Caloric Restriction: A lifestyle intervention with compelling cardiovascular benefits.

Cardiovascular disease is the leading cause of death in the United States and is soon becoming the leading cause of death in most countries in the world. In the USA, cardiovascular disease claims more lives each year than cancer, chronic lower respiratory diseases, accidents, and diabetes mellitus combined. The increasing age along with the obesity and diabetes epidemic will continue to keep cardiovascular disease as the number one health problem in the world.

There has been a recent emphasis on lifestyle changes to prevent the development of cardiovascular risk factors. These include cessation of smoking, prevention of obesity, incorporation of a heart friendly diet and implementation of a regular exercise program. Caloric restriction is a major lifestyle intervention that is also generating increasing scientific interest as a method of reducing cardiovascular morbidity and mortality.

Caloric restriction is the only lifestyle intervention that has consistently been shown to increase the maximum life span in laboratory mice and rats. It achieves this by retarding the aging processes. These effects have been also seen in yeast, worms, fish, spiders and many other lower order animals. Caloric restriction is achieved by feeding animals 70%-75% as many calories as controls, in a nutritious balanced way, avoiding malnutrition.

Similar data, confirming lifespan extension, is emerging from studies in rhesus monkeys. Rhesus monkey is a nonhuman primate that has close evolutionary relationship to humans. It bears many similarities to humans including anatomy and and biochemical functions such as physiology, immunology, endocrinology and neurology. The rhesus monkey is also prone to common human diseases such as obesity, metabolic syndrome, diabetes mellitus and cardiovascular pathologies. As a result, there is considerable interest in experimentally retarding or reversing the aging processes in these ancestral cousins and its possible applicability to humans.

Studies in the rhesus monkeys show that caloric restriction induces the following positive changes on cardiovascular risk factors : 1.Reduction in weight of about 30% compared to the ad libitum group, mainly due to a decrease in visceral fat.2. Improved glucose homeostasis as evidenced by improved fasting insulin and glucose levels, improved HbA1c and decreased insulin resistance.3. Decreased blood pressure and improved lipid parameters. 4. Reduced body temperature more than that explained by the reduction in body mass

Several studies have shown improved cardiovascular morbidity and mortality in humans with calorie restriction. Epidemiological observations from different populations of the world have shown dramatic decreases in cardiovascular diseases, as a result of unintentional caloric restriction. World War II related food shortages in some European countries resulted in a sharp decrease in coronary heart disease mortality, only reversing after the war ended. Japanese living on the Okinawa island, generally eat 30% less calories than the average Japanese population, and experience an almost 35% lower rate of cardiovascular disease and cancer mortality. Similar changes were reported during the food rationing in Cuba due to a significant economic downturn from 1989 to 2000. Deaths caused by diabetes declined by 51%, coronary heart disease mortality dropped 35% and stroke mortality by 20%. Similar effects were noted in the Biosphere experiment. Due to declining food stores, caloric restriction was enforced on the eight individuals, for alamost 2 years. These individuals not only lost weight and fat mass, but also showed improvements in basal glucose, basal insulin, insulin sensitivity, and blood pressure. These effects basically replicated the experimental changes noted in non-human primates.

Reduction of caloric intake by 25%-30% on a consistent basis may be difficult to achieve. Further this reduction has to be nutritionally balanced, with adequate intake of essential macro and micro nutrients. The data on the beneficial cardiovascular effects of caloric restriction, however, are compelling. Calorie restriction may be an important life style intervention to dramatically reduce major cardiovascular risk factors and, and increase healthspan (healthy years) and lifespan in humans.

Smokers have heart attacks a decade earlier!

Cigarette smoking accounts for almost 450,000 deaths every year in the United States. According to CDC, when compared to nonsmokers, smokers have an increased risk of coronary heart disease by 2-4 times, stroke by 2-4 times, lung cancer in men by 23 times and in women by 13 times, and dying from chronic obstructive lung disease by 12-13 times. It is estimated that tobacco use causes more deaths than all deaths from human immunodeficiency virus (AIDS), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined.

Smoking is also the number one preventable cause of cardiovascular disease. It is estimated that almost 30% of all coronary heart disease deaths in the United States each year are related to cigarette smoking.  Smokers also have double the risk of strokes. Second hand smoke or passive smoking also leads to an increased risk of cardiovascular diseases, and increases the risk of death by at least 20%.

