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Green DJ, Chasland LC, Yeap BB, Naylor LH. Comparing the Impacts of Testosterone and Exercise on Lean Body Mass, Strength and Aerobic Fitness in Aging Men. SPORTS MEDICINE - OPEN 2024; 10:30. [PMID: 38563849 PMCID: PMC10987448 DOI: 10.1186/s40798-024-00703-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Based on the largely untested premise that it is a restorative hormone that may reverse the detrimental impacts of aging, prescription of testosterone (T) has increased in recent decades despite no new clinical indications. It is apparent that middle-aged and older men with low-normal serum T levels are considering T supplementation as an anti-aging strategy. At the same time, there is evidence that physical activity (PA) is at historical lows in the Western world. In this review, we compare the impacts of T treatment aimed at achieving physiological T concentrations in middle-aged and older men, alongside the impacts of ecologically relevant forms of exercise training. The independent, and possible combined, effects of T and exercise therapy on physiological outcomes such as aerobic fitness, body composition and muscular strength are addressed. MAIN BODY Our findings suggest that both T treatment and exercise improve lean body mass in healthy older men. If improvement in lean body mass is the primary aim, then T treatment could be considered, and the combination of T and exercise may be more beneficial than either in isolation. In terms of muscle strength in older age, an exercise program is likely to be more beneficial than T treatment (where the dose is aimed at achieving physiological concentrations), and the addition of such T treatment does not provide further benefit beyond that of exercise alone. For aerobic fitness, T at doses aimed at achieving physiological concentrations has relatively modest impacts, particularly in comparison to exercise training, and there is limited evidence as to additive effects. Whilst higher doses of T, particularly by intramuscular injection, may have larger impacts on lean body mass and strength, this must be balanced against potential risks. CONCLUSION Knowing the impacts of T treatment and exercise on variables such as body composition, strength and aerobic fitness extends our understanding of the relative benefits of physiological and pharmacological interventions in aging men. Our review suggests that T has impacts on strength, body composition and aerobic fitness outcomes that are dependent upon dose, route of administration, and formulation. T treatment aimed at achieving physiological T concentrations in middle-aged and older men can improve lean body mass, whilst exercise training enhances lean body mass, aerobic fitness and strength. Men who are physically able to exercise safely should be encouraged to do so, not only in terms of building lean body mass, strength and aerobic fitness, but for the myriad health benefits that exercise training confers.
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Affiliation(s)
- Daniel J Green
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, WA, 6009, Australia.
| | - Lauren C Chasland
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, WA, 6009, Australia
- Allied Health Department, Fiona Stanley Hospital, Perth, WA, Australia
| | - Bu B Yeap
- Medical School, University of Western Australia, Perth, WA, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia
| | - Louise H Naylor
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, WA, 6009, Australia
- Allied Health Department, Fiona Stanley Hospital, Perth, WA, Australia
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2
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Rutledge CA. Molecular mechanisms underlying sarcopenia in heart failure. THE JOURNAL OF CARDIOVASCULAR AGING 2024; 4:7. [PMID: 38455513 PMCID: PMC10919908 DOI: 10.20517/jca.2023.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
The loss of skeletal muscle, also known as sarcopenia, is an aging-associated muscle disorder that is disproportionately present in heart failure (HF) patients. HF patients with sarcopenia have poor outcomes compared to the overall HF patient population. The prevalence of sarcopenia in HF is only expected to grow as the global population ages, and novel treatment strategies are needed to improve outcomes in this cohort. Multiple mechanistic pathways have emerged that may explain the increased prevalence of sarcopenia in the HF population, and a better understanding of these pathways may lead to the development of therapies to prevent muscle loss. This review article aims to explore the molecular mechanisms linking sarcopenia and HF, and to discuss treatment strategies aimed at addressing such molecular signals.
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Affiliation(s)
- Cody A. Rutledge
- Acute Medicine Section, Division of Medicine, Louis Stokes Cleveland Veteran Affairs Medical Center, Cleveland, OH 44106, USA
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
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3
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Henrot P, Blervaque L, Dupin I, Zysman M, Esteves P, Gouzi F, Hayot M, Pomiès P, Berger P. Cellular interplay in skeletal muscle regeneration and wasting: insights from animal models. J Cachexia Sarcopenia Muscle 2023; 14:745-757. [PMID: 36811134 PMCID: PMC10067506 DOI: 10.1002/jcsm.13103] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/24/2022] [Accepted: 09/02/2022] [Indexed: 02/24/2023] Open
Abstract
Skeletal muscle wasting, whether related to physiological ageing, muscle disuse or to an underlying chronic disease, is a key determinant to quality of life and mortality. However, cellular basis responsible for increased catabolism in myocytes often remains unclear. Although myocytes represent the vast majority of skeletal muscle cellular population, they are surrounded by numerous cells with various functions. Animal models, mostly rodents, can help to decipher the mechanisms behind this highly dynamic process, by allowing access to every muscle as well as time-course studies. Satellite cells (SCs) play a crucial role in muscle regeneration, within a niche also composed of fibroblasts and vascular and immune cells. Their proliferation and differentiation is altered in several models of muscle wasting such as cancer, chronic kidney disease or chronic obstructive pulmonary disease (COPD). Fibro-adipogenic progenitor cells are also responsible for functional muscle growth and repair and are associated in disease to muscle fibrosis such as in chronic kidney disease. Other cells have recently proven to have direct myogenic potential, such as pericytes. Outside their role in angiogenesis, endothelial cells and pericytes also participate to healthy muscle homoeostasis by promoting SC pool maintenance (so-called myogenesis-angiogenesis coupling). Their role in chronic diseases muscle wasting has been less studied. Immune cells are pivotal for muscle repair after injury: Macrophages undergo a transition from the M1 to the M2 state along with the transition between the inflammatory and resolutive phase of muscle repair. T regulatory lymphocytes promote and regulate this transition and are also able to activate SC proliferation and differentiation. Neural cells such as terminal Schwann cells, motor neurons and kranocytes are notably implicated in age-related sarcopenia. Last, newly identified cells in skeletal muscle, such as telocytes or interstitial tenocytes could play a role in tissular homoeostasis. We also put a special focus on cellular alterations occurring in COPD, a chronic and highly prevalent respiratory disease mainly linked to tobacco smoke exposure, where muscle wasting is strongly associated with increased mortality, and discuss the pros and cons of animal models versus human studies in this context. Finally, we discuss resident cells metabolism and present future promising leads for research, including the use of muscle organoids.
