterone Therapy. Annals of Pharmacotherap, 48(9), 1138-1144. https://doi.org/10.1177/1060028014539918
Bagatell, C. J., Knopp, R. H., Rivier, J. E., & Bremner, W. J. (1994). Physiological levels of estradiol stimulate plasma high density lipoprotein2 cholesterol levels in normal men. Journal of Clinical Endocrinology Metabolism, 78(4), 855-861. https://doi.org/10.1210/jcem.78.4.8157711
Clark, M. J., Schopp, L. H., Mazurek, M. O., Zaniletti, I., Lammy, A. B., Martin, T. A., Thomas, F. P., & Acuff, M. E. (2008). Testosterone levels among men with spinal cord injury: relationship between time since injury and laboratory values. American Journal Physical Medical Rehabilitation, 87(9), 758-767. https://doi.org/10.1097/PHM.0b013e3181837f4f
Corona, G., Rastrelli, G., Monami, M., Guay, A., Buvat, J., Sforza, A., Forti, G., Mannucci, E., & Maggi, M. (2011). Hypogonadism as a risk factor for cardiovascular mortality in men: a meta-analytic study. European Journal Endocrinology, 165(5), 687-701. https://doi.org/10.1530/EJE-11-0447
Corona, G., Vignozzi, L., Sforza, A., & Maggi, M. (2013). Risks and benefits of late onset hypogonadism treatment: an expert opinion. World Journal Men´s Health, 31(2), 103-125. https://doi.org/10.5534/wjmh.2013.31.2.103
Corona, G., Vignozzi, L., Sforza, A., Mannucci, E., & Maggi, M. (2015). Obesity and late-onset hypogonadism. Molecular and cellular endocrinology, 418 Pt 2, 120-133. https://doi.org/10.1016/j.mce.2015.06.031
Corona, G., Bianchini, S., Sforza, A., Vignozzi, L., & Maggi, M. (2015a). Hypogonadism as a possible link between metabolic diseases and erectile dysfunction in aging men. Hormones (Athens), 14(4), 569-578. https://doi.org/10.14310/horm.2002.1635
Corona G. , Rastrelli, G., Maseroli, E., Sforza, A., & Maggi, M. (2015). Testosterone Replacement Therapy and Cardiovascular Risk: A Review. The world journal of men's health, 33(3), 130-142. https://doi.org/10.5534/wjmh.2015.33.3.130
Calabresi, L., Gomaraschi, M., & Franceschini, G. (2003). Endothelial protection by high-density lipoproteins: from bench to bedside. Arteriosclerosis, Thrombosis, and Vascular Biology, 23(10), 1724-1731. https://doi.org/10.1161/01.ATV.0000094961.74697.54
Cuchel, M., & Rader, D. J. (2006). Macrophage reverse cholesterol transport: key to the regression of atherosclerosis? Circulation, 113(21), 2548-2555. https://doi.org/10.1161/CIRCULATIONAHA.104.475715
Cauley, J. A., Gutai, J. P., Kuller, L. H., & Dai, W. S. (1987). Usefulness of sex steroid hormone levels in predicting coronary artery disease in men. American Journal of Cardiology, 60(10), 771-777. https://doi.org/10.1016/0002-9149(87)91021-6
Dunajska, K., Milewicz, A., Szymczak, J., Jêdrzejuk, D., Kuliczkowski, W., Salomon, P., & Nowicki, P. (2004). Evaluation of sex hormone levels and some metabolic factors in men with coronary atherosclerosis. Aging Male, 7(3), 197-204. https://doi.org/10.1080/13685530400004181
English, K. M., Steeds, R. P., Jones, T. H., Diver, M. J., & Channer, K. S. (2000). Low-dose transdermal testosterone therapy improves angina threshold in men with chronic stable angina: a randomized, double-blind, placebo-controlled study. Circulation, 102(16), 1906-1911. https://doi.org/10.1161/01.cir.102.16.1906
English, K. M., Mandour, O., Steeds, R. P., Diver, M. J., Jones, T. H., & Channer, K. S. (2000). Men with coronary artery disease have lower levels of androgens than men with normal coronary angiograms. European Heart Journal, 21(11), 890-894. https://doi.org/10.1053/euhj.1999.1873
Gremeaux, V., Drigny, J., Nigam, A., Juneau, M., Guilbeault, V., Latour, E., & Gayda, M. (2012). Long-term lifestyle intervention with optimized high-intensity interval training improves body composition, cardiometabolic risk, and exercise parameters in patients with abdominal obesity. American Journal of Physical Medicine & Rehabilitation, 91(11), 941-950. https://doi.org/10.1097/PHM.0b013e3182643ce0