A recent study published online September 15^th, 2011, by the American Journal of Cardiology,  finds that smokers also experience heart attacks a decade before their non-smoking counterparts. Dr. Howe from the University of Michigan Health System in Ann Arbor reviewed the records of 3600 people and found that the male smokers were 55 while male nonsmokers were 64 at the time of admission for a heart attack or unstable angina. The average female smoker was 57 while for female non-smokers was 70. Smoking accelerates the atherosclerotic process leading to premature coronary artery disease.

There is overwhelming evidence that smoking cessation imparts prompt cardiovascular benefits. There are progressively increasing benefits with increasing smoke free interval. This risk benefit is seen both with coronary heart disease and ischemic stroke. And the benefits extend to cancer and chronic lung diseases too.

Smoking is extremely dangerous to your cardiovascular system. Obviously, smoking should never be initiated. However, benefits of smoking cessation on the cardiovascular system begin immediately, even if damage has already occurred. There is a 50% reduction in risk of repeat heart attacks, sudden cardiac death and total mortality in people who stop smoking after their first heart attack. So, do not start smoking, and if you do, stop!

 

Socio-economic Status and Cardio-vascular Disease: An Inverse Relationship

Socioeconomic status is a strong predictor of a person’s morbidity and mortality for most diseases. Lifelong socioeconomic disadvantages also increase cardiovascular risk factors culminating in premature mortality.

Socio-economic disparity is usually evident in education, occupation and financial status. Education is a strong surrogate measure of socioeconomic status. A recent National Health and Nutrition Survey showed a strong inverse relationship between education level and mortality risk. Men aged 45-64 years, with education of 0-7 years had an almost double the risk of premature mortality than those with 12 or more years of education. In white women the risk was one and a half times more. A similar, although weaker, link exists between education and mortality in African American men and women.

Lack of employment and financial status, also have an effect on mortality. Compared to those who are employed, unemployed men and women, both white and black, have almost one and a half times increased mortality rates. Service or blue collar workers, usually earning less, almost universally have a higher rate of early death when compared to professional or white collar workers, who relatively earn more.

The relationships mentioned above also apply to cardiovascular disease morbidity and mortality. Cardiovascular disease studies have shown that lower levels of education are associated with early heart related mortality. Liu and colleagues also reported several epidemiology studies from Chicago, confirming the inverse relationship between education level and coronary heart disease. Similar data emanated from the Systolic Hypertension in the Elderly project, published in the American Journal of Epidemiology in 1987.

A steady high income helps pay for education, healthier lifestyle, and access to better medical care. In the National Longitudinal Mortality Study, both white men and women with incomes less than $5000 had a 1.8 and 1.3 times the mortality rate when compared to those with incomes more than $50,000. These ratios were worse for black men and women (2 and 1.8 respectively). The results of the National Mortality Study were published in the American Journal of Public Health in 1995. Studies have also demonstrated higher cardiovascular mortality in blue collar workers when compared to white collar workers. Some of this data in women came from the Framingham study and was published in the American Journal of Epidemiology in 1992 by Eaker and associates. In the Canadian Health, Canada Fitness Survey, and several other studies, people with low income had a higher atherogenic risk profile, with higher rates of smoking, hypertension, diabetes, obesity, physical inactivity and excessive alcohol consumption, and the resultant higher cardiovascular disease and death rates.

Lower socioeconomic status is also associated with living in impoverished neighborhoods. This results in unhealthy food choices, unsafe exercise options, more psychological stress and poor access to optimal health care. A recent study published in the October 20, 2011 issue of the New England Journal of Medicine, has shown that moving out from these neighborhoods leads to significant health benefits.

In summary, a higher socioeconomic status leads to better life style choices. Better education appears to confer a higher socio-economic status. Educated people are more likely to follow healthier lifestyles and acquire skills to ward off adverse health influences. The ultimate result is improved cardiovascular outcomes including a reduction in premature morbidity and mortality.

Cell Phone Use and Brain Tumors: No Connection!

The World Health Organisation’s International Agency for Research on Cancer (IARC) has warned that the radio-frequency electromagnetic fields emitted by mobile phones are “possibly carcinogenic to humans.”

Epidemiologic observations have suggested that mobile phone users may be at an increased risk for certain brain tumors: gliomas, menongioma and acoustic neuromas. Mobile phones emit  high-frequency electromagnetic fields during use and these have been considered harmful. The head area is also exposed to some, probably harmless, extremely low-frequency magnetic fields from battery discharge.