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Affiliation(s)
- Pauline Henrot
- Centre de Recherche Cardio-thoracique de Bordeaux, Univ-Bordeaux, Pessac, France.,Centre de Recherche Cardio-thoracique de Bordeaux, INSERM, Pessac, France.,CHU de Bordeaux, Service d'exploration fonctionnelle respiratoire, Pessac, France
| | - Léo Blervaque
- PhyMedExp, INSERM-CNRS-Montpellier University, Montpellier, France
| | - Isabelle Dupin
- Centre de Recherche Cardio-thoracique de Bordeaux, Univ-Bordeaux, Pessac, France.,Centre de Recherche Cardio-thoracique de Bordeaux, INSERM, Pessac, France
| | - Maéva Zysman
- Centre de Recherche Cardio-thoracique de Bordeaux, Univ-Bordeaux, Pessac, France.,Centre de Recherche Cardio-thoracique de Bordeaux, INSERM, Pessac, France.,CHU de Bordeaux, Service d'exploration fonctionnelle respiratoire, Pessac, France
| | - Pauline Esteves
- Centre de Recherche Cardio-thoracique de Bordeaux, Univ-Bordeaux, Pessac, France.,Centre de Recherche Cardio-thoracique de Bordeaux, INSERM, Pessac, France
| | - Fares Gouzi
- PhyMedExp, INSERM-CNRS-Montpellier University, CHRU Montpellier, Montpellier, France
| | - Maurice Hayot
- PhyMedExp, INSERM-CNRS-Montpellier University, CHRU Montpellier, Montpellier, France
| | - Pascal Pomiès
- PhyMedExp, INSERM-CNRS-Montpellier University, Montpellier, France
| | - Patrick Berger
- Centre de Recherche Cardio-thoracique de Bordeaux, Univ-Bordeaux, Pessac, France.,Centre de Recherche Cardio-thoracique de Bordeaux, INSERM, Pessac, France.,CHU de Bordeaux, Service d'exploration fonctionnelle respiratoire, Pessac, France
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4
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Samuel GS, Swee DS. Use of testosterone replacement therapy in the rehabilitation of patients with intensive care unit-associated weakness and hospital-associated deconditioning: the Singapore General Hospital rehabilitation experience. Singapore Med J 2023; 0:368090. [PMID: 36751836 DOI: 10.4103/singaporemedj.smj-2021-307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Introduction Rehabilitation medicine in a tertiary care hospital involves attending to many patients affected by intensive care unit (ICU)-associated weakness (ICU-AW) and hospital-associated deconditioning (HAD). These conditions contribute to poor long-term functional outcomes and increased mortality. We explored the role of short-term adjunctive androgen therapy in this group of patients in improving the rehabilitative outcomes. Methods This was a retrospective analysis of five patients with either ICU-AW or HAD who were given testosterone replacement therapy (TRT) or oxandrolone for a total of 2 weeks during the period from April to November 2020 was undertaken. During the 2-week trial period, the subjects underwent standard rehabilitation therapy. Results Grip strength was used as the primary outcome measure, and the mean improvement was 4.2 kg (+24.9%), which is encouraging in a 2-week timeframe. This was matched with good functional recovery in terms of distance ambulated and less assistance needed for ambulation. Sex hormone analysis was also done before initiation of TRT, and it showed that four out of five of the subjects were biochemically hypogonadal. None of the subjects dropped out or experienced any significant adverse events over the 2-week trial period. All the subjects except one improved to full independence at 3 months post-discharge. Conclusion TRT has the potential to be used as a useful adjunct to standard rehabilitation in enhancing functional recovery in critically ill patients. A multidisciplinary approach would ensure that suitable patients benefit from optimal nutrition, optimal rehabilitation and synergistic testosterone therapy in a clinically sound and resource-efficient fashion.
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Affiliation(s)
| | - Du Soon Swee
- Department of Endocrinology, Singapore General Hospital, Singapore
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5
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Isidori AM, Aversa A, Calogero A, Ferlin A, Francavilla S, Lanfranco F, Pivonello R, Rochira V, Corona G, Maggi M. Adult- and late-onset male hypogonadism: the clinical practice guidelines of the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Endocrinology (SIE). J Endocrinol Invest 2022; 45:2385-2403. [PMID: 36018454 PMCID: PMC9415259 DOI: 10.1007/s40618-022-01859-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/29/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To provide the evidence-based recommendations on the role of testosterone (T) on age-related symptoms and signs remains. METHODS The Italian Society of Andrology and Sexual Medicine (SIAMS) and the and the Italian Society of Endocrinology (SIE) commissioned an expert task force to provide an updated guideline on adult-onset male hypogonadism. Derived recommendations were based on Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. RESULTS Clinical diagnosis of adult-onset hypogonadism should be based on a combination of clinical and biochemical parameters. Testosterone replacement therapy (TRT) should be offered to all symptomatic subjects with hypogonadism after the exclusion of possible contraindications. T gels and the long-acting injectable T are currently available preparations showing the best efficacy/safety profile. TRT can improve all aspects of sexual function, although its effect is limited in more complicated patients. Body composition (reducing fat mass and increasing lean mass) is improved after TRT, either in subjects with or without metabolic syndrome or type 2 diabetes. Conversely, the role of TRT in improving glycometabolic control is more conflicting. TRT can result in increasing bone mineral density, particularly at lumbar site, but no information on fracture risk is available. Limited data support the use of TRT for improving other outcomes, including mood frailty and mobility. CONCLUSIONS TRT can improve sexual function and body composition particularly in less complicated adult and in aging subjects with hypogonadism. When hypogonadism is adequately diagnosed, T appropriately prescribed and subjects correctly followed up, no short-term increased risk of adverse events is observed. Longer and larger studies are advisable to better clarify TRT long-term efficacy/safety profile.
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Affiliation(s)
- A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome - Policlinico Umberto I Hospital, Rome, Italy
| | - A Aversa
- Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - A Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - A Ferlin
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padua, Italy
| | - S Francavilla
- Andrology Unit, Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - F Lanfranco
- Division of Endocrinology, Andrology and Metabolism, Humanitas Gradenigo, Department of Medical Sciences, University of Turin, Turin, Italy
| | - R Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile, Università Federico II di Napoli, Naples, Italy
- Staff of UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
| | - V Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - G Corona
- Endocrinology Unit, Medical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Largo Nigrisoli, 2, 40133, Bologna, Italy.
| | - M Maggi
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
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6
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Testosterone replacement therapy and cardiovascular disease. Int J Impot Res 2022; 34:685-690. [PMID: 34999717 DOI: 10.1038/s41443-021-00516-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 01/23/2023]
Abstract
The use of testosterone therapy has a complex history of apprehension and questions regarding its safety. Despite an eventual consensus that testosterone therapy was safe and effective, several studies relating to cardiovascular risks emerged in the last decade, rekindling skepticism regarding the safety of testosterone therapy. Given the utility of testosterone therapy in treating the symptoms of hypogonadism, it remains crucial to closely examine the safety of testosterone therapy. The present article synthesizes the current evidence regarding cardiovascular risks that may be associated with testosterone therapy, the potential mechanisms regarding testosterone's efficacy, and future directions in evaluating the safety of its use.
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7
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Sato R, Vatic M, da Fonseca GWP, von Haehling S. Sarcopenia and Frailty in Heart Failure: Is There a Biomarker Signature? Curr Heart Fail Rep 2022; 19:400-411. [PMID: 36261756 DOI: 10.1007/s11897-022-00575-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW Sarcopenia and frailty are common in patients with heart failure (HF) and are strongly associated with prognosis. This review aims to examine promising biomarkers that can guide physicians in identifying sarcopenia and frailty in HF. RECENT FINDINGS Traditional biomarkers including C-reactive protein, aminotransaminase, myostatin, and urinary creatinine as well as novel biomarkers including microRNAs, suppression of tumorigenicity 2 (ST2), galectin-3, and procollagen type III N-terminal peptide may help in predicting the development of sarcopenia and frailty in HF patients. Among those biomarkers, aminotransferase, urinary creatinine, and ST2 predicted the prognosis in HF patients with sarcopenia and frailty. This review outlines the current knowledge of biomarkers that are considered promising for diagnosing sarcopenia and frailty in HF. The listed biomarkers might support the diagnosis, prognosis, and therapeutic decisions for sarcopenia and frailty in HF patients.
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Affiliation(s)
- Ryosuke Sato
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Str. 40, 37075, Gottingen, Germany
| | - Mirela Vatic
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Str. 40, 37075, Gottingen, Germany
| | | | - Stephan von Haehling
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Gottingen, Germany.
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8
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Di Lodovico E, Facondo P, Delbarba A, Pezzaioli LC, Maffezzoni F, Cappelli C, Ferlin A. Testosterone, Hypogonadism, and Heart Failure. Circ Heart Fail 2022; 15:e008755. [PMID: 35392658 DOI: 10.1161/circheartfailure.121.008755] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Male hypogonadism is defined as low circulating testosterone level associated with signs and symptoms of testosterone deficiency. Although the bidirectional link between hypogonadism and cardiovascular disease has been clarified, the association between testosterone and chronic heart failure (HF) is more controversial. Herein, we critically review published studies relating to testosterone, hypogonadism, and HF and provide practical clinical information on proper diagnosis and treatment of male hypogonadism in patients with HF. In general, published studies are extremely heterogeneous, frequently have not adhered to hypogonadism guidelines, and suffer from many intrinsic methodological inaccuracies; therefore, data provide only low-quality evidence. Nevertheless, by selecting the few methodologically robust studies, we show the prevalence of testosterone deficiency (30%-50%) and symptomatic hypogonadism (15%) in men with HF is significant. Low testosterone correlates with HF severity, New York Heart Association class, exercise functional capacity, and a worse clinical prognosis and mortality. Interventional studies on testosterone treatment in men with HF are inconclusive but do suggest beneficial effects on exercise capacity, New York Heart Association class, metabolic health, and cardiac prognosis. We suggest that clinicians should measure testosterone levels in men with HF who have symptoms of a testosterone deficiency and conditions that predispose to hypogonadism, such as obesity and diabetes. These patients-if diagnosed as hypogonadal-may benefit from the short- and long-term effects of testosterone replacement therapy, which include improvements in both cardiac prognosis and systemic outcomes. Further collaborative studies involving both cardiologists and endocrinologists are warranted.
