Association between testosterone replacement therapy and cardiovascular outcomes: A meta-analysis of 30 randomized controlled trials

• Published in: Progress in cardiovascular diseases Vol. 85; pp. 45 - 53
• Main Authors: Jaiswal, Vikash, Sawhney, Aanchal, Nebuwa, Chikodili, Borra, Vamsikalyan, Deb, Novonil, Halder, Anupam, Rajak, Kripa, Jha, Mayank, Wajid, Zarghoona, Thachil, Rosy, Bandyopadhyay, Dhrubajyoti, Mattumpuram, Jishanth, Lavie, Carl J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2024
• Subjects: Cardiovascular disease; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - mortality; Heart Disease Risk Factors; Hormone Replacement Therapy - adverse effects; Humans; Hypogonadism - drug therapy; Hypogonadism - epidemiology; Incidence; Male; Middle Aged; Mortality; Myocardial infarction; Randomized Controlled Trials as Topic; Risk Assessment; Testosterone - adverse effects; Testosterone - therapeutic use; Testosterone therapy; Time Factors; Treatment Outcome; Myocardial infarction; RR; FDA; RCT; OR; Mortality; CI; Cardiovascular disease; HR; CVD; TD; CV; PE; TRT; Testosterone therapy; TRAVERSE; MI; TEAAM; AKI; BMI
• ISSN: 0033-0620; 1873-1740
• DOI: 10.1016/j.pcad.2024.04.001

The Cardiovascular safety of testosterone replacement therapy (TRT) among men with hypogonadism is not well established to date. Hence, we sought to evaluate the cardiovascular disease (CVD) outcomes among patients receiving testosterone therapy by using all recently published randomized controlled trials.
We performed a systematic literature search on PubMed, EMBASE, and Clinicaltrial.gov for relevant randomized controlled trials (RCTs) from inception until September 30th, 2023.
A total of 30 randomized trials with 11,502 patients were included in the final analysis. The mean age was ranging from 61.61 to 61.82 years. Pooled analysis of primary and secondary outcomes showed that the incidence of any CVD events (OR, 1.12 (95%CI: 0.77–1.62), P = 0.55), stroke (OR, 1.01 (95%CI: 0.68–1.51), P = 0.94), myocardial infarction (OR, 1.05 (95%CI: 0.76–1.45), P = 0.77), all-cause mortality (OR, 0.94 (95%CI: 0.76–1.17), P = 0.57), and CVD mortality (OR, 0.87 (95%CI: 0.65–1.15), P = 0.31) was comparable between TRT and placebo groups.
Our analysis indicates that for patients with hypogonadism, testosterone replacement therapy does not increase the CVD risk and all-cause mortality.
Central illustration highlighting effect of Testosterone therapy on cardiovascular outcomes among hypogonadism patients. [Display omitted]