A new study of 25,420 older men showed that testosterone does not cause heart attacks

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Nelson Vergel

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Testosterone therapy does not increase heart attack risk, study shows

Testosterone prescriptions for older men in the United States have increased more than three-fold over the past decade. Recent studies linking testosterone use with increased risk of heart attack and stroke have caused widespread concern among patients and their families. A new U.S.-based study of more than 25,000 older men shows that testosterone therapy does not increase men's risk for heart attack.

The study, conducted by researchers at the University of Texas Medical Branch at Galveston, examined 25,420 Medicare beneficiaries 66 years or older treated with testosterone for up to eight years. It appears in the July 2 issue of the Annals of Pharmacotherapy.

"Our investigation was motivated by a growing concern, in the U.S. and internationally, that testosterone therapy increases men's risk for cardiovascular disease, specifically heart attack and stroke," said Jacques Baillargeon, UTMB associate professor of epidemiology in the Department of Preventive Medicine and Community Health and lead author of the study. "This concern has increased in the last few years based on the results of a clinical trial and two observational studies," he said. "It is important to note, however, that there is a large body of evidence that is consistent with our finding of no increased risk of heart attack associated with testosterone use."

In recent years, the testosterone therapy market has grown to $1.6 billion annually as men seek to supplement low testosterone counts with products that may increase muscle tone and sex drive. Previous safety investigations presented conflicting findings. A few of these studies suggest testosterone is linked with increased risk of heart attack, although some critics have questioned the quality of these data. Doctors, researchers and government agencies all agree that more research into this issue is necessary.

The Food and Drug Administration decided June 20 to expand labeling on testosterone products to include a general warning about the risk of blood clots in veins. The FDA and European Medicines Agency are also further examining the safety of these products. This newest FDA warning comes shortly after the announcement that several testosterone treatment manufacturers, including Abbott Laboratories, AbbVie Inc., Eli Lilly and Company, Pfizer and Actavis, are facing a consolidated multidistrict litigation in Federal Court based on claims that they hid the risks of using testosterone treatments.

This new UTMB study evaluated enrollment and claims Medicare data for a clinically and socioeconomically diverse national sample treated with testosterone from 1997-2005. Men of the same age, race, Medicaid eligibility, and health status who did not receive testosterone therapy were used as a control group for comparison.

The analyses show that testosterone therapy was not associated with an increased risk of heart attack. Further, testosterone users with a higher probability of cardiovascular problems had a lower rate of heart attacks in comparison to equivalent patients who did not receive testosterone therapy.

"This is a rigorous analysis of a large number of patients," said Baillargeon. "Our findings did not show an increased risk of heart attack associated with testosterone use in older men," he said. "However, large–scale, randomized clinical trials will provide more definitive evidence regarding these risks in the coming years."
Provided by University of Texas Medical Branch at Galveston
 
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Here is another review of papers that just got published.

Expert Opin Drug Saf. 2014 Aug 19:1-25. [Epub ahead of print]

Cardiovascular risk associated with testosterone-boosting medications: a systematic review and meta-analysis.

Corona G1, Maseroli E, Rastrelli G, Isidori AM, Sforza A, Mannucci E, Maggi M.

Abstract

Introduction: Recent reports have significantly halted the enthusiasm regarding androgen-boosting; suggesting that testosterone supplementation (TS) increases cardiovascular (CV) events. Areas covered: In order to overcome some of the limitations of the current evidence, the authors performed an updated systematic review and meta-analysis of all placebo-controlled randomized clinical trials (RCTs) on the effect of TS on CV-related problems. Out of 2747 retrieved articles, 75 were analyzed, including 3016 and 2448 patients in TS and placebo groups, respectively, and a mean duration of 34 weeks. Our analyses, performed on the largest number of studies collected so far, indicate that TS is not related to any increase in CV risk, even when composite or single adverse events were considered. In RCTs performed in subjects with metabolic derangements a protective effect of TS on CV risk was observed. Expert opinion: The present systematic review and meta-analysis does not support a causal role between TS and adverse CV events. Our results are in agreement with a large body of literature from the last 20 years supporting TS of hypogonadal men as a valuable strategy in improving a patient's metabolic profile, reducing body fat and increasing lean muscle mass, which would ultimately reduce the risk of heart disease.


KEYWORDS:
cardiovascular risk; mortality; randomized clinical trial; testosterone
 
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