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Affiliation(s)
- Elena Di Lodovico
- Department of Clinical and Experimental Sciences, University of Brescia, Italy (E.D.L., P.F., L.C.P., C.C., A.F.)
| | - Paolo Facondo
- Department of Clinical and Experimental Sciences, University of Brescia, Italy (E.D.L., P.F., L.C.P., C.C., A.F.)
| | - Andrea Delbarba
- Unit of Endocrinology and Metabolism, ASST Spedali Civili, Brescia, Italy (A.D., F.M., C.C., A.F.)
| | - Letizia Chiara Pezzaioli
- Department of Clinical and Experimental Sciences, University of Brescia, Italy (E.D.L., P.F., L.C.P., C.C., A.F.)
| | - Filippo Maffezzoni
- Unit of Endocrinology and Metabolism, ASST Spedali Civili, Brescia, Italy (A.D., F.M., C.C., A.F.)
| | - Carlo Cappelli
- Department of Clinical and Experimental Sciences, University of Brescia, Italy (E.D.L., P.F., L.C.P., C.C., A.F.).,Unit of Endocrinology and Metabolism, ASST Spedali Civili, Brescia, Italy (A.D., F.M., C.C., A.F.)
| | - Alberto Ferlin
- Department of Clinical and Experimental Sciences, University of Brescia, Italy (E.D.L., P.F., L.C.P., C.C., A.F.).,Unit of Endocrinology and Metabolism, ASST Spedali Civili, Brescia, Italy (A.D., F.M., C.C., A.F.).,Now with Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Italy (A.F.)
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9
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10
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Valentova M, Anker SD, von Haehling S. Cardiac Cachexia Revisited. Cardiol Clin 2022; 40:199-207. [DOI: 10.1016/j.ccl.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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11
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Fernández-Pombo A, Rodríguez-Carnero G, Castro AI, Cantón-Blanco A, Seoane LM, Casanueva FF, Crujeiras AB, Martínez-Olmos MA. Relevance of nutritional assessment and treatment to counteract cardiac cachexia and sarcopenia in chronic heart failure. Clin Nutr 2021; 40:5141-5155. [PMID: 34461588 DOI: 10.1016/j.clnu.2021.07.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/24/2021] [Accepted: 07/21/2021] [Indexed: 12/18/2022]
Abstract
Chronic heart failure (CHF) is frequently associated with the involuntary loss of body weight and muscle wasting, which can determine the course of the disease and its prognosis. While there is no gold standard malnutrition screening tool for their detection in the CHF population, several bioelectrical and imaging methods have been used to assess body composition in these patients (such as Dual Energy X-Ray Absorptiometry and muscle ultrasound, among other techniques). In addition, numerous nutritional biomarkers have been found to be useful in the determination of the nutritional status. Nutritional considerations include the slow and progressive supply of nutrients, avoiding high volumes, which could ultimately lead to refeeding syndrome and worsen the clinical picture. If oral feeding is insufficient, hypercaloric and hyperproteic supplementation should be considered. β-Hydroxy-β-methylbutyrate and omega-3 polyunsaturated fatty acid administration prove to be beneficial in certain patients with CHF, and several interventional studies with micronutrient supplementation have also described their possible role in these subjects. Taking into account that CHF is sometimes associated with gastrointestinal dysfunction, parenteral nutritional support may be required in selected cases. In addition, potential therapeutic options regarding nutritional state and muscle wasting have also been tested in clinical studies. This review summarises the scientific evidence that demonstrates the necessity to carry out a careful nutritional evaluation and nutritional treatment to prevent or improve cardiac cachexia and sarcopenia in CHF, as well as improve its course.
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Affiliation(s)
- Antía Fernández-Pombo
- Division of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain
| | - Gemma Rodríguez-Carnero
- Division of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain; Epigenomics in Endocrinology and Nutrition Group, Epigenomics Unit, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain
| | - Ana I Castro
- Division of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain; CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain
| | - Ana Cantón-Blanco
- Division of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain; Epigenomics in Endocrinology and Nutrition Group, Epigenomics Unit, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain; CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain
| | - Luisa M Seoane
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain; Endocrine Physiopathology Group, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain
| | - Felipe F Casanueva
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain; Laboratory of Molecular and Cellular Endocrinology, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago de Compostela (CHUS/SERGAS), Santiago de Compostela, Spain; Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ana B Crujeiras
- Epigenomics in Endocrinology and Nutrition Group, Epigenomics Unit, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain; CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain.
| | - Miguel A Martínez-Olmos
- Division of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain; Epigenomics in Endocrinology and Nutrition Group, Epigenomics Unit, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain; CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain; Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
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12
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Cittadini A, Isidori AM, Salzano A. Testosterone therapy and cardiovascular diseases. Cardiovasc Res 2021; 118:2039-2057. [PMID: 34293112 DOI: 10.1093/cvr/cvab241] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/16/2021] [Indexed: 11/14/2022] Open
Abstract
Since it was first synthesised in 1935, testosterone (T) has been viewed as the mythical Fountain of Youth, promising rejuvenation, restoring sexual appetites, growing stronger muscles, and quicker thinking. T is endowed with direct effects on myocardial and vascular structure and function, as well as on risk factors for cardiovascular (CV) disease. Indeed, low serum T levels are a risk factor for diabetes, metabolic syndrome, inflammation, and dyslipidaemia. Moreover, many studies have shown that T deficiency per se is an independent risk factor of CV and all-cause mortality. On this background and due to direct-to-patient marketing by drug companies, we have witnessed to the widespread use of T replacement therapy (TT) without clear indications particularly in late-life onset hypogonadism. The current review will dwell upon current evidence and controversies surrounding the role of T in the pathophysiology of CV diseases, the link between circulating T levels and CV risk, and the use of replacing T as a possible adjuvant treatment in specific CV disorders. Specifically, recent findings suggest that heart failure and type 2 diabetes mellitus represent two potential targets of T therapy once that a state of hypogonadism is diagnosed. However, only if ongoing studies solve the CV safety issue the T orchid may eventually 'bloom'.
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Affiliation(s)
- Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Interdisciplinary Research Centre on Biomaterials (CRIB), Federico II University, Naples, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Andrea Salzano
- IRCCS SDN, Diagnostic and Nuclear Research Institute, Naples, Italy
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13
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Zhang X, Zhao H, Horney J, Johnson N, Saad F, Haider KS, Haider A, Xu X. Testosterone Deficiency, Long-Term Testosterone Therapy, and Inflammation. J Cardiovasc Pharmacol Ther 2021; 26:638-647. [PMID: 34247541 DOI: 10.1177/10742484211032402] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES We aimed to evaluate the association of testosterone deficiency with inflammation and how long-term testosterone therapy affects inflammation biomarkers over time. METHODS We conducted a 2-component study. First, we conducted a cross-sectional study using the recently released 2015-2016 National Health and Nutrition Examination Survey (NHANES) data to examine the association between testosterone deficiency and inflammation biomarkers including high sensitivity C-reactive protein (hsCRP), liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the US general population. Then we conducted a longitudinal study to investigate the longitudinal effect of testosterone therapy on inflammation biomarkers and the risk of cardiovascular events, using data from 776 hypogonadal men based on a registry study in Germany with up to 11 years' follow-up. RESULTS The adjusted odds ratios (ORs) describing the associations between testosterone deficiency and hsCRP ≥ 3mg/L, ALT > 40U/L, and AST > 40U/L were 1.81 (P-value < 0.001), 1.46 (P-value = 0.009), and 0.99 (P-value = 0.971), respectively. In the control group, CRP, ALT, and AST levels increased by 0.003 (95%CI: -0.001, 0.007) mg/L, 0.157 U/L (95%CI: 0.145, 0.170), and 0.147 (95%CI: 0.136, 0.159) U/L per month, while in the treatment group, CRP, ALT, and AST levels decreased by 0.05 (95%CI: -0.055, -0.046) mg/L, 0.142 U/L (95%CI: -0.154, -0.130), and 0.148 (95%CI: -0.158, -0.137) U/L per month. CONCLUSION Testosterone deficiency was associated with an increased level of inflammation; long-term testosterone therapy alleviated inflammation among hypogonadal men, which may contribute to the reduced cardiovascular risk. Future large trials are warranted to confirm our observational study findings.
