番茄社区

BOSTON -- Men with hypogonadism on long-term testosterone therapy had improved cardiovascular health, according to researchers here.

According to the 10-year outcomes of hypogonadal men, fewer men experienced death from a major adverse cardiovascular events (MACE) while on testosterone undecanoate treatment compared with hypogonadal men who weren't on testosterone treatment (4% vs 21.7%), reported Farid Saad, PhD, of Bayer Pharma AG in Berlin, and colleagues, in a presentation at the American Association of Clinical Endocrinologists (AACE) annual meeting.

Other cardiovascular-related factors also improved among men on long-term testosterone treatment versus who weren't (P<0.0001 for all between-group differences):

• Systolic blood pressure (BP): 154.1 to 131.1 mmHg for testosterone group vs 146.4 to 149.4 mmHg for controls
• Diastolic BP: 91.6 to 77.6 mmHg vs 83.9 to 87.5 mmHg
• Heart rate: 77.8 to 76.1 bpm vs 76.7 to 78 mmHg
• Pulse pressure: 62.5 to 53.5 mmHg vs unchanged at 62.5 mmHg
• Rate pressure product: 11999 to 9967 mmHg*bpm vs 11230 to 11684 mmHg*bpm

"These findings were independent of anti-hypertensive medication that patients had also been prescribed by their family physicians," Saad told 番茄社区.

Co-author Ahmad Haider, MD, a urology and andrology specialist in Bremerhaven, Germany, initiated this study back in 2004 when 3-monthly testosterone injections become available, said Saad.

"At that time, urologists took an interest in the metabolic syndrome because there was a lot of research conducted with PDE5 inhibitors in erectile dysfunction, and all these studies reported that metabolic syndrome and its individual components, as well as hypogonadism, were closely associated with erectile dysfunction," he stated. At that time, their group decided to start a registry to more closely assess the long-term safety of testosterone injection on metabolic syndrome parameters.

The analysis included a total of 805 men with hypogonadism, defined a a total testosterone of ≤350 ng/dL. Of this group, 676 had clinically defined hypertension or a BP reading of 130/85 mmHg or higher. A total of 376 of these hypogonadal men with hypertension then elected to receive the 3-monthly testosterone undecanoate injections, while 300 men opted against testosterone therapy, and served as the study's controls.

These findings build upon previous 4-year data the group presented at ENDO 2012, which found long-term testosterone replacement therapy aided in a significant weight loss in hypogonadal men with obesity.

Saad stated current BP findings weren't particularly surprised because these patients continued to show a "robust weight loss of approximately 20%" which contributed to normalizing BP.

"It is also known that testosterone is a vasodilator and has anti-inflammatory and anti-atherosclerotic effects. Some studies have shown that it reduces intima media thickness, and all these effects contribute to reducing blood pressure," he said.

Saad underscored the importance of healthcare providers approaching hypogonadism as a chronic disease that requires lifelong treatment. He added that much of the literature assessing heatlhcare insurance data in the U.S. suggests that most patients take their testosterone medication for less than a year.

"That may temporarily take care of their initial complaints -- loss of libido and energy, erectile dysfunction -- but these patients will never experience the long-term metabolic effects of testosterone therapy," he said. "Two things are of utmost importance: achieving adequate testosterone levels at least in the mid-range of the normal range, and adherence to treatment. Not all preparations may be ideal for achieving these goals. If these two things are achieved, however, testosterone therapy can be one of the most beneficial treatments for men in whom this treatment is indicated."

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