High testosterone linked to risk of atrial fibrillation: Study

Atrial fibrillation occurs when the heart’s upper chambers beat irregularly. AFib is the most common type of heart arrhythmia, according to the Centers for Disease Control and Prevention (CDC). The CDC also estimates that by 2030, 12.1 million people will have AFib.

High testosterone levels have been associated with an increased risk of atrial fibrillation. Testosterone may influence the cardiovascular system through various mechanisms, including its effects on inflammation and blood pressure regulation.

Elevated testosterone levels have been linked to changes in cardiac ion channels and electrical activity, which can predispose individuals to abnormal heart rhythms. Additionally, testosterone has been implicated in promoting cardiac fibrosis which may contribute to the development and progression of atrial fibrillation.

In the ASPirin in Reducing Events in the Elderly (ASPREE) study, researchers analyzed data from 4,570 healthy male participants aged over 70 with no history of cardiovascular disease or thyroid cancer. Over an average follow-up period of 4.4 years, 286 men (6.2%) developed atrial fibrillation (AFib). Researchers divided serum testosterone levels into quintiles to examine the relationship between testosterone levels and AFib incidence.

The study revealed a nonlinear association between testosterone levels and AFib incidence. Men with testosterone levels in the highest quintiles had a greater risk of AFib compared to those with average levels. This association persisted even after excluding participants with heart failure or other major cardiovascular events during follow-up. It was independent of factors like body mass index, alcohol consumption, diabetes, and high blood pressure.

“As patients age, testosterone levels drop. Starting at age 30 there’s a one percent reduction in testosterone levels annually. Some patients who start off with relatively high numbers may never notice any change in their energy, their mood, or their sexual performance. However, patients generally complain of symptoms starting around the age of 40 and it’s appropriate to test their levels. It’s important to not just treat a number but actually treat symptoms that patients may be experiencing,” said Mehran Movassaghi, a board-certified urologist and director of Men’s Health at Providence Saint John’s Health Center.

Reference: Cammie Tran k, Bu B. Yeap k, Jocasta Ball, Daniel Clayton-Chubb, Sultana Monira Hussain, Amy Brodtmann, et al.; Testosterone and the risk of incident atrial fibrillation in older men: further analysis of the ASPREE study; eClinicalMedicine, part of The Lancet discovery science; 2024; DOI:https://doi.org/10.1016/j.eclinm.2024.102611