Haddad, R. M., Kennedy, C. C., Caples, S. M., Tracz, M. J., Boloña, E. R., Sideras, K., Uraga, M. V., Erwin, P. J., & Montori, V. M. (2007). Testosterone and cardiovascular risk in men: a systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clinic Proceedings, 82(1), 29-39. https://doi.org/10.4065/82.1.29
Heller, R. F., Jacobs, H. S, Vermeulen, A., & Deslypere, J. P. (1981). Androgens, oestrogens, and coronary heart disease. British Medicine Journal. 282(6262), 438-439. https://doi.org/10.1136/bmj.282.6262.438
Hata, Y., & Nakajima, K. (2000). Life-style and serum lipids and lipoproteins. Journal of Atherosclerosis and Thrombosis, 7(4), 177-197. https://doi.org/10.5551/jat1994.7.177
Kokkinos, P. F., & Fernhall, B. (1999). Physical activity and high density lipoprotein cholesterol levels: what is the relationship? Sports Medicine, (5), 307-314. https://doi.org/10.2165/00007256-199928050-00002
Kokkinos, P. F., Holland, J. C., Narayan, P., Colleran, J. A., Dotson, C. O., & Papademetriou, V. (1995). Miles run per week and high-density lipoprotein cholesterol levels in healthy, middle-aged men. A dose-response relationship. The Archives Internal Medicine, 55(4), 415-420.
Khazai, B., Golden, S. H., Colangelo, L. A., Swerdloff, R., Wang, C., Honoris, L., Gapstur, S. M., Ouyang, P., Cushman, M., Li, D., Kopp, P., Vaidya, D., Liu, K., Dobs, A., & Budoff, M. (2016). Association of endogenous testosterone with subclinical atherosclerosis in men: the multi-ethnic study of atherosclerosis. Clinical endocrinology, 84(5), 700-707. https://doi.org/10.1111/cen.12997
Khera, A. V., Cuchel, M., de la Llera-Moya, M., Rodrigues, A., Burke, M. F., Jafri, K., French, B. C., Phillips, J. A., Mucksavage, M. L., Wilensky, R. L., Mohler, E. R., Rothblat, G. H., & Rader, D. J. (2011). Cholesterol efflux capacity, high-density lipoprotein function, and atherosclerosis. The New England journal of medicine, 364(2), 127-135. https://doi.org/10.1056/NEJMoa1001689
Ludwig, M., von Petzinger-Kruthoff, A., von Buquoy, M., & Stumpe, K. O. (2003). Intima media thickness of the carotid arteries: early pointer to arteriosclerosis and therapeutic endpoint. Ultraschall Medicine, 24(3), 162-174. https://doi.org/10.1055/s-2003-40058
Lafitte, M., Pradeau, V., Leroux, L., Richeboeuf, V., Tastet, S., Boulon, C., Paviot, B., Bonnet, J., & Couffinhal, T. (2009). Efficacy over time of a short overall atherosclerosis management programme on the reduction of cardiovascular risk in patients after an acute coronary syndrome. Archives of cardiovascular diseases, 102(1), 51-58. https://doi.org/10.1016/j.acvd.2008.09.014
Mäkinen, J., Järvisalo, M. J., Pöllänen, P., Perheentupa, A., Irjala, K., Koskenvuo, M., Mäkinen, J., Huhtaniemi, I., & Raitakari, O. T. (2005). Increased carotid atherosclerosis in andropausal middle-aged men. Journal of the American College of Cardiology, 45(10), 1603-1608. https://doi.org/10.1016/j.jacc.2005.01.052
Muraleedharan, V., Marsh, H., Kapoor, D., Channer, K. S., & Jones, T. H. (2013). Testosterone deficiency is associated with increased risk of mortality and testosterone replacement improves survival in men with type 2 diabetes. European journal of endocrinology, 169(6), 725-733. https://doi.org/10.1530/EJE-13-0321
Morgentaler, A., & Traish, A. (2020). The History of Testosterone and the Evolution of its Therapeutic Potential. Sexual Medicine Reviews, 8 (2), 286-296. https://doi.org/10.1016/j.sxmr.2018.03.002
Ozata, M., Yildirimkaya, M., Bulur, M., Yilmaz, K., Bolu, E., Corakci, A., & Gundogan, M. A. (1996). Effects of gonadotropin and testosterone treatments on Lipoprotein(a), high density lipoprotein particles, and other lipoprotein levels in male hypogonadism. The Journal of Clinical Endocrinology & Metabolism, 81(9), 3372-3378. https://doi.org/10.1210/jcem.81.9.8784099
