Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Québec, Canada.
Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Québec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada; Gerald Bronfman Department of Oncology, McGill University, Montreal, Québec, Canada.
Am J Med. 2019 Sep;132(9):1069-1077.e4. doi: 10.1016/j.amjmed.2019.03.022. Epub 2019 Apr 3.
We assessed the risk of ischemic stroke, transient ischemic attack, and myocardial infarction associated with testosterone replacement therapy (TRT) among aging men with low testosterone levels.
Using the UK Clinical Practice Research Datalink, we formed a cohort of men aged 45 years or older with low testosterone levels and no evidence of hypogonadotropic or testicular disease, between 1995 and 2017. Hazard ratios (HRs) and 95% confidence intervals (CIs) of a composite of ischemic stroke/transient ischemic attack and myocardial infarction were estimated using time-dependent Cox proportional hazards models, comparing current use of TRT with nonuse.
The cohort included 15,401 men. During 71,541 person-years of follow-up, 850 patients experienced an ischemic stroke/transient ischemic attack/myocardial infarction (crude incidence rate 1.19 [95% confidence interval (CI), 1.11-1.27] per 100 persons per year). Compared with nonuse, current use of TRT was associated with an increased risk of the composite outcome (HR 1.21; 95% CI, 1.00-1.46). This risk was highest in the first 6 months to 2 years of continuous TRT use (HR 1.35; 95% CI, 1.01-1.79), as well as among men aged 45-59 years (HR 1.44; 95% CI, 1.07-1.92).
TRT may increase the risk of cardiovascular events in aging men with low testosterone levels, particularly in the first 2 years of use. In the absence of identifiable causes of hypogonadism, TRT should be initiated with caution among aging men with low testosterone levels.
我们评估了低睾酮水平的老年男性使用睾丸激素替代疗法（TRT）与缺血性卒中、短暂性脑缺血发作和心肌梗死相关的风险。
利用英国临床实践研究数据链接，我们组建了一个队列，纳入了 1995 年至 2017 年期间年龄在 45 岁及以上、无促性腺激素低下或睾丸疾病证据、低睾酮水平的男性。使用时依 Cox 比例风险模型估计缺血性卒中和/或短暂性脑缺血发作和心肌梗死复合结局的风险比（HR）和 95%置信区间（CI），比较 TRT 与未使用的情况。
队列包括 15401 名男性。在 71541 人年的随访期间，850 名患者发生缺血性卒中和/或短暂性脑缺血发作/心肌梗死（粗发生率为 1.19 [95%CI，1.11-1.27] / 100 人/年）。与未使用相比，当前使用 TRT 与复合结局风险增加相关（HR 1.21；95%CI，1.00-1.46）。这种风险在连续使用 TRT 的前 6 个月至 2 年内最高（HR 1.35；95%CI，1.01-1.79），在 45-59 岁的男性中也是如此（HR 1.44；95%CI，1.07-1.92）。
TRT 可能会增加低睾酮水平的老年男性发生心血管事件的风险，尤其是在使用的头 2 年内。在没有明确的性腺功能减退原因的情况下，低睾酮水平的老年男性应谨慎开始使用 TRT。