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Affiliation(s)
- Xiao Zhang
- Department of Epidemiology and Biostatistics, 14736Texas A&M University, TX, USA
| | - Hongwei Zhao
- Department of Epidemiology and Biostatistics, 14736Texas A&M University, TX, USA
| | - Jennifer Horney
- College of Health Sciences, 5972University of Delaware, DE, USA
| | - Natalie Johnson
- Department of Environmental and Occupational Health, 14736Texas A&M University, TX, USA
| | - Farid Saad
- Research Department, 105956Gulf Medical University, Ajman, UAE
| | | | | | - Xiaohui Xu
- Department of Epidemiology and Biostatistics, 14736Texas A&M University, TX, USA
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14
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Harwood AE, Russell S, Okwose NC, McGuire S, Jakovljevic DG, McGregor G. A systematic review of rehabilitation in chronic heart failure: evaluating the reporting of exercise interventions. ESC Heart Fail 2021; 8:3458-3471. [PMID: 34235878 PMCID: PMC8497377 DOI: 10.1002/ehf2.13498] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/17/2021] [Accepted: 06/16/2021] [Indexed: 12/13/2022] Open
Abstract
A large body of research supports the use of exercise to improve symptoms, quality of life, and physical function in patients with chronic heart failure. Previous reviews have focused on reporting outcomes of exercise interventions such as cardiorespiratory fitness. However, none have critically examined exercise prescription. The aim of this review was to evaluate the reporting and application of exercise principles in randomised control trials of exercise training in patients with chronic heart failure. A systematic review of exercise intervention RCTs in patients with CHF, using the Consensus on Exercise Reporting Template (CERT), was undertaken. The Ovid Medline/PubMed, Embase, Scopus/Web of Science, and Cochrane Library and Health Technology Assessment Databases were searched from 2000 to June 2020. Prospective RCTs in which patients with CHF were randomized to a structured exercise programme were included. No limits were placed on the type or duration of exercise structured exercise programme or type of CHF (i.e. preserved or reduced ejection fraction). We included 143 studies, comprising of 181 different exercise interventions. The mean CERT score was 10 out of 19, with no study achieving a score of 19. Primarily, details were missing regarding motivational strategies, home-based exercise components, and adherence/fidelity to the intervention. Exercise intensity was the most common principle of exercise prescription missing from intervention reporting. There was no improvement in the reporting of exercise interventions with time (R2 = 0.003). Most RCTs of exercise training in CHF are reported with insufficient detail to allow for replication, limiting the translation of evidence to clinical practice. We encourage authors to provide adequate details when reporting future interventions. Where journal word counts are restrictive, we recommend using supplementary material or publishing trial protocols prior to beginning the study.
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Affiliation(s)
- Amy E Harwood
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry, CV1 2DS, UK
| | - Sophie Russell
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry, CV1 2DS, UK
| | - Nduka C Okwose
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry, CV1 2DS, UK.,Cardiovascular Research Division, Translational and Clinical Research Institute, Newcastle University, UK
| | - Scott McGuire
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry, CV1 2DS, UK
| | - Djordje G Jakovljevic
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry, CV1 2DS, UK.,Cardiovascular Research Division, Translational and Clinical Research Institute, Newcastle University, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Gordon McGregor
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry, CV1 2DS, UK.,Department of Cardiopulmonary Rehabilitation, Centre for Exercise and Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
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15
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Falqueto H, Júnior JLR, Silvério MNO, Farias JCH, Schoenfeld BJ, Manfredi LH. Can conditions of skeletal muscle loss be improved by combining exercise with anabolic-androgenic steroids? A systematic review and meta-analysis of testosterone-based interventions. Rev Endocr Metab Disord 2021; 22:161-178. [PMID: 33783694 DOI: 10.1007/s11154-021-09634-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 12/11/2022]
Abstract
Sarcopenia, cachexia, and atrophy due to inactivity and disease states are characterized by a loss of skeletal muscle mass, often accompanied by reduced levels of anabolic hormones (e.g. testosterone). These conditions are associated with an increase in mortality, hospitalization and worsening in quality of life. Both physical exercise (EX) and anabolic-androgenic steroid (AAS) administration can improve the prognosis of patients as they increase physical functionality. However, there is a gap in the literature as to the impact of these therapies on the gains in strength and muscle mass and their implications for patient safety. Accordingly, we performed a random-effects meta-analysis to elucidate the effects of AAS and/or EX interventions on lean body mass (LBM) and muscle strength in conditions involving muscle loss. A systematic search for relevant clinical trials was conducted in MEDLINE, EMBASE, SCOPUS, Web of Science, and SPORTDiscus. Comparisons included AAS vs. Control, EX vs. Control, AAS vs. EX, AAS + EX vs. AAS and AAS + EX vs. EX. A total of 1114 individuals were analyzed. AAS increased LBM (effect size [ES]: 0.46; 95% CI: 0.25, 0.68, P = 0.00) and muscle strength (ES: 0.31; 95% CI: 0.08, 0.53, P = 0.01) when compared to a control group. EX promoted an increase in muscular strength (ES: 0.89; 95% CI: 0.53, 1.25, P = 0.00), with no effect on LBM when compared to the control group (ES: 0.15; 95% CI: -0.07, 0.38, P = 0.17). AAS did not demonstrate statistically significant differences when compared to EX for LBM and muscle strength. The combination of EX + AAS promoted a greater increase in LBM and muscular strength when compared to AAS or EX in isolation. Qualitatively, AAS administration had relatively few side effects. Significant heterogeneity was found in some analyses, which may be explained by the use of different AAS types and EX protocols. Our findings suggest that AAS administration in cachectic and sarcopenic conditions may be a viable interventional strategy to enhance muscle function when exercise is not a possible approach. Moreover, combining AAS with exercise may enhance positive outcomes in this population.
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Affiliation(s)
- Hugo Falqueto
- Medical School, Federal University of Fronteira Sul, SC 484 - Km 02, Chapecó, Santa Catarina, Brazil
- Graduate Program in Biomedical Sciences, UFFS, Chapecó, Santa Catarina, Brazil
| | - Jorge L R Júnior
- Laboratory of Sport Biomechanics, Sports Department, School of Physical Education, Physiotherapy and Occupational Therapy, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Mauro N O Silvério
- Medical School, Federal University of Fronteira Sul, SC 484 - Km 02, Chapecó, Santa Catarina, Brazil
| | - Juliano C H Farias
- Medical School, Federal University of Fronteira Sul, SC 484 - Km 02, Chapecó, Santa Catarina, Brazil
| | | | - Leandro H Manfredi
- Medical School, Federal University of Fronteira Sul, SC 484 - Km 02, Chapecó, Santa Catarina, Brazil.
- Graduate Program in Biomedical Sciences, UFFS, Chapecó, Santa Catarina, Brazil.
