Effects of Oral Testosterone Treatment on Myocardial Perfusion and Vascular Function in Men With Low Plasma Testosterone and Coronary Heart Disease (original) (raw)
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Acute anti-ischemic effect of testosterone in men with coronary artery disease
Circulation, 1999
Background-The role of testosterone on the development of coronary artery disease in men is controversial. The evidence that men have a greater incidence of coronary artery disease than women of a similar age suggests a possible causal role of testosterone. Conversely, recent studies have shown that the hormone improves endothelium-dependent relaxation of coronary arteries in men. Accordingly, the aim of the present study was to evaluate the effect of acute administration of testosterone on exercise-induced myocardial ischemia in men. Methods and Results-After withdrawal of antianginal therapy, 14 men (mean age, 58Ϯ4 years) with coronary artery disease underwent 3 exercise tests according to the modified Bruce protocol on 3 different days (baseline and either testosterone or placebo given in a random order). The exercise tests were performed 30 minutes after administration of testosterone (2.5 mg IV in 5 minutes) or placebo. All patients showed at least 1-mm ST-segment depression during the baseline exercise test and after placebo, whereas only 10 patients had a positive exercise test after testosterone. Chest pain during exercise was reported by 12 patients during baseline and placebo exercise tests and by 8 patients after testosterone. Compared with placebo, testosterone increased time to 1-mm ST-segment depression (579Ϯ204 versus 471Ϯ210 seconds; PϽ0.01) and total exercise time (631Ϯ180 versus 541Ϯ204 seconds; PϽ0.01). Testosterone significantly increased heart rate at the onset of 1-mm ST-segment depression (135Ϯ12 versus 123Ϯ14 bpm; PϽ0.01) and at peak exercise (140Ϯ12 versus 132Ϯ12 bpm; PϽ0.01) and the rate-pressure product at the onset of 1-mm ST-segment depression (24 213Ϯ3750 versus 21 619Ϯ3542 mm Hgϫbpm; PϽ0.05) and at peak exercise (26 746Ϯ3109 versus 22 527Ϯ5443 mm Hgϫbpm; PϽ0.05). Conclusions-Short-term administration of testosterone induces a beneficial effect on exercise-induced myocardial ischemia in men with coronary artery disease. This effect may be related to a direct coronary-relaxing effect. (Circulation. 1999;99:1666-1670.)
Randomized controlled trials - mechanistic studies of testosterone and the cardiovascular system
Asian journal of andrology
Testosterone deficiency is common in men with cardiovascular disease (CVD), and randomized placebo-controlled trials (RCTs) have reported beneficial effects of testosterone therapy on exercise-induced cardiac ischemia in chronic stable angina, functional exercise capacity, maximum oxygen consumption during exercise (VO) and muscle strength in chronic heart failure (CHF), shortening of the Q-T interval, and improvement of some cardiovascular risk factors. Testosterone deficiency is associated with an adverse CV risk profile and mortality. Clinical and scientific studies have provided mechanistic evidence to support and explain the findings of the RCTs. Testosterone is a rapid-onset arterial vasodilator within the coronary circulation and other vascular beds including the pulmonary vasculature and can reduce the overall peripheral systemic vascular resistance. Evidence has demonstrated that testosterone mediates this effect on vascular reactivity through calcium channel blockade (L-ca...
Testosterone and coronary artery disease in men
Maturitas, 2010
Coronary artery disease (CAD) is the leading cardiovascular cause of death, and in men, endogenous testosterone concentrations are inversely related to the extent and severity of CAD. Testosterone is known to affect a number of risk factors for CAD and has effects on vascular tone, vasoreactivity and blood flow of blood vessels beyond the reproductive system, indicating that testosterone may be involved in the pathogenesis of CAD. In this review we will present and discuss the actions of endogenous testosterone and testosterone treatment on risk factors for CAD, on the blood vessel wall and blood flow, and on atheroma development and progression, and discuss the potential for testosterone use in men with CAD.
The Effect of Testosterone on Cardiovacular Biomarkers in the Testosterone Trials
The Journal of clinical endocrinology and metabolism, 2017
Studies of the possible cardiovascular risk of testosterone treatment are inconclusive. To determine the effect of testosterone treatment on cardiovascular (CV) biomarkers in older men with low testosterone. Double-blind, placebo-controlled trial. Twelve academic medical centers in the United States. 788 men ≥65 years old with an average of two serum testosterone levels <275 ng/dL who were enrolled in The Testosterone Trials. Testosterone gel, the dose adjusted to maintain the testosterone level in the normal range for young men, or placebo gel for 12 months. Serum markers of cardiovascular risk, including lipids and markers of glucose metabolism, fibrinolysis, inflammation, and myocardial damage. Testosterone treatment, compared to placebo, significantly decreased total cholesterol (adjusted mean difference -6.1 mg/dL, p<0.001), high density lipoprotein (HDL) cholesterol (adjusted mean difference -2.0 mg/dL, p<0.001) cholesterol and low density lipoprotein (LDL) cholestero...