The exact mechanism behind brain tissue injury from cell phone use is unclear. It has been suggested that at high levels of EMF exposure, significant heating occurs in brain tissues that can be dangerous to health. Another theory is that EMF generates damaging free radicals, and these occur at even non-thermal levels of EMF. However none of these theories have been convincingly linked to the development of brain tumors.

A recent study published in the British MedicalJournal (October 21, 2011),  involving over 350,000 subjects who were monitored over 18 years, found no convincing link between cell phone use and the development of brain tumors.  Patrizia Frei (Danish Cancer Society) and colleagues examined health records from 1990 to 2007  of 358,403 cell phone subscribers and found that although 10,729 tumours of the central nervous system were diagnosed during this period, in the longest mobile phone users (13 years or more), the cancer rate was the same as in the non mobile phone users.

At this time, close to five billion mobile phones are registered in the world.However this number will continues to rise, and is eventually expected to involve every adult human on this planet. The duration of use, both the number ofminutes used daily, as well as the number of years of use, is also expected to rise considerably. Since this study was limited to about a decade of scientific scrutiny, the effects of mobile phone use over 10-13 years still remains to be investigated.

As of now however, we can be reassured thatscientific data has found no link between long-term use of mobile phones and increased risk of brain tumours.

The four biggest killers in the United States: what most of us will die from.

 

It is estimated that most people living in the US will die from the following four  non-communicable diseases:

Cardiovascular Diseases

Cancer

Chronic Respiratory diseases

Diabetes Mellitus

In the United States and other high income countries, out of 100 people who die, 27 would have died from cardiovascular diseases (coronary heart disease and stroke), 15 from cancer (lung, colon, breast and stomach), 7 from diseases of the lung (chronic obstructive pulmonary disease and lower respiratory infections) and 3 from diabetes.

The main causes of these diseases are avoidable and the diseases preventable.  Poor dietary habits with high intake of fats and salt, obesity, lack of physical exercise and smoking are the main culprits.

These four diseases are also major killers in developing nations, with significant socio-economic impact.

In middle income countries, tuberculosis, HIV/AIDS and road traffic accidents also are leading causes of death.

In the low income countries, leading causes of death include lung infections, diarrheal diseases, HIV/AIDS, tuberculosis, malaria and complications of pregnancy and childbirth.

These data were recently released by the United Nations 2011 High Level Meeting on Prevention and Control of Non-Communiable diseases (UN NCD Summit) held in September in New York.

 

Multivitamin Intake: Improved Longevity or Premature Mortality?

By Shashi Agarwal MD

Epidemiological studies have shown that eating foods rich in antioxidants results in a reduced risk of heart attacks,strokes and cancer. Antioxidants reduce damaging oxidative stress caused by highly active free radicals in the blood. These detrimental effects have been implicated as a pathogenic factor in most diseases, including cardiovascular diseases and cancer. Antioxidant rich foods include fruits, vegetables, nuts and whole grains. Phytochemicals are strong antioxidants and are naturally present in these foods. For example, soybeans contain genisten, tomatoes and grapefruit contain lycopene, cabbage and brussel sprouts cotain indoles, garlic and onion contain allylic sulfides, tea contains tannins and most fruits and vegetables are rich in flavonoids. A diet rich in these foods is highly protective. This observation has led to the widespread use of synthetic multivitamins and anti-oxidants to prevent cancer and cardiovascular diseases, and increase life span. However taking these supplements have not shown protective benefits, and have actually been harmful in most people.

 

Dr. Jaakko Mursu and collegues recently presented disturbing data regarding life expentancy with the use of multivitamins and mineral supplements in healthy older women. They found that most supplements in older women were associated with a higher risk of total mortality. These supplements included multivitamins, vitamin B6, folic acid, and minerals such as iron, magnesium, zinc and copper. There was a 3% to 6% increased risk of death with taking vitamin B6, folic acid, iron, magnesium, and zinc supplements and an 18.0% increased risk for total mortality with copper supplementation. The increased rates appear when compared to individuals not taking these supplements. This large study involved a total of 38,772 older women, between the ages of 55 to 69 years. Their results were published in the October 10, 2011 issue of the Archives of Internal Medicine.

 

In an earlier review of 47 studies involving nearly 181,000 participants, Bjelakovic and colleagues reported that taking vitamin A supplements increased the risk of death by 16%, beta-carotene by 7%, and vitamin E by 4%. These findings were published in the Journal of the American Medical Association in 2007.

