Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website http://www.cardiologyres.org

Original Article

Volume 10, Number 1, February 2019, pages 9-17

Clinical Impact of Blood Testosterone Concentration on Cardio-Ankle Vascular Index in Female Patients With Type 2 Diabetes Mellitus

Figure 1. Distribution of T-T and CAVI. Distribution of actual T-T of the study population was not normally distributed, even though CAVI has nearly normal distribution. Therefore, log-T-T was calculated with similar normal distribution. T-T: total testosterone; CAVI: cardio-ankle vascular index.

Figure 2. Comparisons of CAVI or T-T between non-CVD and CVD patients. CAVI is significantly higher (CVD vs. non-CVD: 10.2 ± 1.2 vs. 9.2 ± 1.0, P < 0.001), and log-T-T significantly lower (CVD vs. non-CVD: 1.2 ± 0.2 ng/dL vs. 1.5 ± 0.2 ng/dL, P < 0.001) in patients with CVD than those without CVD. CAVI: cardio-ankle vascular index; T-T: total testosterone; CVD: cardiovascular disease. ***P < 0.001 vs. non-CVD.

Figure 3. The association between CAVI and T-T. CAVI was significantly negatively correlated with log-T-T (r = -0.41; P < 0.001). CAVI: cardio-ankle vascular index; T-T: total testosterone.

**Table 1.** Patient Characteristics
Data are expressed mean ± SD. CVD: cardiovascular disease; BP: blood pressure; LDL: low-density lipoprotein; HDL: high-density lipoprotein; FBG: fasting blood glucose; HOMA-IR: homeostatic model assessment of insulin resistance; HbA1c: hemoglobin A1c; AF: autofluorescence; hs-CRP: high sensitivity C-reactive protein, d-ROMs: derivatives of reactive oxygen metabolites; E₂: estradiol; T-T: total testosterone; CAVI: cardio-ankle vascular index; DPP: dipeptidyl peptidase; RAS: renin-angiotensin system.
N	238
Age (yrs)	73 ± 9
CVD; n (%)	97 (41)
Body mass index (kg/m²)	22.7 ± 3.6
Current smoker; n (%)	20 (8)
Hypertension; n (%)	174 (73)
Systolic BP (mm Hg)	136 ± 8
Diastolic BP (mm Hg)	82 ± 9
Dyslipidemia; n (%)	176 (74)
Total cholesterol (mg/dL)	215 ± 37
LDL cholesterol (mg/dL)	135 ± 35
Triglyceride (mg/dL)	128 ± 64
HDL cholesterol (mg/dL)	54 ± 14
FBG (mg/dL)	133 ± 24
HOMA-IR	2.5 ± 1.6
HbA1c (%)	7.3 ± 1.1
Skin AF (AU)	2.8 ± 0.6
Log- hs-CRP (mg/L)	-1.1 ± 0.5
d-ROMs test (U. Carr)	316 ± 82
Detection of E₂; n (%)	158 (66)
E₂ (pg/mL)	7.9 ± 3.4
Log-T-T (ng/dL)	1.4 ± 0.3
CAVI
Medications
Sulfonylurea; n (%)	157 (66)
Biguanide; n (%)	87 (37)
DPP-4 inhibitor; n (%)	114 (48)
Insulin; n (%)	34 (14)
RAS inhibitor; n (%)	124 (52)
Statin; n (%)	129 (54)

Table 1. Patient Characteristics

Data are expressed mean ± SD. CVD: cardiovascular disease; BP: blood pressure; LDL: low-density lipoprotein; HDL: high-density lipoprotein; FBG: fasting blood glucose; HOMA-IR: homeostatic model assessment of insulin resistance; HbA1c: hemoglobin A1c; AF: autofluorescence; hs-CRP: high sensitivity C-reactive protein, d-ROMs: derivatives of reactive oxygen metabolites; E₂: estradiol; T-T: total testosterone; CAVI: cardio-ankle vascular index; DPP: dipeptidyl peptidase; RAS: renin-angiotensin system.