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16
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Abstract
The consequences of heart failure (HF) remain high despite treatment advances. Deficiency of the anabolic axes is common in HF and is associated with an increased risk of death and worsening functional status. Exogenous testosterone use has been shown to decrease vascular resistance and improve cardiac output. The objective of this systematic review was to assess the efficacy (mortality, hospitalization, cardiac function, and quality of life) and safety of testosterone in HF patients. The Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines were followed. Four electronic databases were searched from inception until November 30, 2019. The initial search yielded 1308 articles, and 10 randomized controlled trials with exogenous testosterone in patients with HF were included after exclusion criteria were applied. One study evaluated the impact of testosterone on mortality and HF hospitalization; no difference was observed compared with placebo. In 5 studies, testosterone use was associated with an improvement in walking distance. In 1 of the 2 studies that evaluated functional status, New York Heart Association class was improved. In 2 out of 4 studies, quality of life was improved with therapy. When reported, testosterone use was not associated with an increase in side effects. Overall, testosterone use has not been shown to reduce the risk of death or HF hospitalization, with inconsistent evidence on the impact of therapy on quality of life. Additional trials are needed before testosterone can be recommended. Patients with HF should receive guideline-directed medical therapy with the assurance that patients are receiving maximum tolerated doses.
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Affiliation(s)
- SoEun Park
- From the Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD
| | - Stormi E Gale
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD
- ATRIUM Cardiology Collaborative, Baltimore, MD
| | - Kristin Watson
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD
- ATRIUM Cardiology Collaborative, Baltimore, MD
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17
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Cannarella R, Barbagallo F, Crafa A, Mongioì LM, Aversa A, Greco E, Condorelli RA, LA Vignera S, Calogero AE. Testosterone replacement therapy in hypogonadal male patients with hypogonadism and heart failure: a meta-analysis of randomized controlled studies. Minerva Urol Nephrol 2021; 74:418-427. [PMID: 33781026 DOI: 10.23736/s2724-6051.21.04307-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The recently published guidelines of the European Academy of Andrology (EAA) recommended not to prescribe testosterone replacement therapy (TRT) in male patients with hypotestosteronemia and severe heart failure (HF) [New York Hearth Association (NYHA) class III and IV] since the risk in these patients has not been formally documented. Therefore, the aim of this study was to systematically evaluate the risk of TRT on the cardiac function and angina, in male patients with hypotestosteronemia and HF or coronary heart disease. METHODS Randomized controlled trials (RCTs) on male patients with hypotestosteronemia and chronic HF (ejection fraction <40%) or stable angina documenting the effect of TRT on NYHA class, left ventricula ejection fraction (LVEF), adverse events, ST depression and other indexes of cardiovascular function. RESULTS Seven articles were included, for a total of 140 participants with HF (71 on TRT and 69 on placebo or no treatment). Included patients were of NYHA class II and III. TRT had no effect on death and rehospitalization rates of patients with HF and significantly delayed the time to ischemia in patients with chronic angina. TRT had not effect on the NYHA class, the LVEF, and on the Minnesota Living with Heart Failure questionnaire. Although a significant increase of oxygen consumption was found in the TRT group, no improvement to the physical exercise tolerance tests was observed. TRT showed no effect on systolic nor diastolic blood pressure, but it significantly ameliorated the heart rate. It significantly decreased the insulin serum levels and the HOMA index. CONCLUSIONS These results suggest the safety of TRT, in patients with hypotestosteronemia and severe HF (class NYHA II and III). Although deriving from a limited number of studies, these data could prompt to perform other RCTs on the effects of TRT in patients with hypotestosteronemia and severe HFrEF (NYHA class III).
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Affiliation(s)
- Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Federica Barbagallo
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Andrea Crafa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Laura M Mongioì
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Antonio Aversa
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Emanuela Greco
- Department of Health Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Sandro LA Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy -
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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18
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New understanding of the pathogenesis and treatment of stroke-related sarcopenia. Biomed Pharmacother 2020; 131:110721. [DOI: 10.1016/j.biopha.2020.110721] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/24/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022] Open
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19
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Matsumura K, Teranaka W, Matsumoto H, Fujii K, Tsujimoto S, Otagaki M, Morishita S, Hashimoto K, Shibutani H, Yamamoto Y, Shiojima I. Loss of skeletal muscle mass predicts cardiac death in heart failure with a preserved ejection fraction but not heart failure with a reduced ejection fraction. ESC Heart Fail 2020; 7:4100-4107. [PMID: 32964678 PMCID: PMC7754999 DOI: 10.1002/ehf2.13021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/01/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022] Open
Abstract
Aims Loss of skeletal muscle mass is an important determinant associated with poor long‐term prognosis in patients with acute decompensated heart failure (ADHF). However, limited evidence is available. This study investigated the prognostic value of the psoas muscle mass index (PMI) in patients with ADHF. Methods and results A total of 210 consecutive patients aged ≥60 years with ADHF were enrolled using a prospective database between 2015 and 2017. Primary endpoint was incidence of cardiac death. Cross‐sectional psoas muscle area at the L3 vertebral level was obtained by computed tomography, and PMI was calculated by height. Reduced PMI was defined as a PMI below the 25th sex‐specific percentile. Patients were also classified by their left ventricular ejection fraction (EF) as having either heart failure with a reduced ejection fraction (HFrEF, EF < 50%) or heart failure with a preserved ejection fraction (HFpEF, EF ≥ 50%). The median follow‐up period was 1.8 years. There were 44 cardiac deaths (21%) during the study period. Patients with reduced PMI had significantly higher cardiac death rates than those with preserved PMI (33% vs. 17%, log‐rank test P = 0.006). In subgroup analysis, HFpEF patients with reduced PMI had significantly higher cardiac death rates than those with preserved PMI (38% vs. 16%, log‐rank test P = 0.006); conversely, HFrEF patients had comparable cardiac death rates regardless of their PMI group (27% for reduced PMI vs. 18% for preserved PMI, log‐rank test P = 0.24). Multivariate Cox proportional hazards model revealed that patients with reduced PMI had a 2.3‐fold higher risk of cardiac death compared with patients with preserved PMI (95% confidence interval 1.23–4.42, P = 0.01). Conclusions Reduced PMI helps to predict long‐term outcome in patients with HFpEF but not HFrEF.
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Affiliation(s)
- Koichiro Matsumura
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, Osaka, 5708507, Japan
| | - Wakana Teranaka
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, Osaka, 5708507, Japan
| | - Hiroshi Matsumoto
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, Osaka, 5708507, Japan
| | - Kenichi Fujii
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, Osaka, 5708507, Japan
| | - Satoshi Tsujimoto
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, Osaka, 5708507, Japan
| | - Munemitsu Otagaki
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, Osaka, 5708507, Japan
| | - Shun Morishita
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, Osaka, 5708507, Japan
| | - Kenta Hashimoto
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, Osaka, 5708507, Japan
| | - Hiroki Shibutani
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, Osaka, 5708507, Japan
| | - Yoshihiro Yamamoto
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, Osaka, 5708507, Japan
| | - Ichiro Shiojima
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, Osaka, 5708507, Japan
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Abstract
In the early days of its use, testosterone therapy faced skepticism regarding its safety and efficacy. After a converging consensus that testosterone therapy was safe and effective for the treatment of hypogonadism, several recent studies showed adverse cardiovascular outcomes associated with testosterone treatment, ultimately resulting in a mandated FDA label warning about the unknown safety of testosterone therapy. Given the clear efficacy of testosterone therapy in the treatment of hypogonadism, establishing the safety of this therapeutic tool is essential. This article summarizes the current evidence regarding the cardiovascular safety of testosterone therapy for the management of hypogonadism, as well as the proposed mechanisms that may explain testosterone's underlying effects.
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Affiliation(s)
- Jeremy M Auerbach
- Department of Urology, Baylor College of Medicine , Houston, TX, USA
| | - Mohit Khera
- Department of Urology, Baylor College of Medicine , Houston, TX, USA
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21
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Abstract
PURPOSE OF REVIEW Malnutrition, sarcopenia, and cachexia are areas of increasing interest in the management of patients with heart failure (HF). This review aims to examine the serological markers useful in guiding the physician in identification of these patients. RECENT FINDINGS Traditional nutritional biomarkers including albumin/prealbumin, iron, and vitamin D deficiencies predict poor prognosis in malnutrition and HF. Novel biomarkers including ghrelin, myostatin, C-terminal agrin fragment, and adiponectin have been identified as possible substrates and/or therapeutic targets in cardiac patients with sarcopenia and cachexia, though clinical trial data is limited to date. Increased focus on nutritional deficiency syndromes in heart failure has led to the use of established markers of malnutrition as well as the identification of novel biomarkers in the management of these patients, though to date, their usage has been confined to the academic domain and further research is required to establish their role in the clinical setting.