 

Meta-analysis of several studies have also documented that antioxidants do not prevent cancer. On the contrary, studies have implicated their intake with a higher incidence of some cancers. In a study by Lawson and associates and published in the Journal of the National Cancer Institute in 2007, the risk of fatal prostate cancer doubled in men who took multivitamins seven days a week, when compared with men who did not take any multivitamin supplements. Their study involed 295,344 men enrolled in the National Institutes of Health Diet and Health Study. Other studies have shown that mortality also appears to be increased in persons with gastrointestinal and lung cancers while ingesting anti-oxidant supplements.

 

The exact mechanism behind this harmful effect of multivitamin/anti-oxidant supplementation is not clear. It has been suggested that supplemental antioxidants may decrease free radicals and upset defensive mechanisms necessary to destroy precancerous and cancerous cells. Synthetic antioxidants may also possess pro-oxidant properties.

 

The American diet provides almost 120% the recommended daily allowances for β-carotene, vitamin A, and vitamin C. Except for calcium and prescribed supplementation for documented deficiency (for example Vitamin D), scientific data suggests that most multivitamins and mineral supplements should not be used in otherwise well nourished individuals.

Article Source: http://EzineArticles.com/?expert=Shashi_Agarwal_MD

 

 

 

Fish Oil Supplementation – Heart Protective

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By: Shashi K. Agarwal, MD

Dyerberg and group in 1978 reported in the Lancet, a health paradox that they noted in the Greenland Eskimos. The Eskimos, despite a high-fat diet, had a low rate of coronary heart disease. The researchers postulated that a protective effect was provided by the fatty oils present in their diet, rich in meat from seals, caribou and fish. Since then, this inverse relationship between fish intake and cardiovascular disease has become well established.

Fish oils are rich in omega-3 fatty acids. Along with omega-6 fatty acids, they are called polyunsaturated fatty acids (PUFAs). Both of these fatty acids cannot be synthesized by humans and are therefore considered ‘essential’. Besides fish, omega-3 fatty acids are also found in walnuts, flaxseed, canola oil, broccoli, cantaloupe, kidney beans, spinach, grape leaves, Chinese cabbage, and cauliflower. Two omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are health and heart protective. A third kind, alpha-linolenic acid, is less potent. Omega-6 fatty acids are detrimental to heart health, and have been associated with depression. Omega-6 fatty acids are abundant in refined vegetable oils commonly used for cooking.

What is the link between fish oil intake and cardiovascular disease protection?

Several studies have shown an inverse relationship between fish consumption and coronary heart disease and death. In the DART study, 2003 men with a previous history of a heart attack were divided into two groups and monitored – one group had an increased fish oil consumption, either by diet or by supplementation compared to the other group, The increased fish oil group had a 29% reduction in death. Studied by Burr and group, this data was published in Lancet in 1989.

In a large GISSI-Prevenzione trial, 11,324 patients with a history of a heart attack were randomly assigned into groups; each group was given either 850 mg omega-3 fatty acid, 300 mg vitamin E, both, or neither. The results showed that the group given the fatty acid alone had a 45% reduction in sudden death and a 20% reduction in all-cause mortality. This was published in Lancet in 1999.

In a review of 11 studies, Markmann and Granbaek found that in populations at a higher risk of coronary heart disease, intake of 40-60 grams of fish per day could reduce the risk of death by 40%-60%. They published their data in the European Journal of Clinical Nutrition in 1999.

How do omega-3 fatty acids protect against heart disease?

Fish oils lower blood pressure and serum triglyceride levels. They also have anti-arrhythmic, anti-thrombotic, anti-atherosclerotic, and anti-inflammatory properties. They also improve endothelial function. All these effects protect against heart attacks from coronary heart disease and sudden death due to an irregular heart rhythm.

How much omega-3 fatty acids do you need?

It is recommended that the daily intake of omega-3 fatty acid be 2.85 g/day. Healthy marine sources are fresh tuna, sardines, salmon, herring, trout and oysters. Fish should be grilled, baked, or broiled — not fried. Fried fish loses all of its benefits. This lack of benefit from fried fish was documented by Mozaffarian in the Cardiovascular Health Study published in Circulation in 2003. As noted earlier, omega-3 fatty acids are also found in walnuts, flaxseed, canola oil, broccoli, cantaloupe, kidney beans, spinach, grape leaves, Chinese cabbage, and cauliflower. Recently, omega-3 fatty acid enriched eggs have become available in the supermarkets and can help meet the daily requirements. If one is unable to eat enough fish or other food sources of omega-3 fatty acids, fish oil supplementation should be considered. The usual amount is 1 gm EPA and DHA per day, although your physician may recommend higher doses in certain situations.