238

Age (yrs)

73 ± 9

CVD; n (%)

97 (41)

Body mass index (kg/m²)

22.7 ± 3.6

Current smoker; n (%)

20 (8)

Hypertension; n (%)

174 (73)

Systolic BP (mm Hg)

136 ± 8

Diastolic BP (mm Hg)

82 ± 9

Dyslipidemia; n (%)

176 (74)

Total cholesterol (mg/dL)

215 ± 37

LDL cholesterol (mg/dL)

135 ± 35

Triglyceride (mg/dL)

128 ± 64

HDL cholesterol (mg/dL)

54 ± 14

FBG (mg/dL)

133 ± 24

HOMA-IR

2.5 ± 1.6

HbA1c (%)

7.3 ± 1.1

Skin AF (AU)

2.8 ± 0.6

Log- hs-CRP (mg/L)

-1.1 ± 0.5

d-ROMs test (U. Carr)

316 ± 82

Detection of E₂; n (%)

158 (66)

E₂ (pg/mL)

7.9 ± 3.4

Log-T-T (ng/dL)

1.4 ± 0.3

CAVI

Medications

Sulfonylurea; n (%)

157 (66)

Biguanide; n (%)

87 (37)

DPP-4 inhibitor; n (%)

114 (48)

Insulin; n (%)

34 (14)

RAS inhibitor; n (%)

124 (52)

Statin; n (%)

129 (54)

**Table 2.** Relationships Between CAVI, T-T and Various Clinical Parameters
	CAVI	Log-T-T
CAVI: cardio-ankle vascular index; T-T: total testosterone; CVD: cardiovascular disease; BP: blood pressure; LDL: low-density lipoprotein; HDL: high-density lipoprotein; FBG: fasting blood glucose; HOMA-IR: homeostatic model assessment of insulin resistance; HbA1c: hemoglobin A1c; AF: autofluorescence; hs-CRP: high sensitivity C-reactive protein; d-ROMs: derivatives of reactive oxygen metabolites; E₂: estradiol; DPP: dipeptidyl peptidase; RAS: renin-angiotensin system. P < 0.05, P < 0.01, **P < 0.001.
Age	0.38***	-0.09
CVD (Yes = 1, No = 0)	0.40***	-0.43***
Body mass index	0.03	-0.07
Current smoker (Yes = 1, No = 0)	0.05	-0.02
Hypertension (Yes = 1, No = 0)	0.15*	-0.14*
Systolic BP	0.14*	-0.13*
Diastolic BP	0.09	-0.08
Dyslipidemia (Yes = 1, No = 0)	0.06	-0.03
Total cholesterol	0.03	0.07
LDL cholesterol	0.02	0.05
Triglyceride	0.08	0.11
HDL cholesterol	-0.04	-0.07
FBG	0.09	0.1
HOMA-IR	0.12	-0.15*
HbA1c	0.14*	-0.21***
Skin AF	0.32***	-0.22***
Log- hs-CRP	0.32***	-0.25***
d-ROMs test	0.33***	-0.43***
Detection of E₂ (Yes = 1, No = 0)	-0.20**	0.47***
E₂	-0.13*	0.19**
Sulfonylurea (Yes = 1, No = 0)	0.09	0.08
Biguanide (Yes = 1, No = 0)	0.03	0.07
DPP-4 inhibitor (Yes = 1, No = 0)	-0.06	0.05
Insulin (Yes = 1, No = 0)	0.1	0.06
RAS inhibitor (Yes = 1, No = 0)	-0.07	0.03
Statin (Yes = 1, No = 0)	-0.06	0.04

Table 2. Relationships Between CAVI, T-T and Various Clinical Parameters

CAVI

Log-T-T

CAVI: cardio-ankle vascular index; T-T: total testosterone; CVD: cardiovascular disease; BP: blood pressure; LDL: low-density lipoprotein; HDL: high-density lipoprotein; FBG: fasting blood glucose; HOMA-IR: homeostatic model assessment of insulin resistance; HbA1c: hemoglobin A1c; AF: autofluorescence; hs-CRP: high sensitivity C-reactive protein; d-ROMs: derivatives of reactive oxygen metabolites; E₂: estradiol; DPP: dipeptidyl peptidase; RAS: renin-angiotensin system. *P < 0.05, **P < 0.01, ***P < 0.001.

