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.
A study has examined the risk of myocardial infarction in a population-based cohort of older men receiving intramuscular Testosterone.
Using a 5% national sample of Medicare beneficiaries, researchers have identified 6355 patients treated with at least 1 injection of Testosterone during the period 1997-2005.
This cohort was matched to 19 065 Testosterone nonusers at a 1:3 ratio based on a composite myocardial infarction prognostic score.
Patients were followed until December 31, 2005, or until they lost coverage from Medicare, enrolled in a health maintenance organization, experienced a myocardial infarction, or died.
In a Cox regression analysis adjusting for demographic and clinical characteristics, receipt of Testosterone therapy was not associated with an increased risk of myocardial infarction ( 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 myocardial infarction ( P = 0.023 ).
For men in the highest quartile of the myocardial infarction prognostic score, Testosterone therapy was associated with a reduced risk of myocardial infarction ( 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 ).
In conclusion, older men who were treated with intramuscular Testosterone did not appear to have an increased risk of myocardial infarction. For men with high myocardial infarction risk, Testosterone use was modestly protective against myocardial infarction. ( Xagena )
Baillargeon J et al, Ann Pharmacother 2014; 48:1138-1144