OR21-2 Lipid Profiles Improve in Men With Hypogonadism and Pre-existing Cardiovascular Disease Under Long-term Testosterone Therapy (TTh) With Testosterone Undecanoate Injections (TU): 10-year Data From a Controlled Registry Study in a Urological Setting

Abstract

Background: Effects of testosterone on lipid patterns are inconsistent. While in short-term studies, testosterone usually lowers HDL, long-term studies seem to increase HDL. Total cholesterol, LDL and triglycerides are either reduced by TTh, or effects are neutral. Effects of TTh on lipids may depend on treatment duration. Material and Methods: In a registry study of 805 men with hypogonadism in a urological office, 194 194 had a pre-existing cardiovascular disease, defined as previous myocardial infarction (MI), stroke, or diagnosis of coronary heart disease (CHD). 78 men received parenteral TU 1000 mg/12 weeks following an initial 6-week interval (T-group) for up to 10 years, 116 men decided against TTh and served as controls (CTRL). Most measurements were performed 1-4 times a year for approximately 1,500 patient-years. 10-year data are reported. Mean changes over time between groups were compared by mixed effects model for repeated measures with random effect for intercept and fixed effects for time, group and their interaction and adjusted for age, weight, waist circumference, fasting glucose, blood pressure and lipids to account for baseline differences between groups. Results: Mean baseline age: 61.3±4.7 years (T-group), 63.8±5 (CTRL) (p<0.001). Mean (median) follow-up was 8.6±2.5 (10) years in the T-group and 7.0±2.6 (7) years in CTRL. Total cholesterol (mmol/L) decreased by 2.6±0.1 in the T-group and increased by 1.2±0.1 in CTRL, estimated adjusted difference between groups: 3.8 (p<0.0001 for all). HDL (mmol/L) increased by 0.4±0.0 in the T-group and decreased by 0.2±0.0 in CTRL, estimated adjusted difference between groups: 0.6 (p<0.0001 for all). LDL (mmol/L) decreased by 1.9±0.1 in the T-group and increased by 0.8±0.1 in CTRL, estimated adjusted difference between groups: 2.8 (p<0.0001 for all). Triglycerides (mmol/L) decreased by 1.1±0.1 in the T-group and increased by 0.4±0.1 in CTRL, estimated adjusted difference between groups: 1.5 (p<0.0001 for all). Non-HDL (mmol/L) decreased by 4.2±0.3 in the T-group and increased by 3.8±0.3 in CTRL, estimated adjusted difference between groups: 7.9 (p<0.0001 for all). Remnant cholesterol (mmol/L) decreased by 1.1±0.1 in the T-group and increased by 0.6±0.1 in CTRL, estimated adjusted difference between groups: 1.7 (p<0.0001 for all). Outcomes T-group: 8 deaths (10.3%). 1 deaths was a traffic accident, 7 were due to surgery (sepsis or thromboembolism). Outcomes CTRL: 39 deaths (33.6%), all cardiovascular, 26 non-fatal myocardial infarctions (22.4%), and 27 non-fatal strokes (23.3%). Medication adherence to testosterone was 100% as all injections were administered in the medical office and documented. Conclusion: In men with hypogonadism and pre-existing cardiovascular disease, long-term TTh improves the lipid profile which may be a contributing factor to the observed reduction in cardiovascular events and mortality.