Age

0.38***

-0.09

CVD (Yes = 1, No = 0)

0.40***

-0.43***

Body mass index

0.03

-0.07

Current smoker (Yes = 1, No = 0)

0.05

-0.02

Hypertension (Yes = 1, No = 0)

0.15*

-0.14*

Systolic BP

0.14*

-0.13*

Diastolic BP

0.09

-0.08

Dyslipidemia (Yes = 1, No = 0)

0.06

-0.03

Total cholesterol

0.03

0.07

LDL cholesterol

0.02

0.05

Triglyceride

0.08

0.11

HDL cholesterol

-0.04

-0.07

FBG

0.09

0.1

HOMA-IR

0.12

-0.15*

HbA1c

0.14*

-0.21***

Skin AF

0.32***

-0.22***

Log- hs-CRP

0.32***

-0.25***

d-ROMs test

0.33***

-0.43***

Detection of E₂ (Yes = 1, No = 0)

-0.20**

0.47***

E₂

-0.13*

0.19**

Sulfonylurea (Yes = 1, No = 0)

0.09

0.08

Biguanide (Yes = 1, No = 0)

0.03

0.07

DPP-4 inhibitor (Yes = 1, No = 0)

-0.06

0.05

Insulin (Yes = 1, No = 0)

0.1

0.06

RAS inhibitor (Yes = 1, No = 0)

-0.07

0.03

Statin (Yes = 1, No = 0)

-0.06

0.04

**Table 3.** Multiple Regression Analysis
Explanatory factor	β	P value
(A): Subordinate factor is CAVI, R² = 0.38; P < 0.001; (B): Subordinate factor is log-T-T, R² = 0.43; P < 0.001. CVD: cardiovascular disease; T-T: total testosterone; AF: autofluorescence; d-ROMs: derivatives of reactive oxygen metabolites; E₂: estradiol; CAVI: cardio-ankle vascular index; HOMA-IR: homeostatic model assessment of insulin resistance; HbA1c: hemoglobin A1c.
(A)
Age	0.31	< 0.001
CVD	0.23	< 0.001
Log-T-T	-0.18	< 0.01
Skin AF	0.14	< 0.05
d-ROMs test	0.13	< 0.05
Detection of E₂	-0.08	0.195
Hypertension	0.07	0.215
(B)
Detection of E₂	0.26	< 0.001
CAVI	-0.19	< 0.001
CVD	-0.18	< 0.01
Skin AF	-0.16	< 0.01
d-ROMs test	-0.13	< 0.05
HOMA-IR	-0.11	0.057
Hypertension	-0.1	0.069
HbA1c	-0.07	0.168

Table 3. Multiple Regression Analysis

Explanatory factor

P value

(A): Subordinate factor is CAVI, R² = 0.38; P < 0.001; (B): Subordinate factor is log-T-T, R² = 0.43; P < 0.001. CVD: cardiovascular disease; T-T: total testosterone; AF: autofluorescence; d-ROMs: derivatives of reactive oxygen metabolites; E₂: estradiol; CAVI: cardio-ankle vascular index; HOMA-IR: homeostatic model assessment of insulin resistance; HbA1c: hemoglobin A1c.

(A)

Age

0.31

< 0.001

CVD

0.23

< 0.001

Log-T-T

-0.18

< 0.01

Skin AF

0.14

< 0.05

d-ROMs test

0.13

< 0.05

Detection of E₂

-0.08

0.195

Hypertension

0.07

0.215

(B)

Detection of E₂

0.26

< 0.001

CAVI

-0.19

< 0.001

CVD

-0.18

< 0.01

Skin AF

-0.16

< 0.01

d-ROMs test

-0.13

< 0.05

HOMA-IR

-0.11

0.057

Hypertension

-0.1

0.069

HbA1c

-0.07

0.168