Tag: Testosterone

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Meta-analysis: Testosterone treatment not linked to short-, medium-term CV events in men

Graphical depiction of data presented in article


Disclosures:
Hudson reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.


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In men with hypogonadism, there was no evidence that testosterone treatments cause short-term or medium-term CV risks, according to a meta-analysis published in The Lancet Healthy Longevity.

There were not enough data to conclude anything about the relationship between testosterone treatments and long-term CV risks, according to the researchers.


Graphical depiction of data presented in article

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“Prescribing of testosterone for hypogonadism is increasing globally, but conflicting messages about its safety may have led to many patients not receiving the treatment,” Jemma Hudson, MSc, from the Health Services Research Unit at the University of Aberdeen, United Kingdom, said in a press release. “Ongoing studies should help to determine the longer-term safety of testosterone, but in the meantime, our results provide much-needed reassurance about its short- to medium-term safety. Our findings could have important implications for the treatment of men with hypogonadism worldwide.”

Hudson and colleagues conducted a meta-analysis of 35 studies of trials of testosterone vs. placebo for hypogonadism including 5,601 participants (mean age, 65 years). Of those studies, 17 comprising 3,431 participants with a mean follow-up of 9.5 months had individual participant data. The researchers performed a one-stage meta-analysis of the individual participant data and a two-stage meta-analysis integrating individual participant data with the studies that did not provide it.

All-cause deaths were numerically lower in the testosterone group but were too few to determine statistical significance (0.4% vs. 0.8%; OR = 0.46; 95% CI, 0.17-1.24; P = .13), according to the researchers.

The rate of CV events was similar in both groups (testosterone, 7.5%; placebo, 7.2%; OR = 1.07; 95% CI, 0.81-1.42; P = .62), Hudson and colleagues wrote.

The most frequently occurring CV events were arrhythmia, CHD, HF and MI, all of which occurred at similar rates in both groups, according to the researchers.

There was no difference in CV risk by age (P for interaction = .17), baseline testosterone level (P for interaction = .69), smoking status (P for interaction = .35) and diabetes status (P for interaction = .025), the researchers wrote.

“An important strength of this [individual participant data] meta-analysis is its large size compared with individual testosterone trials, which have provided limited and situation-dependent information on cardiovascular safety,” Hudson and colleagues wrote. “This study has allowed us to more precisely estimate the incidence of cardiovascular events associated with testosterone treatment, which might be generalizable to patients worldwide.”

Reference:

  • Little evidence testosterone treatment increases the risk of cardiovascular events, most in-depth analysis suggests. www.eurekalert.org/news-releases/954980. Published June 8, 2022. Accessed June 9, 2022.

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Analysis finds little proof that testosterone treatment increases the risk of cardiovascular events

Analysis finds little proof that testosterone treatment increases the risk of cardiovascular events

Testosterone replacement therapy appears safe in the short-to-medium term to treat a condition caused by deficiency of the male sex hormone, according to the most comprehensive analysis of the treatment to date, published in The Lancet Healthy Longevity journal.

The findings suggest that men given testosterone to treat hypogonadism are at no greater risk of heart attack, stroke, and other cardiovascular events in the short-to-medium term than men who do not receive testosterone treatment.

Testosterone replacement therapy is the standard treatment for hypogonadism, which can cause sexual dysfunction, weakening of bones and muscles, and reduced quality of life. Risk factors for the condition include aging (as testosterone levels decline with age), obesity (BMI of 30 kg/m2 or above), and diabetes.

Despite being widely used, the cardiovascular safety of testosterone treatment has until now remained unclear due to inconsistent findings. This is because most previous clinical studies have relied on aggregate data, rather than individual participant data and have not published details of individual adverse events.

Prescribing of testosterone for hypogonadism is increasing globally, but conflicting messages about its safety may have led to many patients not receiving the treatment. Ongoing studies should help to determine the longer-term safety of testosterone but, in the meantime, our results provide much-needed reassurance about its short-to-medium term safety. Our findings could have important implications for the treatment of men with hypogonadism worldwide.”


Jemma Hudson, Study Lead Author, University of Aberdeen

The authors conducted a systematic review identifying 35 eligible clinical trials published since 1992, of which 17 provided individual participant data. A blinded analysis by two independent clinicians enabled the classification of every cardiovascular event, allowing for a more robust analysis of the cardiovascular safety of testosterone treatment.

A meta-analysis using individual participant data from 17 studies and a further meta-analysis integrating these data with the aggregate data provided by the 18 trials that did not provide individual participant data were performed.

Among the 17 trials with individual patient data, 1,750 participants received testosterone and 1,681 were given a placebo. The average length of testosterone treatment was 9.5 months. The average age of participants was 65 years, and most were white and did not smoke. Participants’ average BMI was 30 kg/m2, which is considered obese.

A meta-analysis showed there were 120/1,601 (7.5%) cardiovascular events in the testosterone group and 110/1,519 (7.2%) in the placebo group across 13 trials that provided this information. Patient age, smoking or diabetes status did not affect cardiovascular risk. Similarly, there was no significant difference in mortality rate between the testosterone group (6/1,621 deaths, 0.4%) and the placebo group (12/1,537 deaths, 0.8%) across the 14 trials that provided individual patient data on mortality, but only limited data were available.

The researchers also found that testosterone significantly reduced serum total cholesterol, high-density lipoprotein (HDL), and triglycerides compared with placebo. However, there were no significant differences in serum low-density lipoprotein (LDL), blood pressure, glycaemic parameters, diabetes incidence, and prostate adverse outcomes between the testosterone and placebo groups.

The meta-analysis that integrated individual participant data with aggregate data showed similar results.

The authors acknowledge some limitations to their study. There was little available data evaluating the cardiovascular safety of testosterone treatment beyond 12 months, and the very small number of deaths recorded during testosterone trials hampered the authors’ ability to analyze why they occurred.

However, the longer-term safety of testosterone treatment is currently being investigated in another clinical trial. While the meta-analysis of aggregate data showed similar results to the one involving individual patient data only, it cannot be ruled out with certainty that a high number of unreported cardiovascular events in the trials that did not provide individual participant data could alter the current conclusions.

Source:

Journal reference:

Hudson, J., et al. (2022) Adverse cardiovascular events and mortality in men during testosterone treatment: an individual patient and aggregate data meta-analysis. The Lancet Healthy Longevity. doi.org/10.1016/S2666-7568(22)00096-4