Association Between Serum Testosterone Levels and Premature Coronary Artery Disease in Young Adult Males Undergoing Coronary Angiography.

Premature coronary artery disease (PCAD), defined as > 50% coronary artery stenosis in men < 55 years and women < 65 years, is an escalating public health issue. The role of testosterone as a risk or protective factor remains debated. This study investigated the association between serum testosterone levels and PCAD in young adult males. To investigate the association between serum testosterone levels and premature coronary artery disease (PCAD) in young adult males undergoing coronary angiography. This case-control study enrolled 106 men < 55 years undergoing coronary angiography at Imam Hossein educational hospital (Tehran, Iran) from 2023 to 2024. Participants were divided into two groups: 53 with PCAD (stenosis > 50% in at least one major coronary artery) and 53 with normal coronary arteries. Serum total and free testosterone levels were measured using chemiluminescent immunoassay (CLIA). Anthropometric data, medical history (e.g., hypertension, diabetes), and laboratory parameters were recorded. Statistical analyses included t-tests, Spearman correlation, and logistic regression, with p < 0.05 deemed significant. The mean age was 43.24 ± 4.98 years, with PCAD patients being older (44.81 ± 4.50 vs. 41.68 ± 4.98 years, p = 0.001). Hypertension (49.06% vs. 28.30%, p = 0.028) and diabetes (28.30% vs. 9.43%, p = 0.013) were more prevalent in the PCAD group. Mean total testosterone was significantly lower in PCAD patients (321.45 ± 154.63 ng/dL) than in controls (437.02 ± 142.81 ng/dL, p < 0.05), as was free testosterone (12.38 ± 8.25 vs. 20.86 ± 8.13 pg/mL, p < 0.05). Multivariable logistic regression, adjusted for age, clinical history, and medication use, showed a 1 pg/mL increase in free testosterone reduced PCAD odds by 13% (OR = 0.87, 95% CI: 0.81-0.94, p < 0.001). Lower serum testosterone levels are associated with increased PCAD risk in young males. These findings highlight the need for longitudinal studies to explore testosterone's role in PCAD prevention.