Heart failure accelerates male 'menopause'

The Heart Failure Congress is the main annual meeting of the Heart Failure Association of the European Society of Cardiology and is being held 25-28 May in Lisbon, Portugal (1).

As men get older they are more likely to suffer from andropausal syndrome (AS), also called 'menopause', androgen deficiency in the aging male (ADAM), or late-onset hypogonadism. Men with AS have decreased levels of anabolic hormones, including testosterone, and it has been suggested that these hormone deficiencies are what cause the clinical symptoms.

The symptoms of AS according to the Aging Male Symptom Rating Scale can be divided into three categories: sexual (erectile dysfunction, problems with libido, decrease in beard growth, feelings of 'having passed the zenith of life'), psychological (feeling discouraged, depressed, irritable, anxious, nervous), and somato-vegetative (joint and muscle complaints, sweating, need for more sleep, sleep disturbances, weakness, exhaustion).

Heart failure increases with age. Deficiencies of anabolic hormones are common in men with systolic heart failure, leading to reduced exercise capacity, depression and poor prognosis. But until now the impact of heart failure on the prevalence of AS and the severity of andropausal symptoms has not been studied.

Professor Ewa A. Jankowska (Wroclaw, Poland) said: "AS leads to poor quality of life. We wanted to discover whether heart failure increases AS and whether additional androgen therapies could improve quality of life in heart failure patients."

For the study (2), the researchers compared the prevalence of AS and the severity of andropausal symptoms between 232 men with systolic heart failure aged 40-80 years and 362 age-matched healthy peers. The magnitude of andropausal symptoms (psychological, sexual and somato-vegetative) was assessed using the Aging Males' Symptoms (AMS) Rating Scale and AS was diagnosed if the total AMS score was 50 points or more.

They found that AS affected almost one-third of men with heart failure, regardless of their age group. In men aged 40-59 years, heart failure led to a four-fold increase in the prevalence of AS (28% vs. 7%, p<0.001) and an increase in the severity of sexual and somato-vegetative andropausal symptoms (p<0.001). Men aged 60-80 years with and without heart failure had a similar prevalence of AS and severity of andropausal symptoms. Among men with systolic heart failure, the prevalence of AS was similar in both age groups (40-59 and 60-80 years).

The authors concluded that heart failure accelerates the natural process of aging and favours early onset of AS. Professor Jankowska said: "Heart failure leads to anabolic hormone deficiencies at a relatively young age and thereby accelerates male aging and the development of AS. These patients have poor quality of life and need endocrinological and sexual counselling."

It has been suggested that the anabolic hormone deficiencies in heart failure could be caused by heart failure treatments, which could affect the metabolism of hormones, or comorbidities, which might impair endocrine gland function. But in a second abstract (61271) the research group found few and weak associations between the presence of anabolic deficiencies, comorbidities and therapies in men with systolic heart failure. Professor Jankowska said: "This shows that it is the heart failure itself which impacts on the functioning of the endocrine glands."

She concluded: "Further research is needed to determine whether androgen supplementation can reduce the severity of andropausal symptoms."

References: 1. Heart Failure Congress 2013 http://www.escardio.org/congresses/hf2013/Pages/welcome.aspx?hit=nav 2. Thaczyszyn M, Nega K, Lopuszanska M, et al. Andropausal syndrome in men with systolic chronic heart failure, Presented at Heart Failure Congress 2013 Final Programme Number P640