
You can make your own conclusions:
Of the 1710 outcome events, 748 men died, 443 had MIs, and 519 had strokes.
Of 7486 patients not receiving testosterone therapy, 681 died, 420 had MIs, and 486 had strokes. So, 21 percent of men not using testosterone had a cardiovascular event.
Among 1223 patients receiving testosterone therapy, 67 died, 23 had MIs, and 33 had strokes. So, 10 percent of men using testosterone had a cardiovascular event.
Most men used testosterone patches (which is no longer accepted as standard therapy due to suboptimal testosterone increases)
40 % were not retested for testosterone,so no one knows if they were taking testosterone and what their levels were after they started therapy. The treatment of these men did not follow recommended guidelines. Reference:
How should doctors monitor men receiving testosterone replacement therapy?
Most men's testosterone only went up to 332 mg/dL (we consider this low in 2013 since we aim at total testosterone blood levels above 500 ng/dL). These men are considered to still be hypogonadal. Hypogonadism has been reported to increase cardiovascular events. Reference:
Total testosterone over 550 ng/dL reduced the risk of cardiovascular events
Also, the study showed no estradiol and hematocrit monitoring or reporting. High estradiol and hematocrit can increase cardiovascular risks. Both parameters can be easily managed if monitored. Reference:
Estradiol of < 21.80 pg/ml and > 30.11 pg/ml resulted in greater mortality in men
Under treating men with prior history of heart disease may be worse than not treating them at all. Most of these men with history of heart disease remained hypogonadal even on testosterone treatment (testosterone patches are no longer used since they are sub-optimal therapy). We have several references that link hypogonadism to increased cardiovascular problems.
This type of retrospective studies only sets back the field with poorly gathered data from suboptimal therapies that we no longer use due to their poor absorption. Luckily, the VA hospital system is probably now not mandating the use of patches as the main option for testosterone replacement in their medication formularies.
From the VA study:
"In the cohort of 8709 veterans with a total testosterone level less than 300 ng/dL who underwent coronary angiography, there was a high burden of comorbidities. Approximately 20% had a prior history of MI, 50% had diabetes, and more than 80% had CAD. Of the 8709 patients, 1223 (14.0%) initiated testosterone therapy after a median of 531 days (interquartile range [IQR], 229-894 days) following angiography. "
"Of the patients prescribed testosterone therapy, 734 patients (60.0%) had another testosterone value checked after starting treatment. S
o 40% were not retested. These patients had a mean of 3.3 measurements. Among these patients, the baseline testosterone level was 1
75.5 ng/dL and increased to 332.2 ng/dL for the first repeat testosterone measurement."
"Of the patients receiving testosterone therapy, 13 (1.1%) were prescribed testosterone gel; 436 (35.7%), injections;
and 774 (63.3%), patches. The most common gel dispensed was testosterone 1% 5-g packets; injections, testosterone 200-mg/mL injections; and patch testosterone, 2.5-mg/24-hour patch. We did not detect a significant difference in the risk of adverse outcomes across the 3 testosterone formulations"
"The association between testosterone therapy use and adverse outcomes observed in this study differs from the association observed in a prior retrospective VA study. These discrepant results may be due to differences in the patient populations and methods used to control for confounding. In the study by Shores et al,
28 investigators noted a
39% reduction in mortality risk among patients treated with testosterone therapy. The patients in that cohort had a lower incidence of heart disease ( ~ 20%) defined by angina, MI, CAD, coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, or heart failure. This contrasts with our cohort in which more than 20% had a prior history of MI and heart failure, and more than 50% had confirmed obstructive CAD on angiography. "
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Once initiated, a patient was assumed to have continued treatment until an outcome event occurred or the end of follow-up. " But 40 percent of patients were not tested for testosterone after they started treatment.