Testosterone Therapy and MI: New Study on Risk in New, Current Users

While previous research has suggested an association between testosterone replacement therapy (TRT) and an increased risk of cardiovascular-related events, other studies have yielded conflicting results. A study in the journal Pharmacotherapy reviewed patient data in the IMS LikeLink database for new-onset acute myocardial infarction (MI) in men ages 45–80 who had filled at least one prescription for TRT before the date of the first MI (index date). Current users were men whose last TRT prescription was within 90 days before the index date and past users were those whose last TRT prescription was from 91–364 days before the index date.

Of the 30,066 cases with MI and 120,264 corresponding controls, current or past use of TRT was not associated with an increased risk of MI, although current first-time users (men who received their first TRT prescription in the 90 day window) had a 41% increase in MI risk (absolute risk was small with an overall large number needed to harm of 305). In men with a previous history of coronary artery disease, the TRT incident rate ratios (RRs) for any current use and first-time use were 1.05 (95% CI 0.79–1.41) and 1.78 (95% CI 0.93–3.40), respectively. The RRs for first-time users of topical gels was 1.49 (95% CI 1.02–3.40) and was statistically significant.

Even with these findings, clinicians may wish to advise all new TRT users to weigh the benefits of therapy against a small potential increase in the risk of MI and to recommend ways of reducing other risk factors for MI that may be present. This is particularly recommended for new TRT patients using topical gels.

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