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22
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Peng X, Gao L, Aibai S. Antifatigue effects of anshenyizhi compound in acute excise‐treated mouse via modulation of AMPK/PGC‐1α‐related energy metabolism and Nrf2/ARE‐mediated oxidative stress. J Food Sci 2020; 85:1897-1906. [DOI: 10.1111/1750-3841.15149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/21/2020] [Accepted: 04/04/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Xiaoming Peng
- Xinjiang Institute of Traditional Uygur Medicine Urumqi Xinjiang 830011 China
- Xinjiang Production and Construction Corps Center Blood Station Urumqi Xinjiang 830000 China
| | - Li Gao
- Xinjiang Institute of Traditional Uygur Medicine Urumqi Xinjiang 830011 China
| | - Silafu Aibai
- Xinjiang Institute of Traditional Uygur Medicine Urumqi Xinjiang 830011 China
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Zhang Z, Kang D, Li H. The effects of testosterone on bone health in males with testosterone deficiency: a systematic review and meta-analysis. BMC Endocr Disord 2020; 20:33. [PMID: 32145741 PMCID: PMC7060639 DOI: 10.1186/s12902-020-0509-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/14/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Testosterone deficiency (TD) may induce a series of clinical symptoms. Studies have shown that testosterone supplementation may prevent these unfavourable symptoms and improve patients' quality of life. Given the conflicting findings across studies, this systematic review aims to evaluate the effects and risks associated with testosterone supplementation in middle-aged or aging males with TD. METHODS Electronic databases (MEDLINE, EMBASE, PubMed, and Cochrane. Library were searched to December 2019. The risk of bias of individual included studies and the quality of the aggregate evidence were assessed using the GRADE approach. Our primary outcome was bone mineral density (BMD). Meta-analyses were performed. This systematic review was reported according to the PRISMA statement. RESULTS A total of 52 randomized controlled trials (RCTs) were included. When compared with placebo, testosterone supplementation did not increase total BMD (short-term: 1081 participants, MD - 0.01 g/cm2, 95% CI - 0.02 g/cm2 to 0.01 g/cm2; long-term: 156 participants, MD 0.04 g/cm2, 95% CI - 0.07 g/cm2 to 0.14 g/cm2), lumbar spine, hip, or femur neck BMD. Furthermore, testosterone supplementation did not decrease the risk of falling or fracture. Lastly, it was found that testosterone supplementation did not increase the risk of cardiovascular events (1374 participants, RR 1.28, 95% CI 0.62 to 2.64), all-cause mortality (729 participants, RR 0.55, 95% CI 0.29 to 1.04), or prostatic events. However, testosterone supplementation may improve sexual function and quality of life (1328 participants, MD -1.32, 95% CI - 2.11 to - 0.52). CONCLUSIONS The effect of testosterone supplementation on BMD and the risk of falls or fracture remains inconclusive. However, supplementation may benefit patients in the areas of sexual function and quality of life without increasing the risk of cardiovascular events, all-cause mortality, or prostatic events. RCTs with a longer follow-up period are still required. TRIAL REGISTRATION We registered our protocol in PROSPERO (CRD42018109738).
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Affiliation(s)
- Zhichao Zhang
- Andrology Center, Department of Urology, Peking University First Hospital; Institute of Urology, Peking University, No 8 Xishenku Street, Beijing, 100034, China
| | - Deying Kang
- Department of Evidence based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, China
| | - Hongjun Li
- Urological Department of Peking Union Medical College Hospital (PUMCH), Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifu, Eastern District, Beijing, 100730, China.
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25
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Tao J, Liu X, Bai W. Testosterone Supplementation in Patients With Chronic Heart Failure: A Meta-Analysis of Randomized Controlled Trials. Front Endocrinol (Lausanne) 2020; 11:110. [PMID: 32231640 PMCID: PMC7082858 DOI: 10.3389/fendo.2020.00110] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/19/2020] [Indexed: 01/08/2023] Open
Abstract
Background: The effect of testosterone supplementation in patients with chronic heart failure (CHF) remains uncertain. Methods: A meta-analysis of randomized controlled trials (RCTs) was performed. RCTs that evaluate the chronic effect of testosterone supplementation on exercise capacity and cardiac function in CHF were identified via searching of PubMed, Embase, and the Cochrane's Library databases. Heterogeneity was evaluated by the Cochrane's Q test and I2 statistics. A fixed-effect model was used if the heterogeneity was not significant (I2 < 50%); otherwise, a random-effect model was applied. Results: Eight studies including 170 patients in the testosterone supplementation group and 162 in the control group were included. Overall, testosterone supplementation was not associated with an improved exercise capacity (walking test: standardized mean difference [SMD] = 0.36, p = 0.07). Sensitivity analyses limited to male patients showed similar results (SMD = 0.21, p = 0.15), and subgroup analyses also showed similar results in male HF patients with baseline total testosterone (TT) ≥ or < 10 nmol/L. However, patients with TT at endpoint ≥ 25 nmol/L was associated with improved exercise capacity (SMD = 1.12, p = 0.02), but not for those with TT at endpoint < 25 nmol/L (SMD = 0.24, p = 0.12). In addition, VO2max (weight mean difference [WMD] = 0.85, p = 0.43), the functional classification (the New York Heart Association classification: WMD = -0.08, p = 0.16) and quality of life (Minnesota Living with Heart Failure [MLHF] questionnaire: WMD = -6.03, p = 0.12) were not significantly affected. Moreover, testosterone supplementation did not significantly affect left ventricular ejection fraction (WMD: -1.52%, p = 0.37), serum B-type natriuretic peptide (SMD: -0.19, p = 0.23), or a composite outcome of death or HF hospitalization (risk ratio [RR]: 1.02, p = 0.96). Although testosterone supplementation increased systolic blood pressure (BP) in CHF patients (WMD: 5.68 mmHg, p < 0.001), diastolic BP or heart rate was not significantly changed as compared to control. Conclusions: Testosterone supplementation within a physiological range is not associated with significantly improved exercise capacity, cardiac function, quality of life, or clinical outcome in CHF patients.
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Affiliation(s)
- Jianping Tao
- Department of Anesthesiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaoyong Liu
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wenwei Bai
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
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Cannarella R, Calogero AE, Condorelli RA, Aversa A, La Vignera S. Systemic effects of the hormonal treatment of male hypogonadism with preliminary indications for the management of COVID-19 patients. Ther Adv Endocrinol Metab 2020; 11:2042018820966438. [PMID: 33133492 PMCID: PMC7576928 DOI: 10.1177/2042018820966438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/24/2020] [Indexed: 12/16/2022] Open
Abstract
Male hypogonadism, defined as an inadequate production of testosterone (T), is associated with a greater morbidity and mortality. Epidemiological studies identified T deficiency as a risk factor for cardiovascular disease. Also, low serum T levels impact on glucose homeostasis through a worse glucose uptake, utilization, and disposal, and the general negative impact on metabolism. The aim of this review is to provide a comprehensive and updated overview of the effects of T replacement therapy on metabolic and cardiovascular systems and prostate tissue in patients with hypogonadism, including molecular mechanisms through which T exerts its actions. Furthermore, recent findings on novel coronavirus disease (COVID-19) epidemiology have shown a greater mortality in male compared with female patients and a role of T in promoting the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection of the host cells has been demonstrated. Hence, the secondary aim of this review is to provide preliminary indications on the management in patients with COVID-19.
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Affiliation(s)
- Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Sicily, Italy
| | - Aldo E. Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Sicily, Italy
| | - Rosita A. Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Sicily, Italy
| | - Antonio Aversa
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
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Fatima M, Brennan-Olsen SL, Duque G. Therapeutic approaches to osteosarcopenia: insights for the clinician. Ther Adv Musculoskelet Dis 2019; 11:1759720X19867009. [PMID: 31431811 PMCID: PMC6686316 DOI: 10.1177/1759720x19867009] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 07/06/2019] [Indexed: 12/19/2022] Open
Abstract
Osteopenia/osteoporosis and sarcopenia are both age-related conditions. Given the well-defined bone and muscle interaction, when osteopenia and sarcopenia occur simultaneously, this geriatric syndrome is defined as ‘osteosarcopenia’. Evidence exists about therapeutic interventions common to both bone and muscle, which could thereby be effective in treating osteosarcopenia. In addition, there are roles for common nonpharmacological strategies such as nutritional intervention and physical exercise prescription in the management of this condition. In this review we summarize the evidence on current and upcoming therapeutic approaches to osteosarcopenia.
