Abstract 19261: The Association Between Testosterone Replacement Therapy and Adverse Cardiovascular Outcomes in Veterans Undergoing Coronary Angiography

Abstract

Background: Adverse cardiac events were not demonstrated in randomized controlled trials of testosterone replacement therapy (TRT) in men until 2009 when the Testosterone in Older Men with Mobility Limitations trial was halted due to increased cardiac events in the treatment group. Therefore, the safety of TRT in older men with medical comorbidities is under debate. Methods: We used the VA CART-CL registry to identify all veterans undergoing coronary angiography between 2005 and 2011 who had total testosterone levels ≤ 250 ng/dL measured post-procedure. We derived a propensity-matched (2:1) cohort of patients dispensed TRT to patients not dispensed TRT. Multivariable Cox regression assessed the association between TRT and myocardial infarction (MI) or death treating TRT as a time varying covariate. We also evaluated this association within strata of CAD: no CAD, nonobstructive CAD (>20% stenosis in any vessel), and obstructive CAD (≥ 70% in any vessel or ≥ 50% in the left main). Results: Of the 3,375 veterans who had a total testosterone level ≤ 250, 461 (12%) were initiated on TRT after a mean of 546 days (median 463 days) after coronary angiography. No significant differences were observed in the baseline characteristics of the TRT and non-TRT propensity matched groups including mean age (61), hypertension (89%), diabetes (55%), and mean testosterone level (166). In multivariable analyses, there was a significant interaction between TRT and CAD strata (p=0.04). Among veterans with no CAD or nonobstructive CAD, there was no association between TRT and MI/death (p=0.46 and p=0.3, respectively). Among those with obstructive CAD, TRT was associated with significantly increased risk of MI/death (HR 2.51; 95% CI 1.6 - 3.94). Conclusion: In this cohort of veterans undergoing coronary angiography with low testosterone levels, TRT can be associated with increased risk of MI/death as compared to no TRT. This risk appears to be present in patients with obstructive CAD but not among patients with less severe CAD. These findings may have potential implications for targeting testosterone use among selected patient populations.