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Eur Heart J. 2015 Oct 21;36(40):2706-15. doi: 10.1093/eurheartj/ehv346. Epub 2015 Aug 6.

Normalization of testosterone level is associated with reduced incidence of myocardial infarction and mortality in men.

Author information

1
Division of Cardiovascular Research, Kansas City VA Medical Center, Kansas City, MO, USA.
2
Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, KS, USA.
3
Division of Health Services Research, University of Kansas Medical Center, Kansas City, KS, USA.
4
Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, KS, USA Division of Cardiovascular Medicine, Kansas City VA Medical Center, 4801 E. Linwood Boulevard, Kansas City, MO 64128, USA.
5
Division of Nephrology, Kansas City VA Medical Center, Kansas City, MO, USA.
6
Division of Cardiovascular Medicine, University of California San Francisco, Fresno, CA, USA.
7
Division of Cardiovascular Research, Kansas City VA Medical Center, Kansas City, MO, USA Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, KS, USA Division of Cardiovascular Medicine, Kansas City VA Medical Center, 4801 E. Linwood Boulevard, Kansas City, MO 64128, USA rajat.barua@va.gov.

Abstract

AIMS:

There is a significant uncertainty regarding the effect of testosterone replacement therapy (TRT) on cardiovascular (CV) outcomes including myocardial infarction (MI) and stroke. The aim of this study was to examine the relationship between normalization of total testosterone (TT) after TRT and CV events as well as all-cause mortality in patients without previous history of MI and stroke.

METHODS AND RESULTS:

We retrospectively examined 83 010 male veterans with documented low TT levels. The subjects were categorized into (Gp1: TRT with resulting normalization of TT levels), (Gp2: TRT without normalization of TT levels) and (Gp3: Did not receive TRT). By utilizing propensity score-weighted Cox proportional hazard models, the association of TRT with all-cause mortality, MI, stroke, and a composite endpoint was compared between these groups. The all-cause mortality [hazard ratio (HR): 0.44, confidence interval (CI) 0.42-0.46], risk of MI (HR: 0.76, CI 0.63-0.93), and stroke (HR: 0.64, CI 0.43-0.96) were significantly lower in Gp1 (n = 43 931, median age = 66 years, mean follow-up = 6.2 years) vs. Gp3 (n = 13 378, median age = 66 years, mean follow-up = 4.7 years) in propensity-matched cohort. Similarly, the all-cause mortality (HR: 0.53, CI 0.50-0.55), risk of MI (HR: 0.82, CI 0.71-0.95), and stroke (HR: 0.70, CI 0.51-0.96) were significantly lower in Gp1 vs. Gp2 (n = 25 701, median age = 66 years, mean follow-up = 4.6 years). There was no difference in MI or stroke risk between Gp2 and Gp3.

CONCLUSION:

In this large observational cohort with extended follow-up, normalization of TT levels after TRT was associated with a significant reduction in all-cause mortality, MI, and stroke.

KEYWORDS:

Myocardial infarction; Stroke; Testosterone replacement therapy

PMID:
26248567
DOI:
10.1093/eurheartj/ehv346
[Indexed for MEDLINE]

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