Albert Stewart G, Morley John E
Department of Internal Medicine, Division of Endocrinology, Saint Louis University School of Medicine, St. Louis, MO, USA.
Department of Internal Medicine, Division of Geriatrics, Saint Louis University School of Medicine, St. Louis, MO, USA.
Clin Endocrinol (Oxf). 2016 Sep;85(3):436-43. doi: 10.1111/cen.13084. Epub 2016 May 11.
Although male hypogonadism is associated with increased cardiovascular events (CVE), recent concerns are that testosterone supplementation may increase CVE. The purpose was to determine associations with age, initiation or mode of therapy to explain these discrepancies.
Meta-analyses were supplemented through Scopus and PubMed with search terms 'testosterone', 'random' and 'trial'. CVE, defined before data extraction, were death, myocardial infarction, acute coronary syndrome, percutaneous coronary intervention, coronary bypass, syncope, arrhythmia, hospital admission for congestive heart failure or cerebrovascular event.
There were 45 trials with 5328 subjects evaluated, with a mean age of 63·3 (SD ±7·9) years, followed for mean study duration of 10·6 (± 8·6) months. Overall, testosterone supplementation was not associated with increased CVE risk ratio (rr = 1·10 (95% CI 0·86; 1·41, P = 0·45)). However, there was an increase event rate during the first 12 months (rr = 1·79 (1·13;2·83, P = 0·012)), predominantly in those ≥65 years, (rr = 2·90 (1·35;6·21, P = 0·006)). Within studies with lipid data, CVE were associated with fall in HDL, P = 0·002. Intramuscular testosterone appeared neutral for CVE (rr = 0·96 (0·462;1·98, P = 0·91)) compared with oral testosterone (rr = 2·28 (95% CI 2·28;8·59, P = 0·22)) and transdermal testosterone (rr = 2·80 (1·38;5·68, P = 0·004)). Intramuscular testosterone had the least effect of lowering HDL and non-HDL cholesterol (both P < 0·001).
Testosterone supplementation may be associated with increased CVE in those ≥65 years especially during the first year. Biological actions may differ depending upon mode of testosterone administration with intramuscular testosterone having less cardiovascular risk.
尽管男性性腺功能减退与心血管事件（CVE）增加有关，但近期有人担心补充睾酮可能会增加CVE。目的是确定与年龄、治疗起始或方式的关联，以解释这些差异。
通过Scopus和PubMed补充荟萃分析，搜索词为“睾酮”、“随机”和“试验”。在数据提取前定义的CVE包括死亡、心肌梗死、急性冠状动脉综合征、经皮冠状动脉介入治疗、冠状动脉搭桥术、晕厥、心律失常、因充血性心力衰竭住院或脑血管事件。
共评估了45项试验中的5328名受试者，平均年龄为63.3（标准差±7.9）岁，平均研究持续时间为10.6（±8.6）个月。总体而言，补充睾酮与CVE风险比增加无关（风险比=1.10（95%置信区间0.86；1.41，P=0.45））。然而，在最初12个月内事件发生率有所增加（风险比=1.79（1.13；2.83，P=0.012）），主要发生在≥65岁的人群中（风险比=2.90（1.35；6.21，P=0.006））。在有血脂数据的研究中，CVE与高密度脂蛋白降低有关，P=0.002。与口服睾酮（风险比=2.28（95%置信区间2.28；8.59，P=0.22））和透皮睾酮（风险比=2.80（1.38；5.68，P=0.004））相比，肌内注射睾酮对CVE似乎呈中性（风险比=0.96（0.462；1.98，P=0.91））。肌内注射睾酮对降低高密度脂蛋白和非高密度脂蛋白胆固醇的影响最小（P均<0.001）。
补充睾酮可能与≥65岁人群的CVE增加有关，尤其是在第一年。根据睾酮给药方式的不同，生物学作用可能会有所不同，肌内注射睾酮的心血管风险较小。