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Affiliation(s)
- Mizhgan Fatima
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia
| | - Sharon L Brennan-Olsen
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, 176 Furlong Road, St. Albans, VIC 3021, Australia
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Corona G, Rastrelli G, Guaraldi F, Tortorici G, Reismann Y, Sforza A, Maggi M. An update on heart disease risk associated with testosterone boosting medications. Expert Opin Drug Saf 2019; 18:321-332. [PMID: 30998433 DOI: 10.1080/14740338.2019.1607290] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The cardiovascular (CV) safety of testosterone replacement therapy (TRT) remains a crucial issue in the management of subjects with late-onset hypogonadism. The authors systematically reviewed and discussed the available evidence focusing our analysis on heart-related issues. AREAS COVERED All the available data from prospective observational studies evaluating the role endogenous T levels on the risk of acute myocardial infarction (AMI) were collected and analyzed. In addition, the impact of TRT on heart-related diseases, as derived from pharmaco-epidemiological studies as well as from randomized placebo-controlled trials (RCTs), was also investigated. EXPERT OPINION Available evidence indicates that endogenous low T represents a risk factor of AMI incidence and its related mortality. TRT in hypogonadal patients is able to improve angina symptoms in subjects with ischemic heart diseases and exercise ability in patients with heart failure (HF). In addition, when prescribed according to the recommended dosage, TRT does not increase the risk of heart-related events.
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Affiliation(s)
- G Corona
- a Endocrinology Unit, Medical Department, Azienda-Usl Bologna , Maggiore-Bellaria Hospital , Bologna , Italy
| | - G Rastrelli
- b Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences , University of Florence , Florence , Italy
| | - F Guaraldi
- a Endocrinology Unit, Medical Department, Azienda-Usl Bologna , Maggiore-Bellaria Hospital , Bologna , Italy.,c Pituitary Unit , IRCCS Institute of Neurological Science of Bologna , Bologna , Italy
| | - G Tortorici
- d Cardiology Unit, Medical Department, Azienda-Usl Bologna , Maggiore Hospital , Bologna , Italy
| | - Y Reismann
- e Department of Urology , Amstelland Hospital , Amsterdam , The Netherlands
| | - A Sforza
- a Endocrinology Unit, Medical Department, Azienda-Usl Bologna , Maggiore-Bellaria Hospital , Bologna , Italy
| | - M Maggi
- b Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences , University of Florence , Florence , Italy
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Salzano A, D'Assante R, Lander M, Arcopinto M, Bossone E, Suzuki T, Cittadini A. Hormonal Replacement Therapy in Heart Failure: Focus on Growth Hormone and Testosterone. Heart Fail Clin 2019; 15:377-391. [PMID: 31079696 DOI: 10.1016/j.hfc.2019.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A growing body of evidence led to the hypothesis that heart failure (HF) could be considered a multiple hormone deficiency syndrome. Deficiencies in the main anabolic axes cannot be considered as mere epiphenomena, are very common in HF, and are clearly associated with poor cardiovascular performance and outcomes. Growth hormone deficiency and testosterone deficiency play a pivotal role and the replacement treatment is an innovative therapy that should be considered. This article appraises the current evidence regarding growth hormone and testosterone deficiencies in HF and reviews novel findings about the treatment of these conditions in HF.
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Affiliation(s)
- Andrea Salzano
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK; Department of Translational Medical Sciences, Federico II University, Via Pansini 5, Naples 80138, Italy
| | | | - Mark Lander
- Department of Acute Medicine, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK
| | - Michele Arcopinto
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, Naples 80138, Italy; Emergency Department, A Cardarelli Hospital, Via Cardarelli 9, Naples 80131, Italy
| | - Eduardo Bossone
- Cardiology Division, A Cardarelli Hospital, Via Cardarelli 9, Naples 80131, Italy
| | - Toru Suzuki
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, Naples 80138, Italy; Interdisciplinary Research Centre in Biomedical Materials (CRIB), Piazzale Tecchio 80, Naples 80125, Italy.
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Abstract
The cardiovascular system is particularly sensitive to androgens, but some controversies exist regarding the effect of testosterone on the heart. While among anabolic abusers, cases of sudden cardiac death have been described, recently it was reported that low serum level of testosterone was correlated with increased risk of cardiovascular diseases (CVD) and mortality rate. This review aims to evaluate the effect of testosterone on myocardial tissue function, coronary artery disease (CAD), and death. Low testosterone level is associated with increased incidence of CAD and mortality. Testosterone administration in hypogonadal elderly men and women has a positive effect on cardiovascular function and improved clinical outcomes and survival time. Although at supraphysiologic doses, androgen may have a toxic effect, and at physiological levels, testosterone is safe and exerts a beneficial effect on myocardial function including mechanisms at cellular and mitochondrial level. The interaction with free testosterone and estradiol should be considered. Further studies are necessary to better understand the interaction mechanisms for an optimal androgen therapy in CVD.
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Affiliation(s)
- Vittorio Emanuele Bianchi
- Clinical Center Stella Maris, Laboratory of Physiology of Exercise, Strada Rovereta 42, 47891, Falciano, Republic of San Marino.
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Pencina KM, Travison TG, Bhasin S, Li Z, Nigam N, Manning WJ, Vasan RS, Hoffmann U, O'Donnell CJ, Basaria S. Endogenous circulating testosterone and sex hormone-binding globulin levels and measures of myocardial structure and function: the Framingham Heart Study. Andrology 2019; 7:307-314. [PMID: 30761772 DOI: 10.1111/andr.12590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/14/2018] [Accepted: 01/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The relation between endogenous testosterone concentrations and myocardial mass and function remains incompletely understood. OBJECTIVES To determine the cross-sectional association between endogenous hormone levels with cardiac magnetic resonance measures of myocardial mass, structure, and function in community-dwelling men across a wide age range. METHODS A total of 720 men from the Framingham Heart Study Offspring Cohort (age range 37-82, mean = 59.6 years) who underwent cardiac magnetic resonance imaging and had hormone levels measured. Total testosterone (measured using liquid chromatography-tandem mass spectrometry), sex hormone-binding globulin (measured using an immunofluorometric assay), and calculated free testosterone levels were assessed in male participants of the Framingham Heart Study Offspring Cohort at examination 7. Cardiac magnetic resonance imaging was performed between examinations 7 and 8 (2002-2006). RESULTS Age-adjusted linear regression models showed statistically significant association between total testosterone levels and left ventricular mass (p = 0.009), left ventricular mass index (p = 0.006), cardiac output (p = 0.001), and main pulmonary artery diameter (p = 0.008); the association between total testosterone and these cardiac magnetic resonance measures was weak and was not significant after adjustment for established risk factors-age, body mass index, diabetes, and hypertension. Furthermore, calculated free testosterone level was not significantly associated with any measure of myocardial mass or function. Sex hormone-binding globulin level was significantly associated with left ventricular mass (p = 0.002), left ventricular mass index (p = 0.004), cardiac output (p = 0.003), left ventricular ejection fraction (p = 0.039), and main pulmonary artery diameter (p = 0.042) in age-adjusted models; these associations were also rendered non-significant after adjusting for cardiovascular risk factors. CONCLUSIONS Neither testosterone nor sex hormone-binding globulin levels in men are associated significantly with myocardial mass and function independent of established cardiovascular risk factors.
