Atrial fibrillation (AF) is highly prevalent with a lifetime risk of about 1 in 3-5 individuals after the age of 45. Between the 2010 and 2019, the global prevalence of AF has risen markedly from 33.5 million to 59 million. Recent trial data has suggested that males with cardiovascular (CV) risk factors or disease had no differences in rates of major adverse cardiovascular events (MACE) or death but noted to have more AF events, particularly if they were treated with testosterone. Why? Well, Tran et al., (2024) evaluated the relationship between endogenous testosterone concentrations with risk of developing AF in healthy older males. The study performed a post-hoc analysis on 4,570 males in ASPirin in Reducing Events in the Elderly (ASPREE) study. Males aged ≥70 years, with no history of CV disease including AF or others were followed-up for 4.4 years, and remarkably, 286 males developed AF (15.3 per 1000 participant-years). Interestingly, baseline testosterone was higher in males who developed AF compared to males who did not (17.0 (12.4-21.2) versus (vs) 15.7 (12.2-20.0) nmol/L. Furthermore, the study concluded that circulating testosterone concentrations with the high-normal range are independently associated with an increased risk of incidence of AF amongst healthy older males. This may suggest that AF may be an adverse end result of high-normal total testosterone concentrations. Nonetheless, more long-term studies are warranted to evaluate this relationship further.

References

1. Linz D, et al. Lancet Reg Health Eur 2024; 37: 100786.  2. Tran C, et al. eClinicalMedicine 2024; 72: 102611.