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23.03.2014

Testosterone therapy can increase chance of heart attack

Healthy men under the age of 65 who are prescribed testosterone by their doctors are not more at risk of having a heart attack. But in men over 65 and younger men with cardiovascular problems, testosterone therapy can increase the chance of a heart attack by a factor two to three. Researchers at the private Consolidated Research in Los Angeles have reached this conclusion.

Cardiologists still don't know exactly how dangerous testosterone therapy is. There are studies in which testosterone, in older men in particular, raises the chances of cardiovascular disease, but there are others that indicate the risks are negligible. Meta-studies therefore tend to conclude that the cardiological risks of testosterone therapy have not been proven – but sometimes add a warning note that most of the research has been funded by manufacturers of testosterone products.

The researchers wanted to throw more light on the safety of testosterone supplementation in an unusually big study. They gathered data on 55,593 men who had been prescribed injectable testosterone cypionate or testosterone gels by doctors, and monitored them for a period.

The maximum length of time that the researchers monitored the men was 25 months. The researchers noted whether the men had a heart attack.

They also looked at whether the men had had a heart attack in the period before they started using testosterone. This way they could determine whether testosterone boosted the chance of a heart attack, and if so, by how much.

The researchers also gathered data on 167,279 men who had been prescribed the erection medicines sildenafil or tadalafil by their doctors. This enabled the researchers to compare the risks of both types of medication.

Erection medicines did not increase the likelihood of a heart attack, the researchers discovered. The miniscule increase shown in the figure below was not statistically significant.

Testosterone, on the other hand, did increase the likelihood of a heart attack, as the graph below shows.

In healthy men under 65 the testosterone therapy did not increase the risk of a heart attack, but in men with cardiovascular problems in this age group, testosterone administration tripled the chance of a heart attack. Testosterone doubled the chance of a heart attack in men over the age of 65.

"Given the rapidly increasing use of testosterone therapy, the current results, along with other recent findings emphasize the urgency of the previous call for clinical trials adequately powered to assess the range of benefits and risks suggested for such therapy", the researchers conclude. "Until that time clinicians might be well advised to include serious cardiovascular events in their discussions with patients of potential risks, particularly for men with existing cardiovascular disease."

Source:
PLoS One. 2014 Jan 29;9(1):e85805.

More:
Testosterone too dangerous for older men – trial stopped 21.07.2010
Effect of testosterone on heart research unreliable 14.03.2010