Risk of Myocardial Infarction in Older Men Receiving Testosterone Therapy

Abstract

Background Testosterone therapy for older men has increased substantially over the past decade. Research on the effects of testosterone therapy on cardiovascular outcomes has yielded inconsistent results. Objective To examine the risk of myocardial infarction (MI) in a population-based cohort of older men receiving intramuscular testosterone. Method Using a 5% national sample of Medicare beneficiaries, we identified 6355 patients treated with at least 1 injection of testosterone between January 1, 1997, and December 31, 2005. We matched this cohort to 19 065 testosterone nonusers at a 1:3 ratio based on a composite MI prognostic score. Patients were followed until December 31, 2005, or until they lost coverage from Medicare, enrolled in a health maintenance organization, experienced a MI, or died. Result In a Cox regression analysis adjusting for demographic and clinical characteristics, receipt of testosterone therapy was not associated with an increased risk of MI (hazard ratio [HR] = 0.84; 95% CI = 0.69–1.02). In this analysis, there was an interaction between receipt of testosterone and quartile of risk of MI (P = 0.023). For men in the highest quartile of the MI prognostic score, testosterone therapy was associated with a reduced risk of MI (HR = 0.69; 95% CI = 0.53–0.92), whereas there was no difference in risk for the first (HR = 1.20; 95% CI = 0.88–1.67), second (HR = 0.94; 95% CI = 0.69–1.30), and third quartiles (HR = 0.78; 95% CI = 0.59–1.01). Conclusion Older men who were treated with intramuscular testosterone did not appear to have an increased risk of MI. For men with high MI risk, testosterone use was modestly protective against MI.

An update on the role of testosterone replacement therapy in the management of hypogonadism

“…Both papers were criticized for possible selection bias, but strengths were reliable pretreatment diagnosis and accurate reporting of medications. Baillargeon and colleagues retrospectively compared acute myocardial infarction (MI) rates for 6355 men over 8 years receiving at least one testosterone injection compared with a matched placebo group and found no overall increase in events, including MI, stroke and thromboembolism [Baillargeon et al 2014]. In the quartile at greatest risk, there was a significant reduction in events and mortality.…”

“…Given the strength of evidence that low testosterone is associated with increased allcause mortality, it is intuitive that appropriate testosterone replacement therapy (TRT) would reduce mortality. Whilst several studies, especially in T2DM, suggest that this is the case [Shores et al 2012;Muraleedaran et al 2013;Sharma et al 2015;Baillargeon et al 2014;Hackett et al 2015], some retrospective studies, often with no baseline assessment or evidence of adequate follow up, suggest that there might be risk associated with TRT [Vigen et al 2013;Finkle et al 2014]. These confusing messages may prevent men with clear indication for treatment from receiving entirely appropriate TRT.…”

Guidelines for the diagnosis and treatment of testosterone deficiency (hypogonadism) in male patients with diabetes mellitus (Draft)

“…Мужчины, имеющие сердечно-сосудистые заболевания, до начала лечения должны быть обследованы кардиологом, а в период терапии должен проводиться тщательный мониторинг состояния сердечно-сосудистой системы [59]. В крупном наблюдательном ис-следовании было установлено, что терапия тестостероном даже сопровождалась уменьшением вероятности развития инфаркта миокарда у мужчин, относящихся к категории наиболее высокого риска (уровень 1б, степень А) [82].…”

Hypogonadism in Male Sexual Dysfunction

“…Because of this opposing data, the FDA (Food and Drug Administration) still recommends that larger interventional studies are needed to have a definitive conclusion regarding testosterone treatment on cardiac safety [120]. Observational studies did not confirm the increase in cardiovascular events in long-term follow-up studies [121]. The EMA (European Medicines Agency) had agreed by consensus that there is no consistent evidence of an increased risk for heart problems with testosterone replacement in men lacking the hormone [122].…”