Testosterone replacement is increasingly used by older men, particularly in the United States. The Food and Drug Administration has warned of the risk of heart attack and stroke on testosterone, and requested a large randomized controlled trial to assess the cardiovascular effects of testosterone.
To explore whether there is a strong association between testosterone and the development of heart disease, CUNY SPH Professor Mary Schooling led a study using a technique called Mendelian randomization to analyze genetic variants that predict testosterone levels and their associations with blood clots, heart failure and heart attack in almost 400,000 men and women from a large genetic study and the UK Biobank study. The findings were published in the British Medical Journal.
The study found that in men, endogenous testosterone was associated with a higher risk of blood clots and heart failure, but not heart attack. In a validation study, performed to help define the scope or range of conditions under which reliable results may be obtained, endogenous testosterone was associated with a higher risk of heart attack. Associations were less obvious in women.
“Testosterone increasing the risk of cardiovascular disease explains why men have substantially higher rates of these diseases than women,” Schooling said. “In fact, several of the most effective existing means of preventing heart disease and stroke reduce testosterone, such as statins, digoxin and spironolactone. Explicitly, targeting testosterone provides a timely new avenue for preventing ischemic cardiovascular disease at a time when the development of new preventative treatments targeting lipids and inflammation has delivered little despite very substantial investment.”
Shan Luo, Shiu Lun Au Yeung, Jie V Zhao, Stephen Burgess, C Mary Schooling, Association of genetically predicted testosterone with thromboembolism, heart failure, and myocardial infarction…BMJ 2019;364:l476