Testosterone, testosterone replacement therapy and cardiovascular disease

Description

Dr Barua presents the current state of knowledge about testosterone therapy and cardiovascular events. Numerous studies show that low testosterone increases risk of both cardiovascular mortality and all-cause mortality. Despite this, a few highly debated studies made the allusion that testosterone therapy increases risk of cardiovascular disease. A notable study conducted by Dr Barua’s group showed that normalization of testosterone levels is associated with reduced incidence of myocardial infarction (MI) and mortality in men.1 Specifically, in men who have low total testosterone levels but no previous MI or stroke, testosterone therapy is associated with decreased risks of MI, stroke, and all-cause mortality during a long-term follow-up of up to 14 years. Compared to non-treated men, testosterone treated men who achieved normalization of their testosterone levels had a major and significant reduction in MI, stroke and all-cause mortality by 24%, 36% and 56%, respectively. Compared to non-treated men, testosterone treated men who failed to achieve normalization of their testosterone levels did not have a reduction in heart attack or stroke, and had significantly less benefit on mortality risk. This is the first study to highlight that testosterone therapy should aim for doses resulting in normalization of testosterone levels because this is a prerequisite to achieve a reduction in MI and stroke. In smokers, testosterone therapy has no significant effect on MI or stroke, but does reduce all-cause mortality. Normalisation of testosterone levels with testosterone therapy also reduces incidence of atrial fibrillation, a benefit which is not seen in men who get sub-optimal testosterone therapy that does not raise testosterone level high enough to provide therapeutic benefit.2

There have been concerns regarding a possible increased incidence of DVT and pulmonary embolism (PE) with testosterone therapy. However, few data support the association between testosterone therapy and DVT/PE. In another study, Dr Barua’s group evaluated the incidence of DVT and PE in men who were prescribed testosterone therapy for low testosterone levels.3 This was a large study including 71,407 subjects with low baseline testosterone and low to moderate baseline risk of DVT/PE. After a follow-up of 14 years, there was no significant association between testosterone therapy and risk of DVT/PE.3


 

Speakers

Prof. Dr. med. Marija Pfeifer

Rajat Barua, MD, PhD, FACC, FSCAI
Associate professor of Medicine
University of Kansas School of Medicine
Director, Interventional Cardiology & Cardiac Cath. Laboratory
Director Cardiovascular Research
Kansas City VA Medical Center

References

  • Sharma R, Oni OA, Gupta K, Chen G, Sharma M, Dawn B, Sharma R, Parashara D, Savin VJ, Ambrose JA, Barua RS. Normalization of testosterone level is associated with reduced incidence of myocardial infarction and mortality in men. Eur Heart J. 2015 Oct 21;36(40):2706-15. Return to content
  • Sharma R, Oni OA, Gupta K, Sharma M, Sharma R, Singh V, Parashara D, Kamalakar S, Dawn B, Chen G, Ambrose JA, Barua RS. Normalization of Testosterone Levels After Testosterone Replacement Therapy Is Associated With Decreased Incidence of Atrial Fibrillation. J Am Heart Assoc. 2017; 6:e004880 Return to content
  • Sharma R, Oni OA, Chen G, Sharma M, Dawn B, Sharma R, Parashara D, Savin VJ, Barua RS, Gupta K. Association Between Testosterone Replacement Therapy and the Incidence of DVT and Pulmonary Embolism: A Retrospective Cohort Study of the Veterans Administration Database. Chest. 2016 Sep;150(3):563-71 Return to content