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159 Testosterone Therapy in Men with Coronary Artery Disease
  1. Mohamed Farag1,
  2. Mike Kirby2,
  3. Ahmed Ibrahim3,
  4. Saima Khan1,
  5. Diana Gorog4
  1. 1East and North Hertfordshire NHS Trust
  2. 2Bedfordshire and Hertfordshire Postgraduate Medical School
  3. 3Hertfordshire Postgraduate Medical School
  4. 4Imperial College

Abstract

Background Testosterone levels are inversely associated with the severity of coronary artery disease (CAD). Testosterone may cause vasodilatation via the opening of potassium and calcium channels in smooth muscle cells, or via nitric oxide release, although the evidence is inconsistent. Whether testosterone reduces cardiovascular risk in men with CAD, is unclear. Data supports testosterone supplementation in hypogonadal men as a valuable strategy to reduce cardiovascular events. We aimed to review chronic testosterone therapy in patients with CAD and relate this to gonadal status and clinical outcomes.

Methods The PubMed/Medline, Embase, Scopus and Cochrane Central Register of Controlled Trials databases were searched. All randomised trials comparing the effects of testosterone therapy and alternative interventions in patient with CAD, and reporting clinical outcomes were included. For the purposes of statistical meta-analysis, only the endpoint of time to 1 mm ST-segment depression on exercise tolerance testing was included. Overall estimates of effect were calculated with a random-effects model.

Results Seven trials involving 290 patients with stable angina were included. Baseline gonadal state of patients ranged from true hypogonadism (< 8 nmol/l), to biochemical hypogonadism (8–12 nmol/l), to normal testosterone levels. At the end of follow up, the majority of patients had a significant increase (within normal physiological range) in serum testosterone levels. There were no significant adverse effects reported. In 3 trials involving 69 patients (70% eu-, 30% hypo-gonadal) with angina, chronic testosterone therapy significantly increased the time to 1 mm ST-segment depression on the treadmill (p = 0.02), compared to placebo. Two trials reported improvement in angina symptoms with testosterone therapy. Assessments of lipid profile showed inconsistent results.

Conclusions Testosterone appears to confer no harm and have some anti-ischaemic properties in patients with established CAD. Chronic therapy prolongs the time to ischaemia in men with CAD. Large prospective trials of testosterone in men with CAD are required to understand the true benefit.

  • Steroids
  • Angina pectoris
  • Drug therapy

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