Testosterone and the Heart, Part Two
by Jeffrey Dach MD
In Part One, we discussed a 2010 study from Boston University in which testosterone was given to immobilized, elderly, obese male smokers. The study was halted early because of poor outcome with increased heart attacks and “cardiac events” in the testosterone treated group. (1) Upper Left Image VA Hospital in Waco Texas, Courtesy of Wikimedia Commons.
Second Study Shows Poor Outcome in Testosterone Group
A second study from the University of Texas was just published in JAMA .(2) This study was done on Veterans undergoing coronary angiography with documented coronary artery disease. Some of these Veterans had low testosterone levels (below 300) . These veterans were given testosterone treatment and followed. At the end of three years of follow up, the untreated men had a 20% incidence of stroke, heart attack or death, while the testosterone treated group had a higher 26% incidence. This is 20% untreated, vs. 26% treated. Clearly, the testosterone did not miraculously reverse the atherosclerosis disease in this group of veterans.(2-6)
Benefits of Testosterone Clearly Documented in Medical Literature
As discussed in part one, decades of research studies have shown that low testosterone in men is a risk factor for early mortality from cardiovascular disease, and testosterone treatment reduces mortality, especially in the diabetic males. (7-10)
Testosterone Treatment Does Not Reverse Heart Disease
However, it is clear from these two studies that testosterone by itself is insufficient as a therapy to reverse coronary artery plaque in men who have diets and lifestyles which promote heart disease, and who already have significant underlying coronary artery disease.
Track Your Plaque Program
For our office patients who are interested in reversing coronary artery plaque, we use the William Davis MD Track Your Plaque Program. This is an excellent program which is well thought out. See my article on this: Reversing Heart Disease.
Left Image logo courtesy of Track Your Plaque Blog.
I wonder what the outcome of these two studies would have been if the testosterone treated group had been started on the Track Your Plaque Program which monitors lipo-protein profile and the Calcium Score, and uses diet and lifestyle modification and supplements to reduce Calcium Score and increase LDL particle size.
There are many unanswered questions. I also wonder what the Vitamin D levels were, and what the thyroid levels were on these men, How much trans fats were they consuming? How much were they smoking and how much alcohol did they consume? How overweight were they?
One conclusion seems clear and that is testosterone by itself does not replace the Track Your Plaque Program of Diet, Lifestyle modification and Supplements to reverse heart disease. As these two studies show, clinical outcomes for Testosterone Treatment may actually be worse for subgroups of men with severe coronary artery disease, especially when no changes are made to the diet and lifestyles that promote heart disease.
This is part two of a series, for Part Three Click Here.
Jeffrey Dach MD
7450 Griffin Road, Suite 180/190
Davie, Florida 33314
Articles With Related Content:
Low Testosterone Diagnosis and Treatment
HCG in Males with Low Testosterone
Testosterone Benefits, PSA and Prostate Part One
Clomid for Men with Low Testosterone Part One
Low Testosterone From Pain Pills
Low Testosterone Associated with Increased Mortality
Testosterone Reduces Mortality
Testosterone Blockade Increases Mortality
Testosterone Found Beneficial For Diabetes
Links and References:
N Engl J Med. 2010 Jul 8;363(2):109-22. Epub 2010 Jun 30.
Adverse events associated with testosterone administration.
Basaria S, Coviello AD, Travison TG, Storer TW, Farwell WR, Jette AM, Eder R, Tennstedt S, Ulloor J, Zhang A, Choong K, Lakshman KM, Mazer NA, Miciek R, Krasnoff J, Elmi A, Knapp PE, Brooks B, Appleman E, Aggarwal S, Bhasin G, Hede-Brierley L, Bhatia A, Collins L, LeBrasseur N, Fiore LD, Bhasin S. Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts 02118, USA.
