(302) Changes In Hematocrit Predict More Frequent Major Adverse Cardiac Events In Men Receiving Testosterone Therapy - A Large Claims Database Analysis

Abstract

Abstract Introduction Elevated hematocrit (Hct > 52%) in men receiving testosterone therapy (TTh) has been associated with major adverse cardiac events (MACE), but it remains unclear if the degree of change from baseline Hct after starting TTh confers additional MACE risk. Objective The objective of this study is to assess if greater changes in Hct after initiation of TTh for men is associated with greater risk of MACE. Methods We compared the occurrence of MACE within 3 and 24 months of initiating TTh in men who did and did not experience an increase in Hct after TTh initiation. We queried the TriNetX Research network database, a health research network of 88 million patients, encompassing healthcare encounters and prescriptions between 2009-2021. Men without unstable angina or heart failure over age 18 were included if their Hct was tested within 1 year prior to initiating TTh and had follow up Hct within 3 and 24 months after beginning TTh. Men with and without increase in Hct after TTh were propensity matched on age, race/ethnicity, hypertension, diabetes, hyperlipidemia, prior myocardial infarction or stroke, and number of hospital/outpatient visits. MACE were defined as myocardial infarction (ICD-10: I21-22), stroke (I60-63), or death. Results A total of 11,561 men with an increase in Hct and an equal number of controls were included (average age 49.4 years). When compared to men who received TTh who did not have an increase in Hct, the majority of men with an increase in subsequent Hct a statistically significant increase risk of MACE (Table 1). For example, men with baseline Hct of 44-47% and saw a subsequent increase of Hct to 48-51% were twice as likely to experience MACE (Risk Ratio: 2.07, 95% Confidence Interval 1.13-2.43) when compared to men whose baseline and subsequent Hct was 44-47% after TTh. As the change in Hct from baseline becomes larger, the magnitude of the risk ratio increased. Conclusions While absolute Hct is associated with increased risk of MACE after initiating TTh, we demonstrate that increases in Hct from baseline are associated with dose-dependent increased risk of MACE, compared to men with minimal changes to Hct who receive TTh. Disclosure No