Cardiovascular risk and testosterone - from subclinical atherosclerosis to lipoprotein function to heart failure

Area of Science:

• Endocrinology
• Cardiovascular Medicine
• Men's Health

Background:

• Cardiovascular (CV) risks associated with low testosterone are debated.
• Previous testosterone replacement therapy (TRT) studies excluded high-CV-risk patients.
• TRT's impact on atherosclerosis and CV events requires further investigation.

Purpose of the Study:

• To review the cardiovascular benefit and safety of TRT.
• To evaluate testosterone's impact on atherosclerosis markers.
• To inform clinical decisions regarding TRT in men with CV disease.

Main Methods:

• Comprehensive review of observational, interventional, and prospective studies.
• Analysis of testosterone's effects on lipoprotein functionality, inflammation, and coagulation.
• Evaluation of TRT's impact on atherosclerosis progression (e.g., carotid intima-media thickness, plaque volume, vascular calcification).

Main Results:

• Testosterone deficiency is linked to increased major adverse CV events.
• TRT's effects on atherosclerosis markers (lipoproteins, inflammation, coagulation) are complex.
• Limited data exists on TRT's CV safety in high-risk populations.

Conclusions:

• Clinicians should carefully consider TRT for men with atherosclerotic cardiovascular disease.
• Discuss potential benefits and harms of TRT with patients.
• Awaiting results from large-scale trials like TRAVERSE for definitive guidance.