睾酮缺乏症和心血管疾病死亡率.pdf

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睾酮缺乏症和心血管疾病死亡率.pdf

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睾酮缺乏症和心血管疾病死亡率

AsianJournalofAndrology(2015)17．26-31 @ 2015AJA．SIMM ＆SJTU Allrightsreserved1008—682X 星昌wwwa羹siaandrocom；wwwajandrologY．com OpenAccess INVITEDREVIEW TestosteronedeficiencyandCardiOVaSCUlarmortality Abraham Morgentaler NewconcernshavebeenraisedregardingcardiOvascular(CV)riskswithtestosterone(T)therapy(TTh)．Theseconcernsarebased primarilyontwowidelyreportedretrospectivestudies．However．methodologicaIflawsanddataerrorsinvalidatebothstudiesas credibleevidenceofrisk．OneshowedreducedadverseeventsbyhalfinT-treatedmenbutreversedthisresultusinganunproven statisticaIapproach．Theauthorssubsequently acknowledged seriousdataerrors includingnearly 10％ contaminationofthe datasetbywomen．ThesecondstudymistakenlyusedtherateofTprescriptionswrittenbyhealthcareproviderstomenwithrecent myocardiaIinfarction(M1)asaproxyforthenaturallyoccurringrateofM1．NumerousstudiessuggestTisbeneficial。including decreasedmortalityinassociationwithTTh．reducedMIratewithTThinmenwiththegreatestMlriskprognosis。andreducedCV andoverallmortalitywithhigherserum levelsofendogenous RandomizedcontrolledtrialshavedemonstratedbenefitsofTTh inmenwithcoronaryarterydiseaseandcongestiveheartfailure．ImprovementinCVriskfactorssuchasfatmassandglycemic controlhavebeenrepeatedlydemonstratedinT-deficientmentreatedwithT．Thecurrentevidencedoesnotsupportthebeliefthat TThisassociatedwithincreasedCVriskorCVmortality．Onthecontrary,awealthofevidenceaccumulatedoverseveraldecades suggeststhatlowserum TIevelsareassociatedwithincreasedriskandthathigherendogenousT-aswelIasTThitself。appearto bebeneficialforCVmortalityandrisk． AsianJourna／ofAndrology(2015)17，26_31-1doj：10．4103／1008—682X．143248；publishedonIine：18November2014 Keywords．cardiOvascular：mortality；myocardialinfarction：risk；stroke；testosterone lNTR0DUCT10N men．Themajoriytofthosestudieshaveshownasignificnatassociation Astheuseoft