Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men

4 min

Background

Dramatic increases in the use of testosterone therapy (TT) in both older and younger men have been reported recently.

There have also been several recent studies suggesting an association between TT and cardiovascular disease including a clinical trial in old frail men that was stopped due to adverse cardiovascular events, and an observational study of men in a Veteran’s healthcare system in the USA that showed as association between TT a combined outcome measure of overall mortality, MI and stroke. 

Aim

The authors used a large healthcare database in the USA to investigate the question of whether TT increases the risk of acute non-fatal myocardial infarction (MI), and whether any effect might be stronger in those with pre-existing cardiac disease.

The study also investigate the associations in younger as well as older men.

Methods

55,593 men in a large health-care database were included in the cohort with data from 2006 – 2010. The outcome of acute non-fatal MI was assessed following an initial TT prescription.

The incidence rate of MI in the 90 days following the initial prescription (post-prescription interval) was compared with the rate in the one year prior to the initial prescription (pre-prescription interval) (post/pre).

A comparison group of 167,279 men prescribed phosphodiesterase type 5 inhibitors (PDE5i; sildenafil or tadalafil) was assessed in a similar manner. TT prescription post/pre rates were also compared with the PDE5I post/pre rates, adjusting for potential confounders using doubly robust estimation.

Men with a history of MI prior to the first prescription of TT or PDE5i were excluded from the analysis. A large number of covariates were considered including co-morbidities, prescription medications and age.

Results

In all subjects, the TT post/pre-prescription rate ratio (RR) for MI was 1.36 (95% CI: 1.03, 1.81).

In men aged 65 years and older, the RR was 2.19 (1.27, 3.77) for TT prescription and 1.15 (0.83, 1.59) for PDE5i, and the ratio of the rate ratios (RRR) for TT prescription relative to PDE5i was 1.90 (1.04, 3.49).

The RR for TT prescription increased with age from 0.95 (0.54, 1.67) for men under age 55 years to 3.43 (1.54, 7.56) for those aged ≥75 years (ptrend = 0.03), while no trend was seen for PDE5i (ptrend = 0.18).

In men under age 65 years, excess risk was confined to those with a prior history of heart disease, with RRs of 2.90 (1.49, 5.62) for TT prescription and 1.40 (0.91, 2.14) for PDE5i, and a RRR of 2.07 (1.05, 4.11).

Conclusion

This study demonstrated an increased risk of MI following initiation of TT prescription in older men (≥ 65 years old), and in younger men (< 65 years) with pre-existing diagnosed heart disease.

Given the recent trends in T prescribing these data, in addition to other recent studies, underline the need for adequately powered clinical trials to fully assess the benefits and risks of TT.

More for health practitioners

We offer a range of evidence-based resources for health practitioners to develop their understanding of male health.


Did you find this page helpful?

Information provided on this website is not a substitute for medical advice

Call 000 for emergency services

If you or someone you know needs urgent medical attention.

Call MensLine Australia on 1300 78 99 78 for 24/7 support

MensLine Australia is a telephone and online counselling service for men with emotional health and relationship concerns.

Sign up to our newsletter

We release two monthly newsletters – one written for men, family and friends, and another for health practitioners.

Your preferred mailing list

Your name

Your email

Stay up to date

FacebookInstagramLinkedinTwitterYoutubespotifytiktok

Healthy Male acknowledges the traditional owners of the land. We pay our respects to elders past, present and future. We are committed to providing respectful, inclusive services and work environments where all individuals feel accepted, safe, affirmed and celebrated. Aboriginal and Torres Strait Islander people should be aware that this website may contain images, voices and names of deceased persons.

Disclaimer

Healthy Male is funded by the Australian Government Department of Health and Aged Care. This website does not host any form of advertisement. Information provided on this website is not a substitute for medical advice.

Trusted information partner of