Testosterone: Friend or foe for the cardiovascular system in men?
Annals of Clinical and Analytical Medicine, 2020
Epidemiological studies showed that cardiovascular diseases occur 7-10 years earlier in men than in women. One in two men and one in three women will have coronary artery disease events at the age of 40, and this observation is attributed to many factors, including differences in the steroidal hormonal status. In experimental trials, testosterone showed both beneficial and deleterious effects on the cardiovascular system. In addition, some trials found low levels of serum testosterone in men with coronary artery disease or heart failure and that patients with hypogonadism are at higher risk of cardiovascular diseases than patients with a normal serum level of testosterone. Clinical studies demonstrated cardiovascular deleterious effects of hypogonadism but no improvement with testosterone replacement therapy. It is unclear whether the differences in cardiovascular risk between men and women are due to the hormonal status or socio-cultural status.
Long-term benefits of testosterone replacement therapy on angina threshold and atheroma in men
European Journal of Endocrinology, 2009
Introduction: In short-term studies, testosterone replacement therapy has been shown to protect male subjects from exercise-induced ischaemia and modify cardiovascular risk factors such as insulin resistance, fat mass and lipid profiles. Methods: This randomised parallel group controlled trial was designed to assess the treatment effect of testosterone therapy (Nebido) compared with placebo in terms of exercise-induced ischaemia, lipid profiles, carotid intima-media thickness (CIMT) and body composition during 12 months treatment in men with low testosterone levels and angina. Results: A total of 15 men were recruited but 13 (nZ13) reached adequate duration of follow-up; seven were treated with testosterone and six with placebo. Testosterone increased time to ischaemia (129G48 s versus 12G18, PZ0.02) and haemoglobin (0.4G0.6 g/dl versus K0.03G0.5, PZ0.04), and reduced body mass index (K0.3 kg/m 2 versus 1.3G1, PZ0.04) and triglycerides (K0.36 G0.4 mmol/l versus 0.3G1.2, PZ0.05). The CIMT decreased in the testosterone group more than placebo, but full between group analyses suggested this was only a statistical trend (K0.5G0.1 vs K0.09G0.06, PZ0.16). There were no significant effects on serum prostate specific antigen, total or high-density lipoprotein cholesterol; or on mood and symptom scores as assessed by Seattle Angina Score and EuroQol. Conclusion: The protective effect of testosterone on myocardial ischaemia is maintained throughout treatment without decrement. Previously noted potentially beneficial effects of testosterone on body composition were confirmed and there were no adverse effects.
Testosterone and cardiovascular disease
Current Opinion in Endocrinology & Diabetes and Obesity, 2014
Testosterone (T) is the principal male sex hormone. As men age, T levels typically fall. Symptoms of low T include decreased libido, vasomotor instability, and decreased bone mineral density. Other symptoms may include depression, fatigue, erectile dysfunction, and reduced muscle strength/mass. Epidemiology studies show that low levels of T are associated with more atherosclerosis, coronary artery disease, and cardiovascular events. However, treating hypogonadism in the aging male has resulted in discrepant results in regard to its effect on cardiovascular events. Emerging studies suggest that T may have a future role in treating heart failure, angina, and myocardial ischemia. A large, prospective, long-term study of T replacement, with a primary endpoint of a composite of adverse cardiovascular events including myocardial infarction, stroke, and/or cardiovascular death, is needed. The Food and Drug Administration recently put additional restrictions on T replacement therapy labeling and called for additional studies to determine its cardiac safety.
Reviews in Endocrine and Metabolic Disorders, 2021
The cardiovascular (CV) benefit and safety of treating low testosterone conditions is a matter of debate. Although testosterone deficiency has been linked to a rise in major adverse CV events, most of the studies on testosterone replacement therapy were not designed to assess CV risk and thus excluded men with advanced heart failure or recent history of myocardial infarction or stroke. Besides considering observational, interventional and prospective studies, this review article evaluates the impact of testosterone on atherosclerosis process, including lipoprotein functionality, progression of carotid intima media thickness, inflammation, coagulation and thromboembolism, quantification of plaque volume and vascular calcification. Until adequately powered studies evaluating testosterone effects in hypogonadal men at increased CV risk are available (TRAVERSE trial), clinicians should ponder the use of testosterone in men with atherosclerotic cardiovascular disease and discuss benefit ...