The relationship between plasma androgens (dehydroepiandrosterone sulfate and testosterone), insulin, coagulation and fibrinolytic factors in men with coronary arteriosclerosis

Thrombosis plays an important role in the pathogenesis of myocardial infarction and stroke. It is known that a decrease in estradiol plasma concentration in postmenopausal women results in an increase in fibrinogen, plasminogen activator inhibitor (PAI) and tissue-type plasminogen activator (tPA) concentrations, whereas estradiol replacement therapy decreases the plasma concentrations of these factors. In men, the risk of developing myocardial infarction is higher than in premenopausal women. However, the role of male sex hormones in the pathogenesis of arteriosclerosis, although the subject of many studies, has not yet been elucidated. The aim of this study was to determine the plasma levels of and correlation between androgens, insulin, coagulation and fibrinolytic factors in men with coronary arteriosclerosis with and without a history of myocardial infarction. The study was carried out in a group of 109 non-obese men, aged 28-60 years, with coronary artery disease demonstrated by coronary angiography. In this group, 64 men had a history of one myocardial infarction and ten reported two or more such episodes. The control group consisted of 14 volunteers, who were healthy men aged 39-63 years with normal body weight. In men with coronary arteriosclerosis, the plasma levels of dehydroepiandrosterone sulfate (DHEAS) and testosterone were lower, whilst insulin, fibrinogen, PAI, PAI activity and lipoprotein(a) were higher in comparison with the group of healthy controls. We found that, in men with coronary arteriosclerosis, those with the highest incidence of infarction demonstrated the most advanced hyper-insulinism, had lower levels of DHEAS and testosterone, the highest fibrinogen plasma concentrations, as well as PAI-1, tPA and PAI activity. A positive correlation between insulin, PAI-1, tPA and fibrinogen has been shown. In conclusion, low androgen and high insulin concentrations, high PAI-1 and PAI activity, high tPA and fibrinogen concentration may be prognostic indicators of myocardial infarction in men with arteriosclerosis.