Is fish safe?

Fish at the top of the food chain often contain significant levels of methylmercury, polychlorinated biphenyls, dioxins, and other environmental contaminants. These include mackerel, shark, swordfish, and tile fish (golden bass or golden snapper). The FDA advises pregnant women, women wanting to become pregnant, nursing mothers and children to avoid these fish as they may be at an increased risk of mercury intoxication.

Are fish oils safe?

In general, most fish oils sold over the counter in the USA are safe. The FDA in 1997 indicated that the consumption of up to 3 g EPA + DHA/day from all sources is safe for American adults. Fish oils do not interact with other drugs and usually have no side effects. Fishy aftertaste can be lessened by keeping the supplements in the freezer. Rarely nausea, bloating and belching can occur. Excessive intake may cause bleeding. There is only one FDA approved fish oil preparation in the USA. It is available by prescription under the trade name of Omacor. Because of a patented refining process, toxins such as mercury are completely removed, It also has more PUFAs – 90% compared with 60% in some commercially available products. This makes Omacor more reliable and efficacious.

Summary

The heart protective effects of omega-3 fatty acids are very compelling. These essential polyunsaturated fatty acids are abundant in fish and certain vegetables and nuts. People at a high risk of developing heart disease or who have established heart disease, should supplement their diet with fish oil capsules providing 1 gm EPA and DHA per day. It would be prudent to discuss this therapy with your physician.

Dr. Shashi K. Agarwal is a Board Certified Internist and Cardiologist with a private practice in New York City and New Jersey. He is also a diplomat of the American Board of Holistic Medicine and the American Academy of Anti-Aging Medicine.

Article Source: http://EzineArticles.com/?expert=Shashi_Agarwal_MD

Liposuction: Cosmetic Only or Associated Cardioprotection?

By Shashi Agarwal MD

Liposuction, a cosmetic procedure, is commonly performed in the United States. It is estimated that approximately 400.000 of these procedures occur yearly. Most of these are women between the ages of 19 to 50. Through tiny incisions in the skin, cannulas are inserted and the abdominal fat is sucked out using medical grade vacuums. This fat is sometimes also removed from the arms or thighs for cosmetic remodeling.

The majority of patients undergoing liposuction are obese. Obesity is defined as a body mass index(BMI) of more than 30. Body mass index is calculated by dividing an individual’s body weight by the square of his or her height. BMI is categorized as follows in the United States: underweight: <18.5, normal weight: 18.5-24.9, overweight: 25-29.9 and obese: >30.

Obesity has become an escalating problem in the United States. It is estimated that between 60 and 70% of Americans (approximately75 million) are either overweight or obese. And, nearly one in three (31.7%) U.S. children (23,500,000) ages 2 to 19 are overweight or obese. Obesity is also becoming epidemic in many parts of the world.

Obesity has been linked to several dangerous conditions such as, high blood pressure and related cardiovascular diseases, diabetes mellitus, osteoarthritis, cancer, gall bladder disease, gout and sleep apnea. Cardiovascular disease (heart attacks, heart failure and stroke) remains the number one killer in the USA. It is estimated that more than 2,200 Americans die of cardiovascular disease every day or about one death every 39 seconds. The cardiovascular complications of obesity are partly due to high blood cholesterol, high triglyceride levels and low ‘good’ HDL cholesterol seen in these patients.

BMI is commonly used as a heuristic proxy for human body fat. However, BMI may also be high if there is a significant amount of muscle tissue and may falsely raise concerns about an increased cardiovascular risk. Excess fat around the waist appears to be a better marker for an increased risk. In men, a waist measurement of more than 35 inches and in women, a waist measurement of more than 40 inches indicates a higher propensity for cardiovascular disease when compared with people with smaller waist measurements. Since liposuction removes abdominal fat and reduces waist measurements, it has been suggested that liposuction should be associated with a decrease in cardiovascular risk.

The fat removed during liposuction is however, peripheral fat. Most scientific studies have shown that it is the central or visceral fat that is metabolically active and harmful. This fat is inside the abdomen in and around organs is the visceral fat, and is not removed during liposuction. A lack of benefit on the cardiovascular system from liposuction has been established in two studies. Scientific research reported by Klein and associates in 2004 and published in the New England Journal of Medicine, and Mohammed and associates in 2008 and published in Obesity, established that there was no improvement in cardiometabolic factors and glucose metabolism following removal of subcutaneous or peripheral fat.

