Finkle William D, Greenland Sander, Ridgeway Gregory K, Adams John L, Frasco Melissa A, Cook Michael B, Fraumeni Joseph F, Hoover Robert N
Consolidated Research, Inc., Los Angeles, California, United States of America.
Department of Epidemiology and Department of Statistics, University of California, Los Angeles, California, United States of America.
PLoS One. 2014 Jan 29;9(1):e85805. doi: 10.1371/journal.pone.0085805. eCollection 2014.
An association between testosterone therapy (TT) and cardiovascular disease has been reported and TT use is increasing rapidly.
We conducted a cohort study of the risk of acute non-fatal myocardial infarction (MI) following an initial TT prescription (N = 55,593) in a large health-care database. We compared the incidence rate of MI in the 90 days following the initial prescription (post-prescription interval) with the rate in the one year prior to the initial prescription (pre-prescription interval) (post/pre). We also compared post/pre rates in a cohort of men prescribed phosphodiesterase type 5 inhibitors (PDE5I; sildenafil or tadalafil, N = 167,279), and compared TT prescription post/pre rates with the PDE5I post/pre rates, adjusting for potential confounders using doubly robust estimation.
In all subjects, the post/pre-prescription rate ratio (RR) for TT prescription was 1.36 (1.03, 1.81). In men aged 65 years and older, the RR was 2.19 (1.27, 3.77) for TT prescription and 1.15 (0.83, 1.59) for PDE5I, and the ratio of the rate ratios (RRR) for TT prescription relative to PDE5I was 1.90 (1.04, 3.49). The RR for TT prescription increased with age from 0.95 (0.54, 1.67) for men under age 55 years to 3.43 (1.54, 7.56) for those aged ≥ 75 years (p trend = 0.03), while no trend was seen for PDE5I (p trend = 0.18). In men under age 65 years, excess risk was confined to those with a prior history of heart disease, with RRs of 2.90 (1.49, 5.62) for TT prescription and 1.40 (0.91, 2.14) for PDE5I, and a RRR of 2.07 (1.05, 4.11).
In older men, and in younger men with pre-existing diagnosed heart disease, the risk of MI following initiation of TT prescription is substantially increased.
已有报道称睾酮治疗（TT）与心血管疾病之间存在关联，且TT的使用正在迅速增加。
我们在一个大型医疗保健数据库中对首次开具TT处方后发生急性非致命性心肌梗死（MI）的风险进行了队列研究（N = 55,593）。我们将首次处方后90天内（处方后间隔）的MI发病率与首次处方前一年（处方前间隔）的发病率进行比较（处方后/处方前）。我们还比较了开具5型磷酸二酯酶抑制剂（PDE5I；西地那非或他达拉非，N = 167,279）的男性队列中的处方后/处方前比率，并使用双重稳健估计法对潜在混杂因素进行调整后，将TT处方的处方后/处方前比率与PDE5I的处方后/处方前比率进行比较。
在所有受试者中，TT处方的处方后/处方前比率（RR）为1.36（1.03，1.81）。在65岁及以上的男性中，TT处方的RR为2.19（1.27，3.77），PDE5I的RR为1.15（0.83，1.59），TT处方相对于PDE5I的比率比（RRR）为1.90（1.04，3.49）。TT处方的RR随年龄增长而增加，从55岁以下男性的0.95（0.54，1.67）增至75岁及以上男性的3.43（1.54，7.56）（p趋势 = 0.03），而PDE5I未见此趋势（p趋势 = 0.18）。在65岁以下的男性中，额外风险仅限于有心脏病史的男性，TT处方的RR为2.90（1.49，5.62），PDE5I的RR为1.40（0.91，2.14），RRR为2.07（1.05，4.11）。
在老年男性以及已有确诊心脏病的年轻男性中，开始TT处方后发生MI的风险大幅增加。
