Sharma Rishi, Oni Olurinde A, Gupta Kamal, Sharma Mukut, Sharma Ram, Singh Vikas, Parashara Deepak, Kamalakar Surineni, Dawn Buddhadeb, Chen Guoqing, Ambrose John A, Barua Rajat S
Division of Cardiovascular Research, Kansas City VA Medical Center, Kansas City, MO.
Division of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS.
J Am Heart Assoc. 2017 May 9;6(5):e004880. doi: 10.1161/JAHA.116.004880.
Atrial fibrillation (AF) is the most common cardiac dysrhythmia associated with significant morbidity and mortality. Several small studies have reported that low serum total testosterone (TT) levels were associated with a higher incidence of AF. In contrast, it is also reported that anabolic steroid use is associated with an increase in the risk of AF. To date, no study has explored the effect of testosterone normalization on new incidence of AF after testosterone replacement therapy (TRT) in patients with low testosterone.
Using data from the Veterans Administrations Corporate Data Warehouse, we identified a national cohort of 76 639 veterans with low TT levels and divided them into 3 groups. Group 1 had TRT resulting in normalization of TT levels (normalized TRT), group 2 had TRT without normalization of TT levels (nonnormalized TRT), and group 3 did not receive TRT (no TRT). Propensity score-weighted stabilized inverse probability of treatment weighting Cox proportional hazard methods were used for analysis of the data from these groups to determine the association between post-TRT levels of TT and the incidence of AF. Group 1 (40 856 patients, median age 66 years) had significantly lower risk of AF than group 2 (23 939 patients, median age 65 years; hazard ratio 0.90, 95% CI 0.81-0.99, =0.0255) and group 3 (11 853 patients, median age 67 years; hazard ratio 0.79, 95% CI 0.70-0.89, =0.0001). There was no statistical difference between groups 2 and 3 (hazard ratio 0.89, 95% CI 0.78- 1.0009, =0.0675) in incidence of AF.
These novel results suggest that normalization of TT levels after TRT is associated with a significant decrease in the incidence of AF.
心房颤动（AF）是最常见的心律失常，与显著的发病率和死亡率相关。几项小型研究报告称，血清总睾酮（TT）水平低与AF的较高发病率相关。相反，也有报告称使用合成代谢类固醇与AF风险增加有关。迄今为止，尚无研究探讨睾酮替代疗法（TRT）后睾酮水平正常化对睾酮水平低的患者AF新发病率的影响。
利用退伍军人管理局企业数据仓库的数据，我们确定了一个由76639名TT水平低的退伍军人组成的全国队列，并将他们分为3组。第1组接受TRT后TT水平正常化（正常化TRT），第2组接受TRT但TT水平未正常化（未正常化TRT），第3组未接受TRT（无TRT）。采用倾向评分加权稳定逆概率治疗加权Cox比例风险方法对这些组的数据进行分析，以确定TRT后TT水平与AF发病率之间的关联。第1组（40856例患者，中位年龄66岁）的AF风险显著低于第2组（23939例患者，中位年龄65岁；风险比0.90，95%CI 0.81-0.99，P=0.0255）和第3组（11853例患者，中位年龄67岁；风险比0.79，95%CI 0.70-0.89，P=0.0001）。第2组和第3组的AF发病率无统计学差异（风险比0.89，95%CI 0.78-1.0009，P=0.0675）。
这些新结果表明，TRT后TT水平正常化与AF发病率显著降低相关。
