Testosterone to Oestradiol Ratio: A Signi cant Indicator for Prediction of Coronary Artery Disease in Males | [Journal of the College of Physicians and Surgeons Pakistan • 2025]

Author(s):

1. Hafsa Aziz: Department of Chemical Pathology, National University of Medical Sciences, Rawalpindi, Pakistan

2. Muhammad Anwar: Department of Chemical Pathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan

3. Muhammad Qaiser Alam Khan: Department of Chemical Pathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan

4. Muhammad Younas: Department of Chemical Pathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan

5. Zujaja Hina Haroon: Department of Chemical Pathology, Combined Military Hospital, Peshawar, Pakistan

6. Uzma Naeem: Department of Chemical Pathology, Combined Military Hospital, Rawalpindi, Pakistan

Abstract:

To determine the association of serum testosterone / oestradiol ratio (T/E2) with coronary artery disease (CAD) in males. Study Design: A comparative cross-sectional study. Place and Duration of the Study: Department of Chemical Pathology, Armed Forces Institute of Pathology, in collaboration with Armed Forces Institute of Cardiology, Rawalpindi, Pakistan, from February 2023 to January 2024. Methodology: Plasma testosterone and oestradiol concentrations were determined in the blood samples of 300 males. Serum T/E2 ratio was associated with history and baseline characteristics. CAD markers according to serum T/E2 quartiles were compared to study the relation of T/E2 ratio with disease progression. T/E2, C-reactive protein (CRP), and total cholesterol were compared by oneway ANOVA test in groups divided based on the cardiac calcium score. Results: Higher calcium scores were connected with greater amounts of CRP (low: 10.0 mg/L, moderate: 16.5 mg/L, and high: 33.0 mg/L, p <0.001), oestradiol (median: 165.0 pmol/L, IQR: 212.0 14.0), and less testosterone (median: 12.0 nmol/L, IQR: 18.5 6.0). T/E2 ratios were found to play a role in coronary risk, as they decreased a lot as the calcium score increased (from 0.98 in the low group to 0.40 in the high group, p <0.001). The ndings also highlighted that di erent biochemical patterns correspond with the link between T/E2 ratios and the risk of heart disease. Conclusion: Men with a T/E2 ratio lower than 1.41 had more calci ed plaque (median calcium score: 100.0, IQR: 410.0 50.0) and higher levels of systemic in ammation (median CRP: 22.0 mg/L, IQR: 59.0 9.0). Consequently, a T/E2 ratio below 1.41 can be used as a simple and inexpensive marker to predict major heart events in men.

Page(s): 814-818

DOI: 10.29271/jcpsp.2025.07.814

Published: Journal: Journal of the College of Physicians and Surgeons Pakistan, Volume: 35, Issue: 07, Year: 2025

Keywords:

Body mass index , Coronary artery disease , Myocardial Infarction , CT angiography , Cardiac calcium score , Testosterone to oestradiol ratio

References:

[1] Crawford K,Jakub K,Lockhart JS,Wold JL .2023 .Knowledge, attitudes, and beliefs of cardiovascular disease prevention in young adults in the country of Georgia. J Nurs Scholarsh, 10(5) : 903-13.

[2] Francula-Zaninovic S,Nola IA .2018 .Management of measurable variable cardiovascular disease' risk factors. Curr Cardiol Rev, 10(3) : 153-63.

[3] Roth GA,Mensah GA,Johnson CO,Addolorato G,Ammirati E,Baddour LM .2020 .Update from the GBD 2019 study. J Am Coll Cardiol, 11(25) : 2982-3021.

[4] Figtree GA,Ngo DT,Bubb KJ .2019 .Testosterone to oestradiol ratio and plaque in ammation: Mechanistic insights and biomarker potential?. Cardiovasc Res, 10(2) : 255-7.

[5] Gheisari F,Emami M,Raeisi H,Samipour S,Nematollahi P. .2020 .The role of gender in the importance of risk factors for coronary artery disease. Cardiol Res Pract, 10 : .

[6] Abdel-Qadir H,Thavendiranathan P,Austin PC,Lee DS,Amir E,Tu JV .2019 .The risk of heart failure and other cardiovascular hospitalizations after early stage breast cancer: A matched cohort study. J Natl Cancer Inst, 10(8) : 854-62.

[7] Cooke PS,Nanjappa MK,Ko C,Prins GS,Hess RA .2016 .Oestrogens in male physiology. Physiol Rev, 10(3) : 995-1043.

[8] Dias JP,Shardell MD,Carlson OD,Melvin D,Caturegli G,Ferrucci L .2017 .Testosterone vs. aromatase inhibitor in older men with low testosterone: E ects on cardiometabolic parameters. Andrology, 10(1) : 31-40.

[9] Goetz TG,Mamillapalli R,Sahin C,Majidi-Zolbin M,Ge G,Mani A .2018 .Addition of oestradiol to cross-sex testosterone therapy reduces atherosclerosis plaque formation in female ApoE / mice. Endocrinology, 00884(2) : 754-62.

[10] Ansari WM,Humphries SE,Naveed AK,Khan OJ,Khan DA,Khattak EH DA .2017 .E ect of coronary artery disease risk SNPs on serum cytokine levels and cytokine imbalance in premature coronary artery disease. Cytokine, 05 : 154060.

[11] Simpson ER .2003 .Sources of oestrogen and their importance. J Steroid Biochem Mol Biol, 0760(03) : 00360-1.

[12] Hwang J,Rouhanizadeh M,Hamilton RT,Lin TC,Eiserich JP,Hodis HN .2006 .-Oestradiol reverses shear-stress-mediated low density lipoprotein modi cationsF. ree Radic Biol Med, 04(4) : 568-78.

[13] van Koeverden ID,de Bakker M,Haitjema S,de Vries JP,Hoefer IE .2019 .Testosterone to oestradiol ratio re ects systemic and plaque in ammation and predicts future cardiovascular events in men with severe atherosclerosis. Cardiovasc Res, 10(2) : 453-62.

[14] Belladelli F,Del Giudice F,Kasman A,Salonia A,Eisenberg ML .2021 .The association between testosterone, oestradiol and their ratio and mortality among US men. Andrologia, 10(4) : .

[15] Dixit KCS,Wu J,Smith LB,Hadoke PWF,Wu FCW,De Groot LJ,Chrousos G,Dungan K,Feingold KR,Grossman A,Hershman JM . .Androgens and coronary artery disease. South Dartmouth, : 2000-2015.

[16] Wu FC .2003 .von Eckardstein A. Androgens and coronary artery disease. Endocr Rev, 0025(2) : 183-217.

[17] Ridker PM,Bhatt DL,Pradhan AD,Glynn RJ,MacFadyen JG,Nissen SE .2023 .In ammation and cholesterol as predictors of cardiovascular events among patients receiving statin therapy: A collaborative analysis of three randomised trials. Lancet, 6736(23) : 00215-5.

[18] Borges JY .2024 .The inverse association between testosterone replacement therapy and cardiovascular disease risk: A systematic 10 year review and meta-analysis analysis of prospective cohort studies from 2003-2023. , 10 : 2024-06.

[19] Aryan L,Younessi D,Zargari M,Banerjee S,Agopian J,Rahman S .2020 .The role of oestrogen receptors in cardiovascular disease. Int J Mol Sci, 10(12) : 4314.

[20] Khanna R,Bansal A,Kumar S,Garg N,Tewari S,Kapoor A .2021 .Association between endogenous sex hormones and coronary artery disease in postmenopausal women. Indian J Cardiovasc Dis Women-WINCARS, 10(3) : 168-73.

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