MD, PhD, Department of Endocrinology, Ghent University Hospital, De Pintelann 185, B9000 Gent, Belgium.
J Clin Endocrinol Metab. 2013 Nov;98(11):4300-10. doi: 10.1210/jc.2013-1970. Epub 2013 Sep 24.
The widespread use of T therapy, particularly in aging males, necessitates knowledge of the relationship between T and the cardiovascular system.
The review is based on a 1970 to 2013 PubMed search with terms related to androgens in combination with cardiovascular disease, including T, dihydrotestosterone, trial, mortality, cardiovascular disease, myocardial infarction, blood pressure, endothelial function, dyslipidemia, thrombosis, ventricular function, and arrhythmia. Original articles, systematic reviews and meta-analyses, and relevant citations were screened.
Low T has been linked to increased blood pressure, dyslipidemia, atherosclerosis, arrhythmia, thrombosis, endothelial dysfunction, as well as to impaired left ventricular function. On the one hand, a modest association is suggested between low endogenous T and incident cardiovascular disease or cardiovascular mortality, implying unrecognized beneficial T effects, residual confounding, or a relationship with health status. On the other hand, treatments with T to restore "normal concentrations" have so far not been proven to be beneficial with respect to cardiovascular disease; neither have they definitely shown specific adverse cardiovascular effects. The cardiovascular risk-benefit profile of T therapy remains largely evasive in view of a lack of well-designed and adequately powered randomized clinical trials.
The important knowledge gap as to the exact relationship between T and cardiovascular disease would support a cautious, restrained approach to T therapy in aging men, pending clarification of benefits and risks by adequately powered clinical trials of sufficient duration.
睾酮治疗的广泛应用，特别是在老年男性中，需要了解睾酮与心血管系统之间的关系。
本综述基于 1970 年至 2013 年 PubMed 检索，检索词涉及雄激素与心血管疾病（包括睾酮、二氢睾酮、试验、死亡率、心血管疾病、心肌梗死、血压、内皮功能、血脂异常、血栓形成、心室功能和心律失常）的结合。筛选了原始文章、系统评价和荟萃分析以及相关引文。
低睾酮与血压升高、血脂异常、动脉粥样硬化、心律失常、血栓形成、内皮功能障碍以及左心室功能受损有关。一方面，低内源性睾酮与心血管疾病或心血管死亡率的发生之间存在适度的关联，这表明存在未被认识到的有益的睾酮作用、残留混杂因素或与健康状况有关。另一方面，用睾酮治疗恢复“正常浓度”尚未被证明对心血管疾病有益；它们也没有明确显示出特定的不良心血管作用。鉴于缺乏精心设计和充分有力的随机临床试验，睾酮治疗的心血管风险-效益状况在很大程度上仍不清楚。
鉴于睾酮与心血管疾病的确切关系存在重要的知识空白，在充分有力的临床试验明确获益和风险之前，对于老年男性的睾酮治疗应采取谨慎、克制的方法。
