Relation of Testosterone Normalization to Mortality and Myocardial Infarction in Men With Previous Myocardial Infarction 2019

The effect of normalization of serum testosterone levels with testosterone replacement therapy (TRT) in patients with a prior history of myocardial infarction (MI) is unknown. The objective of this study was to determine the incidence of recurrent MI and all-cause mortality in subjects with a history of MI and low total testosterone (TT) with and without TRT. We retrospectively examined 1470 males with documented low TT levels and prior MI, categorized into Gp1: TRT with normalization of TT levels (N=755) Gp2: TRT without normalization of TT levels (N=542), and Gp3: no TRT (N=173). The association of TRT with all-cause mortality and recurrent MI was compared using propensity score-weighted Cox proportional hazard models. All-cause mortality was lower in Gp1 vs. Gp2 (HR 0.76, CI 0.64–0.90, P=0.002), and Gp1 vs Gp3 (HR 0.76, CI 0.60–0.98, P=0.031). There was no significant difference in the risk of death between Gp2 vs. Gp3 (HR: 0.97, CI 0.76–1.24, P=0.81). Adjusted regression analyses showed no significant differences in the risk of recurrent MI between groups (Gp1 vs. Gp3, HR 0.79, CI 0.12–5.27, P=0.8; Gp1 vs. Gp2 HR 1.10, CI 0.25–4.77, P=0.90; Gp2 vs. Gp3 HR 0.58, CI 0.08– 4.06, P=0.58). In conclusion, in a large observational cohort of male veterans with prior MI, normalization of TT levels with TRT was associated with decreased all-cause mortality compared to those with non-normalized TT levels and the untreated group. Furthermore, in this high-risk population, TRT was not associated with an increased risk of recurrent MI.

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