The Relationship Between Levels of Sex Steroids and Coronary Collateral Circulation in Men Patients with Coronary Artery Disease

Introduction: Coronary collateral circulation (CCC) is a natural bypass system for restoring blood flow, and a well-developed CCC is held to protect myocardial function and improve survival after coronary obstruction in patients with coronary artery disease (CAD). Sex steroids have been suggested as potentially hampering the course of CAD progression. We explored the relationship between the serum levels of sex steroids and CCC. Patients and Methods: A total of 115 males with chronic coronary artery disease who had at least one total coronary artery occlusion were included. Patients were divided into two groups: a well CCC group (Rentrop grades 2-3, n= 64) and a poorly developed CCC group (Rentrop grades 0-1, n= 51). Serum levels of total testosterone, free testosterone, sex hormone-binding globulin (SHBG), and dehydroepiandrosterone sulfate (DHEA-S) were recorded. A p-value below 0.05 was accepted as significant in all analyses. The confidence interval was accepted as 95%. Results: Serum total testosterone (ng/dL; 274.5 ± 57.7 vs. 329 ± 64.8, p< 0.001), free testosterone (pg/mL; 8.2 ± 2.4 vs. 12 ± 3.2, p< 0.001), DHEAS [µg/dL; 111 (58) vs. 160 (85.5), p< 0.001] and SHBG concentrations (nmol/L; 29.3 ± 8.6 vs. 33.2 ± 10.2; p= 0.027) were significantly higher in the well coronary collateral group (WCG). According to the results of multiple regression analyses, diabetes [OR= 3.56, CI (1.26-3.5) p= 0.017], free testosterone level [OR= 1.57, CI (1.26-1.96), p< 0.001] and total testosterone level [OR= 1.01, CI (1.00-1.02), p= 0.009] were determined to be independent predictors. Conclusion: This study showed that a high level of sex steroids was a predictor of good collateral development in patients with chronic CAD.