The Role of Steroids in Endothelial Function in the Ageing Male

Abstract

Normal vascular endothelium is essential for the synthesis and release of substances affecting vascular tone, cell adhesion and the homoeostasis of clotting and fibrinolysis. The degeneration of endothelial integrity promotes adverse events leading to atherogenesis. Circulating levels of endogenous hormones decline during ageing and this may contribute to the occurrence of major adverse cardiovascular events, independently of gender differences. During the last decade more attention has been drawn to the importance of testosterone, oestradiol and adrenal androgens in the pathophysiology, prevention and treatment of male ageing-associated diseases. A considerable body of literature is available indicating that steroid hormones, particularly the sex steroids, are known to modulate endothelial function in all vascular beds and their deficiency may promote endothelial dysfunction. Testosterone decrease and increased mineralocorticoid activity in the ageing male are frequent and may yield endothelial dysfunction and increased cardiovascular burden; we recommend careful hormonal investigations in men who present comorbidities such as diabetes, hypertension and dyslipidaemia.