Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.
Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
J Sex Med. 2022 Aug;19(8):1243-1254. doi: 10.1016/j.jsxm.2022.05.145. Epub 2022 Jun 23.
In the context of established male hypogonadism, testosterone therapy (TTh) has been employed to regain physiologic levels of circulating testosterone and improve sexual function and overall quality of life.
To assess the risk of cardiovascular disease and mortality as time-dependent outcomes in treated vs TTh untreated hypogonadal men.
A meta-analysis using weighted time-related measure of risk (hazard ratios (HRs)) for each of the outcome for all included studies was performed. Studies investigating male adults (≥18 years old) diagnosed with hypogonadism and divided into 2 arms (a treatment arm [any TTh] and a control arm [observation or placebo]) and assessing the risk of death and/or cardiovascular events were included. Single arm, non-comparative studies were excluded as well as studies that did not report the HRs for the chosen outcomes. This systemic review was registered on PROSPERO (CRD42022301592) and performed according to MOOSE and PRISMA guidelines.
Overall mortality and cardiovascular events of any type.
Overall, 10 studies were included in the meta-analysis, involving 179,631 hypogonadal men. Hypogonadal men treated with TTh were found to be at lower mortality risk from all causes relative to the control (observation or palcebo) arm (HR: 0.70; 95% Confidence Interval [CI]: 0.54-0.90; P < .01), whilst any unfavorable effect of TTh in hypogonadal men in terms of cardiovascular events compared to untreated/observed hypogonadal men was found (HR: 0.98; 95% CI 0.73-1.33; P = .89).
TTh in hypogonadal men might play a role in reducing the overall risk of death without increasing cardiovascular events risk.
STRENGTHS & LIMITATION: Main limitations are represented by the high heterogeneity among the studies in terms of included population, definition for hypogonadism, type of TTh, definition of cardio-vascular event used, and the length of follow-up.
According to time-related measures of risk only, an increased risk of long-term morbidity and early mortality for untreated hypogonadal men was depicted, further outlining the clinical importance and safety of TTh in true hypogonadal men, with the urgent need of collecting long-term follow-up data. Fallara G, Pozzi E, Belladelli F, et al. Cardiovascular Morbidity and Mortality in Men - Findings From a Meta-analysis on the Time-related Measure of Risk of Exogenous Testosterone. J Sex Med 2022;19:1243-1254.
在已确立的男性性腺功能减退症的背景下，睾酮治疗（TTh）已被用于恢复循环睾酮的生理水平，改善性功能和整体生活质量。
评估作为时间依赖性结局的心血管疾病和死亡率风险，在接受治疗的性腺功能减退症男性与未接受 TTh 治疗的性腺功能减退症男性之间。
对所有纳入研究的每种结局进行加权时间相关风险测量（风险比（HRs））的荟萃分析。纳入研究了诊断为性腺功能减退症的成年男性（≥18 岁），分为治疗组（任何 TTh）和对照组（观察或安慰剂），并评估死亡和/或心血管事件的风险。排除单臂、非对照研究以及未报告所选结局的 HRs 的研究。本系统评价在 PROSPERO（CRD42022301592）上进行，并根据 MOOSE 和 PRISMA 指南进行。
总体死亡率和任何类型的心血管事件。
总共纳入了 10 项荟萃分析研究，涉及 179631 名性腺功能减退症男性。与对照组（观察或安慰剂）相比，接受 TTh 治疗的性腺功能减退症男性的总体全因死亡率风险较低（HR：0.70；95%置信区间 [CI]：0.54-0.90；P<.01），而与未治疗/观察的性腺功能减退症男性相比，TTh 对性腺功能减退症男性心血管事件的任何不良影响（HR：0.98；95%CI 0.73-1.33；P=0.89）。
TTh 可降低性腺功能减退症男性的总体死亡风险，而不增加心血管事件风险。
主要局限性在于研究中包含的人群、性腺功能减退症的定义、TTh 类型、使用的心血管事件定义以及随访时间存在高度异质性。
仅根据风险的时间相关测量，描述了未治疗的性腺功能减退症男性的长期发病率和早期死亡率增加，进一步概述了 TTh 在真正的性腺功能减退症男性中的临床重要性和安全性，迫切需要收集长期随访数据。
