Impact of Testosterone Replacement Therapy on Thromboembolism, Heart Disease, and Obstructive Sleep Apnea
OBJECTIVES: To assess the association of TRT with thromboembolism, cardiovascular disease (stroke, coronary artery disease, and heart failure) and obstructive sleep apnea (OSA).
METHODS: A cohort of 3,422 male United States military service members, retirees and their dependents, aged 40-64 was identified, who were prescribed TRT between 2006-2010 for low testosterone. Men in this cohort were matched on a 1:1 basis by age and comorbidities to men without a prescription for TRT. Event-free survival and rates of thromboembolism, cardiovascular events and OSA were compared between men using TRT and controls with a median follow-up of 17 months.
RESULTS: There was no difference in event free survival from thromboembolism (p=0.239). Relative to controls, patients using TRT had improved cardiovascular event free survival (p=0.004), mainly due to decreased coronary artery disease (p=0.0082). Risk of OSA was worse in TRT users (2-year risk 16.5% in TRT vs. 12.7% in controls, 95% CI: 15.1%-18.1% vs. 11.4%-14.1%).
CONCLUSIONS: This study adds to growing evidence that cardiovascular risk from TRT may be less than once feared. The increased risk of sleep apnea in men using TRT is noteworthy. The study strengths include the large number of healthy and young men exposed to TRT.
Limitations include the retrospective study design inability to account for granular details of TRT use such as dosage, specific forms of TRT and serum testosterone levels pre- and post-TRT.
Cole AP, Hanske J, Jiang W, et al. Impact of testosterone replacement therapy on thromboembolism, heart disease, and obstructive sleep apnea in men. BJU international 2018. Impact of testosterone replacement therapy on thromboembolism, heart disease, and obstructive sleep apnea in men
OBJECTIVES: To assess the association of TRT with thromboembolism, cardiovascular disease (stroke, coronary artery disease, and heart failure) and obstructive sleep apnea (OSA).
METHODS: A cohort of 3,422 male United States military service members, retirees and their dependents, aged 40-64 was identified, who were prescribed TRT between 2006-2010 for low testosterone. Men in this cohort were matched on a 1:1 basis by age and comorbidities to men without a prescription for TRT. Event-free survival and rates of thromboembolism, cardiovascular events and OSA were compared between men using TRT and controls with a median follow-up of 17 months.
RESULTS: There was no difference in event free survival from thromboembolism (p=0.239). Relative to controls, patients using TRT had improved cardiovascular event free survival (p=0.004), mainly due to decreased coronary artery disease (p=0.0082). Risk of OSA was worse in TRT users (2-year risk 16.5% in TRT vs. 12.7% in controls, 95% CI: 15.1%-18.1% vs. 11.4%-14.1%).
CONCLUSIONS: This study adds to growing evidence that cardiovascular risk from TRT may be less than once feared. The increased risk of sleep apnea in men using TRT is noteworthy. The study strengths include the large number of healthy and young men exposed to TRT.
Limitations include the retrospective study design inability to account for granular details of TRT use such as dosage, specific forms of TRT and serum testosterone levels pre- and post-TRT.
Cole AP, Hanske J, Jiang W, et al. Impact of testosterone replacement therapy on thromboembolism, heart disease, and obstructive sleep apnea in men. BJU international 2018. Impact of testosterone replacement therapy on thromboembolism, heart disease, and obstructive sleep apnea in men
