Kirby Michael, Hackett Geoffrey, Ramachandran Sudarshan
University of Hertfordshire Hatfield, UK.
Spire Little Aston Hospital Sutton Coldfield, UK.
Eur Cardiol. 2019 Jul 11;14(2):103-110. doi: 10.15420/ecr.2019.13.1. eCollection 2019 Jul.
The development of a subnormal level of testosterone (T) is not universal in ageing men, with 75% of men retaining normal levels. However, a substantial number of men do develop T deficiency (TD), with many of them carrying a portfolio of cardiovascular (CV) risk factors, including type 2 diabetes (T2D) and the metabolic syndrome. TD increases the risk of CV disease (CVD) and the risk of developing T2D and the metabolic syndrome. The key symptoms suggesting low T are sexual in nature, including erectile dysfunction (ED), loss of night-time erections and reduced libido. Many men with heart disease, if asked, admit to ED being present; a problem that is often compounded by drugs used to treat CVD. A large number of studies and meta-analyses have provided evidence of the link between TD and an increase in CVD and total mortality. Patients with chronic heart failure (CHF) who have TD have a poor prognosis and this is associated with more frequent admissions and increased mortality compared with those who do not have TD. Conversely, in men with symptoms and documented TD, T therapy has been shown to have beneficial effects, namely improvement in exercise capacity in patients with CHF, improvement of myocardial ischaemia and coronary artery disease. Reductions in BMI and waist circumference, and improvements in glycaemic control and lipid profiles, are observed in T-deficient men receiving T therapy. These effects might be expected to translate into benefits and there are more than 100 studies showing CV benefit or improved CV risk factors with T therapy. There are flawed retrospective and prescribing data studies that have suggested increased mortality in treated men, which has led to regulatory warnings, and one placebo-controlled study demonstrating an increase in coronary artery non-calcified and total plaque volumes in men treated with T, which is open for debate. Men with ED and TD who fail to respond to phosphodiesterase type 5 (PDE5) inhibitors can be salvaged by treating the TD. There are data to suggest that T and PDE5 inhibitors may act synergistically to reduce CV risk.
睾酮（T）水平低于正常并非所有老年男性都会出现，75%的男性睾酮水平保持正常。然而，相当一部分男性确实会出现睾酮缺乏（TD），其中许多人伴有一系列心血管（CV）危险因素，包括2型糖尿病（T2D）和代谢综合征。TD会增加患心血管疾病（CVD）的风险以及患T2D和代谢综合征的风险。提示低睾酮的关键症状本质上是性方面的，包括勃起功能障碍（ED）、夜间勃起丧失和性欲减退。许多患有心脏病的男性，如果被问及，会承认存在ED；而用于治疗CVD的药物常常会使这个问题更加复杂。大量研究和荟萃分析提供了证据，证明TD与CVD增加和总死亡率上升之间存在关联。患有TD的慢性心力衰竭（CHF）患者预后较差，与没有TD的患者相比，这与更频繁的住院和更高的死亡率相关。相反，在有症状且记录有TD的男性中，睾酮治疗已显示出有益效果，即改善CHF患者的运动能力、改善心肌缺血和冠状动脉疾病。接受睾酮治疗的睾酮缺乏男性，其体重指数（BMI）和腰围会降低，血糖控制和血脂水平会改善。这些效果可能会带来益处，有100多项研究表明睾酮治疗对心血管有益或能改善心血管危险因素。有存在缺陷的回顾性研究和处方数据研究表明接受治疗的男性死亡率增加，这导致了监管警告，还有一项安慰剂对照研究表明接受睾酮治疗的男性冠状动脉非钙化斑块和总斑块体积增加，这一点仍存在争议。对5型磷酸二酯酶（PDE5）抑制剂无反应的ED和TD男性，通过治疗TD可能会得到改善。有数据表明，睾酮和PDE5抑制剂可能协同作用以降低心血管风险。