4) Testosterone treatments linked with heart risks
Veterans With History of Heart Disease Had Higher Risk of Death, Heart Attack and Stroke, According
7) http://www.ncbi.nlm.nih.gov/pubmed/22496507 J Clin Endocrinol Metab. 2012 Jun;97(6):2050-8. doi: 10.1210/jc.2011-2591. Epub 2012 Apr 11. Testosterone treatment and mortality in men with low testosterone levels. Shores MM, Smith NL, Forsberg CW, Anawalt BD, Matsumoto AM.
Source Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, S-116PES, Seattle, Washington 98108, USA.
Endocrine Abstracts (2011) 25 P163
Low testosterone predicts increased mortality and testosterone replacement therapy improves survival in men with type 2 diabetes
Vakkat Muraleedharan1,2, Hazel Marsh1 & Hugh Jones1,2
Eur J Endocrinol. 2013 Oct 21;169(6):725-33. doi: 10.1530/EJE-13-0321. Print 2013.
Testosterone deficiency is associated with increased risk of mortality and testosterone replacement improves survival in men with type 2 diabetes.
Muraleedharan V, Marsh H, Kapoor D, Channer KS, Jones TH.
Source Robert Hague Centre for Diabetes and Endocrinology, Barnsley Hospital NHSFT, Gawber Road, Barnsley S75 2EP, UK.
Jeffrey Dach MD
7450 Griffin Road, Suite 180/190
Davie, Florida 33314
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Bruce Kimzey January 29, 2014 at 8:42 AM
Dear Dr. Dach,
I have a comment about your above article. My comment referrs to the second study in JAMA by Ho which concludes that testosterone is a heart risk for men over 60 with heart trouble.
I read a summary of that study, and while it is true that death was higher at 26% as you say, it was also true (as researcher Dr. Michael Ho affirms below in his Jan 22 email to me) that those deaths were all-cause deaths, not cardiac deaths.
On the other hand, if you read the full article in JAMA the study indicates that those who were using testosterone supplements who did not die, actually had MIs and strokes at only 1/3 the rate that those who had not used supplemental testosterone, indicating considerable cardiovascular benefit from use of testosterone.
This suggests to me a possible statistical anomaly and I found it interesting that this aspect of the study seems to have been ignored, even by you, no offense intended.
@QuintBy on Twitter
From: Ho, Michael
Sent: Wednesday, January 22, 2014 10:42 AM
To: Bruce Kimzey
Subject: RE: [EXTERNAL] Cardiac advantage or disadvantage
The rate of events was for all-cause mortality, myocardial infarction or stroke and it was the time to the first event (any one of those three). We did not know the cause of death for these patients. Hope that helps.
From: Bruce Kimzey
Sent: Tuesday, January 21, 2014 12:50 PM
To: Ho, Michael
Subject: [EXTERNAL] Cardiac advantage or disadvantage
Dear Dr. Ho,
I can see that you gave been building much of your career upon finding answers about the real world effects of medications upon heart patients and as a HF and quintuple bypass patient, I do wish to thank you for that work. There should be more people doing the work that you do.
I confess to not having been able to read your full report regarding the primary events associated with the use of testosterone supplementation, having only just now received a ‘complimentary’ summary of your report from NEJM. However from the information I was given access to,
it appears that while the all-cause mortality rate was 26% vs 21%, the occurrence of MI and stroke in those not undergoing testosterone therapy was somewhere in the neighborhood of 2 ½ -3 times as high. If this is true, I would think that this warrants attention along with the all-cause mortality
Was this abstract mistaken in not identifying the deaths as
being cardiac-related? That of course would put an entirely different gloss upon your results.
Again, thank you!
Jeffrey Dach MD January 29, 2014 at 8:59 AM
Dear Bruce Kimzey,
Thanks very much for your added information which adds to the discussion considerably.
jeffrey dach md
Testosterone Erythrocytosis Thombophilia and Heart Attack - Jeffrey Dach MD February 19, 2014 at 8:42 AM
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