Testosterone Therapy Adds MI Risk, Especially in Older Men — Physician’s First Watch
Testosterone Therapy Adds MI Risk, Especially in Older Men
By Joe Elia
Risk for incident myocardial infarction increases significantly in the months after starting testosterone therapy, particularly among older men, according to a PLoS ONE study.
Using insurance claims data, researchers compared the incidence of nonfatal MI in some 55,000 men in the year before their first prescription for testosterone therapy with the rate in the 90 days after filling that prescription. As a check, they also compared post- and pre-therapy MI rates for a separate cohort of 165,000 men taking drugs for erectile dysfunction.
In the testosterone cohort, the post-/pre-rate ratio for MI was 1.36, increasing to 2.19 in those 65 and older, and to 3.43 in those 75 and older. Younger men with a history of heart disease also showed an increased risk. The cohort taking sildenafil or tadalafil showed no post/pre effect.
The authors note that their study is limited in that they did not have information on the "serologic or diagnostic indications" for therapy. Nonetheless, they advise clinicians to include serious cardiovascular risks in their discussions with patients when prescribing testosterone.