Phillips, G. B. (1976). Evidence for hyperoestrogenaemia as a risk factor for myocardial infarction in men. Lancet, 2(7975), 14-18. https://doi.org/10.1016/s0140-6736(76)92968-8
Phillips, G. B., Castelli, W. P., Abbott, R. D., & McNamara, P. M. (1983). Association of hyperestrogenemia and coronary heart disease in men in the Framingham cohort. American Journal Medicine, 74(5), 863-869. https://doi.org/10.1016/0002-9343(83)91078-1
Phillips, G. B., Yano, K., & Stemmermann, G. N. (1988). Serum sex hormone levels and myocardial infarction in the Honolulu Heart Program. Pitfalls in prospective studies on sex hormones. Journal Clinical Epidemiology, 41(12), 1151-1156. https://doi.org10.1016/0895-4356(88)90018-2
Price, J. F., & Leng, G. C. (2002). Steroid sex hormones for lower limb atherosclerosis. The Cochrane database of systematic reviews, (1), CD000188. https://doi.org/10.1002/14651858.CD000188
Rosenson, R. S., Brewer, H. B., Jr, Chapman, M. J., Fazio, S., Hussain, M. M., Kontush, A., Krauss, R. M., Otvos, J. D., Remaley, A. T., & Schaefer, E. J. (2011). HDL measures, particle heterogeneity, proposed nomenclature, and relation to atherosclerotic cardiovascular events. Clinical chemistry, 57(3), 392-410. https://doi.org/10.1373/clinchem.2010.155333
Ruige, J. B., Mahmoud, A. M., De Bacquer, D., & Kaufman, J. M. (2011). Endogenous testosterone and cardiovascular disease in healthy men: a meta-analysis. Heart, 97(11), 870-875. https://doi.org/10.1136/hrt.2010.210757
Rubinow, K. B., Vaisar, T., Tang, C., Matsumoto, A. M., Heinecke, J. W., & Page, S. T. (2012). Testosterone replacement in hypogonadal men alters the HDL proteome but not HDL cholesterol efflux capacity. Journal of Lipid Research, 53(7), 1376-1383. https://doi.org/10.1194/jlr.P026005
Sudhir, K., & Komesaroff, P. A., (1999). Clinical review 110: Cardiovascular actions of estrogens in men. Journal of Clinical Endocrinolgy Metabolism, 84(10), 3411-3415. https://doi.org/10.1210/jcem.84.10.5954
Seeman, E. (2001). Unresolved issues in osteoporosis in men. Reviews in Endocrine and Metabolic Disorders, 2(1), 45-64. https://doi.org/10.1023/a:1010054924085
Shabsigh, R., Katz, M., Yan, G., & Makhsida., N. (2005). Cardiovascular issues in hypogonadism and testosterone therapy. American Journal of Cardiology, 96(12B), 67M-72M. https://doi.org/0.1016/j.amjcard.2005.10.009
Svartberg, J., von Mühlen, D., Mathiesen, E., Joakimsen, O., Bønaa, K. H., & Stensland-Bugge, E. (2006). Low testosterone levels are associated with carotid atherosclerosis in men. Journal Internal Medicine, 259(6), 576-582. https://doi.org/10.1111/j.1365-2796.2006.01637.x
Srinivas-Shankar, U., Roberts, S. A., Connolly, M. J., O'Connell, M. D., Adams, J. E., Oldham, J. A., & Wu, F. C. (2010). Effects of testosterone on muscle strength, physical function, body composition, and quality of life in intermediate-frail and frail elderly men: a randomized, double-blind, placebo-controlled study. Journal Clinic Endocrinology Metabolism, 95(2), 639-650. https://doi.org/10.1210/jc.2009-1251
Shores, M. M., & Matsumoto, A. M. (2014). Testosterone, aging and survival: biomarker or deficiency. Current Opinion Endocrinology Diabetes Obesity, 21(3), 209-216. https://doi.org/10.1097/MED.0000000000000057
Shivanand Reddy, K. V., Thrishuli, P. B., & Manjunath S. (2014). Relation between low serum testosterone level and peripheral arterial disease in men and clinical evaluation of effect of testosterone administration. Surgery Current Research, 4(6), 63. https://doi.org/10.4172/2161-1076.S1.016
Solakovic, S., Vrcic, M., Pavlovic, R., & Pupiš, M. (2016). HDL Level in Amateur Bodybuilders who Misuse the Combination of Testesterone Products and Anabolic Steroids in Bosnia and Herzegovina. Slovak Journal of Sport Science, 1(1), 1-8.
