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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone and Men's Health Articles
Study Finds Increased Risk of CVD from TRT
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<blockquote data-quote="Jinzang" data-source="post: 155030" data-attributes="member: 12925"><p>Here's more information on the study from an <a href="https://www.medscape.com/viewarticle/916013" target="_blank">editorial in MedScape</a>:</p><p></p><p>Renoux and colleagues' latest work provides no easy answers, despite a large cohort of 15,401 men, aged 45 years or older (mean 60.4 years), diagnosed with low testosterone without evidence of hypogonadotropic or testicular disease in the UK Clinical Practice Research Datalink database between 1995 and 2017.</p><p></p><p>Most patients received testosterone gels or creams (56.8%) and 33.6% received injections.</p><p></p><p>The results show a 21% increased risk for the composite of MI and ischemic stroke/transient ischemic attack (TIA) in current TRT users vs nonusers after adjusting for more than 20 potential confounders (hazard ratio<hr /><p>, 1.21; 95% confidence interval [CI], 1.00 - 1.46).</p><p></p><p>This corresponds to an adjusted risk difference of 2.4 events per 1000 persons per year, the authors reported July 18 in the <em>American Journal of Medicine</em>.</p><p></p><p>MI and stroke risk was highest in the first 6 months to 2 years of continuous use and mostly driven by an increased risk among men aged 45 to 59 years. Risk was also increased in men with and without prior cardiovascular disease (CVD), but the results did not reach statistical significance.</p><p></p><p>Surprisingly, current TRT use was associated with a lower risk for all-cause mortality (HR, 0.64; 95% CI, 0.52 - 0.78) and past use with an increased risk when compared with nonuse (HR, 1.72; 95% CI, 1.21 - 2.45).</p><p></p><p>"It's difficult to reconcile on one hand an increased risk of cardiovascular disease, which is one of the leading causes of mortality in older men, and at the same time finding a strong predictive effect on all-cause mortality," Renoux said.</p><p></p><p>"When you see such a strong protective effect on all-cause mortality, you have to begin to wonder because if it's too good to be true, it probably is," she said. "Because how many drugs can you claim have a 75% decrease risk in all-cause mortality?"</p><p></p><p>Reached for comment, Bradley Anawalt, an endocrinologist and chief of medicine at the University of Washington Medical Center in Seattle, said he was surprised the authors dismissed the all-cause mortality findings and highlighted a 2012 study he coauthored with "equally stringent statistical analyses," in which the risk for death was lower among men aged 40 years or older treated with testosterone (adjusted HR, 0.61; 95% CI, 0.42 - 0.88). </p><p></p><p>"There are plausible mechanisms; testosterone increases strength, which means perhaps these men didn't fall and break their hips or die from fractures," he said.</p><p></p><p>"To a priori say it couldn't be a drug effect that has the same biases and errors in logic someone might have if they say it couldn't have been the testosterone causing the heart attacks and strokes," Anawalt said.</p><p></p><p>As for the effect of testosterone on the composite of MI/stroke/TIA, Anawalt said that the absolute risk difference for just 2.4 events/1000 persons/year was very small. Exactly how TRT imparts CVD risks remains unclear, but the authors note it may enhance platelet aggregation.</p></blockquote><p></p>
[QUOTE="Jinzang, post: 155030, member: 12925"] Here's more information on the study from an [URL='https://www.medscape.com/viewarticle/916013']editorial in MedScape[/URL]: Renoux and colleagues' latest work provides no easy answers, despite a large cohort of 15,401 men, aged 45 years or older (mean 60.4 years), diagnosed with low testosterone without evidence of hypogonadotropic or testicular disease in the UK Clinical Practice Research Datalink database between 1995 and 2017. Most patients received testosterone gels or creams (56.8%) and 33.6% received injections. The results show a 21% increased risk for the composite of MI and ischemic stroke/transient ischemic attack (TIA) in current TRT users vs nonusers after adjusting for more than 20 potential confounders (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.00 - 1.46). This corresponds to an adjusted risk difference of 2.4 events per 1000 persons per year, the authors reported July 18 in the [I]American Journal of Medicine[/I]. MI and stroke risk was highest in the first 6 months to 2 years of continuous use and mostly driven by an increased risk among men aged 45 to 59 years. Risk was also increased in men with and without prior cardiovascular disease (CVD), but the results did not reach statistical significance. Surprisingly, current TRT use was associated with a lower risk for all-cause mortality (HR, 0.64; 95% CI, 0.52 - 0.78) and past use with an increased risk when compared with nonuse (HR, 1.72; 95% CI, 1.21 - 2.45). "It's difficult to reconcile on one hand an increased risk of cardiovascular disease, which is one of the leading causes of mortality in older men, and at the same time finding a strong predictive effect on all-cause mortality," Renoux said. "When you see such a strong protective effect on all-cause mortality, you have to begin to wonder because if it's too good to be true, it probably is," she said. "Because how many drugs can you claim have a 75% decrease risk in all-cause mortality?" Reached for comment, Bradley Anawalt, an endocrinologist and chief of medicine at the University of Washington Medical Center in Seattle, said he was surprised the authors dismissed the all-cause mortality findings and highlighted a 2012 study he coauthored with "equally stringent statistical analyses," in which the risk for death was lower among men aged 40 years or older treated with testosterone (adjusted HR, 0.61; 95% CI, 0.42 - 0.88). "There are plausible mechanisms; testosterone increases strength, which means perhaps these men didn't fall and break their hips or die from fractures," he said. "To a priori say it couldn't be a drug effect that has the same biases and errors in logic someone might have if they say it couldn't have been the testosterone causing the heart attacks and strokes," Anawalt said. As for the effect of testosterone on the composite of MI/stroke/TIA, Anawalt said that the absolute risk difference for just 2.4 events/1000 persons/year was very small. Exactly how TRT imparts CVD risks remains unclear, but the authors note it may enhance platelet aggregation.[/HR] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone and Men's Health Articles
Study Finds Increased Risk of CVD from TRT
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