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Ageing men on TRT suffer from greater cardiovascular risk

21 Oct 2019
Looking into 2018, Singapore has a few plans in mind to improve healthcare for the public, especially the elderly.

Testosterone replacement therapy (TRT) may come with an increased risk of cardiovascular events in ageing men with low testosterone levels, a new study has found.

Accessing the UK Clinical Practice Research Datalink, researchers investigated the role of TRT on clinical outcomes in 15,041 men (mean age, 60.4±9.6 years) with low testosterone levels and no evidence of hypogonadotropic or testicular disease. The primary outcome was a composite between ischaemic stroke/transient ischaemic attacks and myocardial infarction.

TRT was prescribed to 4,485 men on at least one occasion, most of whom used testosterone gels/creams (56.8 percent); 33.6 percent received TRT via injections.

Over 71,541 person-years of follow-up, 850 cases of the composite outcome were reported, resulting in a crude incidence rate of 1.19 (95 percent CI, 1.11–1.27) per 100 persons per year. Current TRT use increased the risk of the primary outcome by 21 percent (hazard ratio [HR], 1.21, 1.00–1.46).

In absolute terms, TRT use would account for an adjusted risk difference of 2.4 events per 1,000 persons per year.

Stratified analysis found that this risk peaked in the first 6 months to 2 years of continuous TRT use (HR, 1.35, 1.01–1.79) but tapered thereafter. The effect was also strongest among those aged 45–59 years (HR, 1.44, 1.07–1.92).

Notably, current use significantly reduced the risk of all-cause mortality (HR, 0.64, 0.52–0.78) relative to nonuse of TRT, while past use had the opposite effect (HR, 1.72, 1.21–2.45).

The principal results were robust to sensitivity analyses and remained consistent even after disaggregation according to TRT formulation.

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Most Read Articles
Pearl Toh, 31 Dec 2019
Adding the neuraminidase inhibitor oseltamivir to usual care speeds up recovery from influenza-like illness by a day compared with usual care alone, with even greater benefits seen in older, sicker patients with comorbidities, according to the ALIC4E study.
23 Dec 2019
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6 days ago
Testosterone treatment may slightly improve sexual functioning and quality of life in men without underlying organic causes of hypogonadism, but it offers little to no benefit for other common symptoms of ageing, according to a study. In addition, long-term efficacy and safety of this therapy remain unknown.
11 Jan 2020
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