Solakovic, S., Vrcic, M., Solakovic, N., & Pavlović, R. (2016). Irrational Abuse of Testosterone and Mass Supplements by Recreational Bodybuilders with "Adonis Complex" Leads to Potential Cardiovascular Diseases and Psychophysical Disorders International Journal of Sports Science, 6(6), 230-236.
Solaković, S., Vrcić, M., & Pavlović, R. (2016). Benefits of physical activity on diabetic and non-diabetic patients in fontaine’s stage IIa of peripheral artery disease in Bosnia and Herzegovina. Journal of Physical Education Research, 3(2), 23-33.
Snyder, P. J., Kopperdahl, D. L., Stephens-Shields, A. J., Ellenberg, S. S., Cauley, J. A., Ensrud, K. E., Lewis, C. E., Barrett-Connor, E., Schwartz, A. V., Lee, D. C., Bhasin, S., Cunningham, G. R., Gill, T. M., Matsumoto, A. M., Swerdloff, R. S., Basaria, S., Diem, S. J., Wang, C., Hou, X., Cifelli, D., … Keaveny, T. M. (2017). Effect of Testosterone Treatment on Volumetric Bone Density and Strength in Older Men With Low Testosterone: A Controlled Clinical Trial. JAMA internal medicine, 177(4), 471-479. https://doi.org/10.1001/jamainternmed.2016.9539
Tanasescu, M., Leitzmann, M. F., Rimm, E. B., Willett, W. C., Stampfer, M. J., & Hu, F. B. (2002). Exercise type and intensity in relation to coronary heart disease in men. Journal of the American Medical Association, 288(16), 1994-2000. https://doi.org/10.1001/jama.288.16.1994
Tivesten, A., Mellström, D., Jutberger, H., Fagerberg, B., Lernfelt, B., Orwoll, E., Karlsson, M. K., Ljunggren, O., & Ohlsson, C. (2007). Low serum testosterone and high serum estradiol associate with lower extremity peripheral arterial disease in elderly men. The MrOS Study in Sweden. Journal of the American College of Cardiology, 50(11), 1070-1076. https://doi.org/10.1016/j.jacc.2007.04.088
Torkler, S., Wallaschofski, H., Baumeister, S. E., Völzke, H., Dörr, M., Felix, S., Rettig, R., Nauck, M., & Haring, R. (2011). Inverse association between total testosterone concentrations, incident hypertension and blood pressure. The aging male, 14(3), 176-182. https://doi.org/10.3109/13685538.2010.529194
Vanhees, L., Schepers, D., & Fagard, R. (1997). Comparison of maximum versus submaximum exercise testing in providing prognostic information after acute myocardial infarction and/or coronary artery bypass grafting. American Journal of Cardiology, 80(3), 257-262. https://doi.org/10.1016/s0002-9149(97)00342-1
Webb, C. M., Adamson, D. L., de Zeigler, D., & Collins, P. (1999). Effect of acute testosterone on myocardial ischemia in men with coronary artery disease. The American journal of cardiology, 83(3), 437-A9. https://doi.org/10.1016/s0002-9149(98)00880-7
Yarrow, J. F., Conover, C. F., Beggs, L. A., Beck, D. T., Otzel, D. M., Balaez, A., Combs, S. M., Miller, J. R., Ye, F., Aguirre, J. I., Neuville, K. G., Williams, A. A., Conrad, B. P., Gregory, C. M., Wronski, T. J., Bose, P. K., & Borst, S. E. (2014). Testosterone dose dependently prevents bone and muscle loss in rodents after spinal cord injury. Journal of neurotrauma, 31(9), 834-845. https://doi.org/10.1089/neu.2013.3155
Zmuda, J. M., Yurgalevitch, S. M., Flynn, M. M., Bausserman, L. L., Saratelli, A., Spannaus-Martin, D. J., Herbert, P. N., & Thompson, P. D. (1998). Exercise training has little effect on HDL levels and metabolism in men with initially low HDL cholesterol. Atherosclerosis, 137(1), 215-221. https://doi.org/10.1016/s0021-9150(97)00257-8
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