A recent study however suggested that there may be some improvement in triglyceride levels following liposuction. In this study, presented at the American Society of Plastic Surgeons Annual Meetings in 2011, Dr. Swanson reported that following removal of subcutaneous fat, mean triglyceride levels decreased 26%. Triglyceride levels above 150 mg/dL have been associated with an elevated risk for metabolic syndrome, type 2 diabetes, stroke, coronary artery disease, and peripheral vascular disease.

This study also found no significant change in the total cholesterol, low-density-lipoprotein cholesterol (bad cholesterol), or high-density-lipoprotein cholesterol (good cholesterol).

Remember, visceral fat is reduced by reducing total caloric intake, reducing the amount of calories obtained from fats, and regular exercise. These lifestyle changes are cardioprotective. Liposuction should only be considered for cosmetic reasons and still remains only minimally cardioprotective. Further information on liposuction is available at these sites:

American Society for Dermatologic Surgery: http://www.asds.net/
American Academy of Cosmetic Surgery: http://www.cosmeticsurgery.org/

 

Article Source: http://EzineArticles.com/?expert=Shashi_Agarwal_MD

Want to prevent heart attacks? Eat like a Chimpanzee (or take a statin)

In a recent scientific study, Dr. KI Hong Lee from the Chonnam National University Hospital in South Korea found that patients who had been on a statin in spite of their LDL levels being below 70 mg/dl, had significantly less heart attacks, repeat stenting, repeat heart surgery and cardiac deaths when compared to those who were not discharged on a statin (Journal of the American College of Cardiology, October 11, 2011). General recommendations are to keep the LDL levels at less than 100 mg/dl. If the patient is at high risk (those with coronary artery disease and two or more risk factors for cardiovascular disease), most cardiologists try to decrease the LDL levels to less than 70mg/dl. This study suggests that the LDL target may need to be lowered to levels much below 70mg/dl – maybe 50 mg/dl or even 40 mg/dl. LDL is the bad cholesterol that is associated with hardening of the arteries, or atherosclerosis.

Statin drugs are commonly used in patients with high cholesterol levels to improve the lipid profile and prevent atherosclerosis. Whether the benefits noted in the Korean study population was from a further decrease in LDL levels or other beneficial effects of  statins is not known. Scientific data shows that the benefits of statin  therapy  goes beyond that achieved by lipid improvement alone. These drugs improve vascular elasticity, reduce vascular inflammation, stabilize plaques, reduce clotting tendencies, and help prevent harmful remodeling of the heart.

Chimpanzees maintain their LDL levels in the range of 40 to 70. They do not eat meat and very little of their caloric intake is from fat. Chimpanzees rarely get atherosclerosis. So irrespective of how you bring your LDL down to this range, there is a major benefit in terms of reduced or even absent cardiovascular disease and cardiovascular events.

So eat like a chimpanzee to avoid atherosclerosis. Or take a statin (physician prescribed) if you have cardiovascular disease – even if your LDL is low. Your future may be free of heart attacks and strokes.

 

 

Testosterone: Cardiovascular Protective

Testosterone is an anabolic steroid. It is the principle male sex hormone and is mainly responsible for the development of the testes, prostate and secondary sexual characteristics. Small amounts of this hormone are also present in the females and is produced by the ovaries.

Testosterone deficiency is common in patients seen in patients visiting primary care physicians. It is estimated that as many as 14 million male patients over the age of 45 years may suffer from low testosterone levels (HIM Study. Int J Clin Pract. 2006;60:762-769)

Recent studies have found a link between low testosterone levels and higher rates of cardiovascular disease. Testosterone has been shown to increase lean body mass, decrease visceral mass, and have beneficial effects on cholesterol and blood sugar levels.

A recent study from Sweden further strengthens the link between high testosterone levels and increased cardiovascular protection. In this study of elderly men, there was a 30% lower risk of cardiovascular events over five years in men with the highest testosterone levels compared to those with the lowest levels.

Dr Claes Ohlsson and colleagues from the University of Gothenburg, Sweden studied 2416 men aged 69 to 81 years and found that testesterone levels and cardiovascular events were inversely related. These findings were reported in the October 11, 2011 issue of the Journal of the American College of Cardiology.

The benefits of testosterone replacement in preventing cardiovascular disease, however, remain unknown.