Another Study Suggests Excess Cardiovascular Risk with Testosterone

In a recent observational U.S. study, testosterone therapy was associated with excess cardiovascular risk in older men with risk factors (NEJM JW Gen Med Nov 19 2013). In this new study, NIH-supported researchers examined the same issue, using a large database with information from employer-sponsored insurance plans.

Nearly 56,000 men received new prescriptions for testosterone. Their annualized rate of myocardial infarction (MI) during the 3 months after initiating testosterone therapy was significantly higher (by 36%) than the rate during the previous year. In contrast, MI rates were not significantly different before and after initiation of phosphodiesterase type 5 (PDE5) inhibitors (sildenafil and tadalafil [Cialis]) prescribed for erectile dysfunction.

Next, the testosterone and PDE5 cohorts were compared after extensive adjustment for baseline differences. In younger patients (age, <65) without MI histories, testosterone use (compared with PDE5 use) was not associated with excess MI risk. However, in younger patients with previous MIs, and in older patients (regardless of MI history), testosterone use was associated with roughly twice the risk for MI, compared with PDE5 use.