MI risk not increased in older men receiving testosterone therapy

Baillargeon

Older men treated with intramuscular testosterone did not appear to have an increased risk of myocardial infarction (MI). For men with high MI risk, testosterone use was modestly protective against MI, according to a study published in Annals of Pharmacotherapy.

Jacques Baillargeon, PhD, director, epidemiology division, associate professor, department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas, and colleagues found that use of testosterone therapy was not associated with an increased risk of MI (HR=0.84, 95% CI, 0.69-1.02).

For men in the highest quartile of the MI prognostic score, testosterone therapy was associated with a reduced risk of MI (HR=0.69, 95% CI, 0.53-0.92). 

The researchers used a 5% national sample of Medicare beneficiaries to identify 6,355 patients treated with at least 1 injection of testosterone between January 1, 1997 and December 31, 2005. They matched this cohort to 19,065 testosterone nonusers at a 1:3 ratio based on a composite MI prognostic index score. Patients were followed until December 31, 2005, or until they lost coverage from Medicare, enrolled in a health maintenance organization, experienced a myocardial infarction, or died.

A dose-response analysis demonstrated no increased risk in MI according to estimated cumulative dose of testosterone, according to the authors. 

“These findings were robust across a range of sensitivity analyses that addressed eligibility criteria, exposure thresholds, follow-up periods, and covariate adjustment,” Baillargeon said. “We believe this is a methodologically rigorous study and should be thoughtfully weighed, critiqued and discussed alongside the other studies of testosterone therapy and cardiovascular outcomes.”  

The study was motivated by a growing concern, in the United States and internationally, that testosterone therapy increases men’s risk for cardiovascular disease, specifically heart attack and stroke.

“Although recent observational studies have reported an increased risk of cardiovascular disease associated with testosterone use, there is a large body of evidence that is consistent with our finding of no increased risk of heart attack associated with testosterone use,” Baillargeon said.  “Also, there are cardiovascular risks associated with untreated hyponadism. So those should be factored in to the risk-benefit assessment.”