Serum testosterone and cardiometabolic risk in Nigerian men with type 2 diabetes: a cross−sectional study

Abstract

Introduction Type 2 diabetes mellitus (T2DM) increasingly burdens cardiometabolic health in Nigerian men, with evidence indicating testosterone deficiency may worsen atherosclerotic cardiovascular disease (ASCVD) risk. Despite the high rates of hypogonadism in T2DM men, limited studies have examined how low testosterone is linked with cardiometabolic risk. This study assessed the associations between serum testosterone and cardiometabolic risk in Nigerian men with T2DM. Methods In this cross-sectional study, 537 adult men were recruited, 358 with T2DM and 179 non-diabetic controls. Participants were stratified by T2DM and testosterone levels. Clinical, anthropometric, and biochemical measurements, including lipid and serum testosterone, were obtained. The 10-year ASCVD risk was estimated using ACC/AHA equations. Data were analyzed using two-way ANOVA, Pearson correlations, and multivariable regression. Results Men with T2DM had significantly higher ASCVD 10-year score than non-diabetic controls, independent of testosterone status (P T2DM <0.0001). Hypogonadal T2DM men exhibited higher BMI, central obesity, total and LDL cholesterol, and lower HDL cholesterol. In multivariable analyses within the T2DM cohort, serum testosterone was not independently associated with the ASCVD risk score or any individual cardiometabolic risk factor. Conclusion Men with T2DM have a higher estimated 10-year ASCVD risk than non-diabetic controls, irrespective of testosterone status, with T2DM men with low testosterone showing a more adverse cardiometabolic profile. However, testosterone is not an independent predictor of ASCVD risk after multivariable adjustment, suggesting that T2DM-related metabolic risk factors are the dominant drivers of calculated cardiovascular risk. Longitudinal studies are required to establish causality and clinical relevance.