Testosterone for secondary prevention in men with ischaemic heart disease?

Abstract

Atherosclerotic coronary artery disease (CAD) is a leading cause of mortality and morbidity in the western world. It is a chronic progressive condition, and treatment is required indefinitely. Men are more than twice as likely as women to develop CAD:1 this ratio is consistent in all populations and is not related to differences in risk factors. Pre-menopausal females have a lower incidence of CAD, but this rises after the menopause, so that the risk of CAD rapidly approaches that of males after about 10 years. One explanation for these epidemiological observations is that female hormones protect against the development of CAD. Observational studies of hormone replacement therapies in women have suggested some benefit,2 but large randomized controlled trials have failed to show protective effects.3,,4 Little attention has been paid to the role of testosterone in the pathogenesis of CAD. Males do not have a menopause equivalent, but sex hormones do fall with advancing age.5,,6 The more elderly population, in which the prevalence of CAD is highest, has relatively low testosterone levels. Furthermore, males with CAD have lower testosterone levels than men with normal coronary angiograms males of the same age.7 Moreover, there is evidence that testosterone therapy delays the onset of cardiac ischaemia,8 probably as a consequence of a coronary vasodilator mechanism,8 improving the symptom of angina.8,,10 The ability of testosterone replacement therapy to alter disease progression to reduce events or mortality has not been examined. In this article, we review the effects of testosterone therapy on factors known to influence cardiovascular risk, and propose a justification for further studies into its use for males with coronary disease as secondary prevention. Testosterone has well-established functions in the adult male. It induces secondary sexual characteristics, and is …