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Affiliation(s)
- K M Pencina
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - T G Travison
- Program on Aging, Hebrew Senior Life, Roslindale, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - S Bhasin
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Z Li
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - N Nigam
- St. Mary's Medical Center, San Francisco, CA, USA
| | - W J Manning
- Harvard Medical School, Boston, MA, USA.,Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - R S Vasan
- Framingham Heart Study, Section of Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Section of Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Department of Epidemiology, Boston University School of Medicine, Boston, MA, USA
| | - U Hoffmann
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
| | | | - S Basaria
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Walther A, Breidenstein J, Miller R. Association of Testosterone Treatment With Alleviation of Depressive Symptoms in Men: A Systematic Review and Meta-analysis. JAMA Psychiatry 2019; 76:31-40. [PMID: 30427999 PMCID: PMC6583468 DOI: 10.1001/jamapsychiatry.2018.2734] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Countering depressive disorders is a public health priority. Currently, antidepressants are the first-line treatment, although they show modest effects. In men, testosterone treatment is a controversial alternative or adjunct treatment option. OBJECTIVES To examine the association of testosterone treatment with alleviation of depressive symptoms in men and to clarify moderating effects of testosterone status, depression status, age, treatment duration, and dosage. DATA SOURCES English-language studies published in peer-reviewed journals identified from PubMed/Medline, Embase, Scopus, PsychINFO, and the Cochrane Controlled Trials Register from database inception to March 5, 2018, using the search terms testosterone, mood, administration, dosage, adverse effects, deficiency, standards, therapeutic use, therapy, treatment, and supplementation. STUDY SELECTION Randomized placebo-controlled clinical trials (RCTs) of testosterone treatment that together cover a broad age range and hypogonadal or eugonadal men reporting depressive symptoms on psychometrically validated depression scales. DATA EXTRACTION AND SYNTHESIS Of 7690 identified records, 469 were evaluated against full study inclusion criteria after removing duplicates, reviews, and studies that did not examine male patients or testosterone. Quality assessment and data extraction from the remaining 27 RCTs were performed. MAIN OUTCOMES AND MEASURES Primary outcomes were testosterone treatment effectiveness (standardized score difference after treatment), efficacy (proportion of patients who responded to testosterone treatment with a score reduction of 50% or greater), and acceptability (proportion of patients who withdrew for any reason). RESULTS Random-effects meta-analysis of 27 RCTs including 1890 men suggested that testosterone treatment is associated with a significant reduction in depressive symptoms compared with placebo (Hedges g, 0.21; 95% CI, 0.10-0.32), showing an efficacy of odds ratio (OR), 2.30 (95% CI, 1.30-4.06). There was no significant difference between acceptability of testosterone treatment and placebo (OR, 0.79; 95% CI, 0.61-1.01). Meta-regression models suggested significant interactions for testosterone treatment with dosage and symptom variability at baseline. In the most conservative bias scenario, testosterone treatment remained significant whenever dosages greater than 0.5 g/wk were administered and symptom variability was kept low. CONCLUSIONS AND RELEVANCE Testosterone treatment appears to be effective and efficacious in reducing depressive symptoms in men, particularly when higher-dosage regimens were applied in carefully selected samples. However, given the heterogeneity of the included RCTs, more preregistered trials are needed that explicitly examine depression as the primary end point and consider relevant moderators.
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Affiliation(s)
- Andreas Walther
- Department of Biological Psychology, Technische Universität Dresden, Dresden, Germany,Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland,Task Force on Men’s Mental Health of the World Federation of the Societies of Biological Psychiatry
| | - Jonas Breidenstein
- Department of Biological Psychology, Technische Universität Dresden, Dresden, Germany
| | - Robert Miller
- Department of Biological Psychology, Technische Universität Dresden, Dresden, Germany,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Traustadóttir T, Harman SM, Tsitouras P, Pencina KM, Li Z, Travison TG, Eder R, Miciek R, McKinnon J, Woodbury E, Basaria S, Bhasin S, Storer TW. Long-Term Testosterone Supplementation in Older Men Attenuates Age-Related Decline in Aerobic Capacity. J Clin Endocrinol Metab 2018; 103:2861-2869. [PMID: 29846604 PMCID: PMC6669813 DOI: 10.1210/jc.2017-01902] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 05/22/2018] [Indexed: 12/13/2022]
Abstract
CONTEXT Testosterone increases skeletal muscle mass and strength, but long-term effects of testosterone supplementation on aerobic capacity, or peak oxygen uptake (V̇O2peak), in healthy older men with low testosterone have not been evaluated. OBJECTIVE To determine the effects of testosterone supplementation on V̇O2peak during incremental cycle ergometry. DESIGN A double-blind, randomized, placebo-controlled, parallel-group trial (Testosterone's Effects on Atherosclerosis Progression in Aging Men). SETTING Exercise physiology laboratory. PARTICIPANTS Healthy men aged ≥ 60 years with total testosterone levels of 100 to 400 ng/dL (3.5 to 13.9 nmol/L) or free testosterone levels < 50 pg/mL (174 pmol/L). INTERVENTIONS Randomization to 1% transdermal testosterone gel adjusted to achieve serum levels of 500 to 950 ng/dL or placebo applied daily for 3 years. MAIN OUTCOME MEASURES Change in V̇O2peak. RESULTS Mean (±SD) baseline V̇O2peak was 24.2 ± 5.2 and 23.6 ± 5.6 mL/kg/min for testosterone and placebo, respectively. V̇O2peak did not change in men treated with testosterone but fell significantly in men receiving placebo (average 3-year decrease, 0.88 mL/kg/min; 95% CI, -1.39 to 0.38 mL/kg/min; P = 0.035); the difference in change in V̇O2peak between groups was significant (average 3-year difference, 0.91 mL/kg/min; 95% CI, 0.010 to 0.122 mL/kg/min; P = 0.008). The 1-g/dL mean increase in hemoglobin (P < 0.001) was significantly associated with changes in V̇O2peak in testosterone-treated men. CONCLUSION The mean 3-year change in V̇O2peak was significantly smaller in men treated with testosterone than in men receiving placebo and was associated with increases in hemoglobin. The difference in V̇O2peak change between groups may indicate attenuation of its expected age-related decline; the clinical meaningfulness of the modest treatment effect remains to be determined.
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Affiliation(s)
- Tinna Traustadóttir
- Northern Arizona University, Flagstaff, Arizona
- Kronos Longevity Research Institute, Phoenix, Arizona
| | - S Mitchell Harman
- Kronos Longevity Research Institute, Phoenix, Arizona
- Phoenix VA Health Care System, Phoenix, Arizona
| | - Panayiotis Tsitouras
- Kronos Longevity Research Institute, Phoenix, Arizona
- DWR Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Karol M Pencina
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Zhuoying Li
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thomas G Travison
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts
| | - Richard Eder
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Renee Miciek
- Division of Endocrinology, Boston University School of Medicine, Boston, Massachusetts
| | - Jennifer McKinnon
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Erin Woodbury
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shehzad Basaria
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shalender Bhasin
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thomas W Storer
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Correspondence and Reprint Requests: Thomas W. Storer, PhD, Research Program in Men’s Health, Aging, and Metabolism, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, Massachusetts 02115. E-mail:
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Navarro-Peñalver M, Perez-Martinez MT, Gómez-Bueno M, García-Pavía P, Lupón-Rosés J, Roig-Minguell E, Comin-Colet J, Bayes-Genis A, Noguera JA, Pascual-Figal DA. Testosterone Replacement Therapy in Deficient Patients With Chronic Heart Failure: A Randomized Double-Blind Controlled Pilot Study. J Cardiovasc Pharmacol Ther 2018; 23:543-550. [PMID: 29929385 DOI: 10.1177/1074248418784020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Testosterone deficiency is associated with heart failure (HF) progression and poor prognosis. Testosterone therapy has been shown to improve exercise capacity in patients with chronic HF, but no trial has evaluated the impact of replacement in patients with demonstrated testosterone deficiency. METHODS Prospective, randomized, double-blind, placebo-controlled, and parallel-group trial comparing testosterone replacement with placebo in males with chronic HF with reduced ejection fraction (HFrEF) and testosterone deficiency (NCT01813201). Long-acting undecanoate testosterone at a fixed dose of 1000 mg was supplied by intramuscular injection at inclusion and then every 3 months. The placebo group received isotonic saline serum. Patients were randomly allocated 1:1 to testosterone or placebo while receiving optimal medical therapy, and the study was conducted for 12 months. RESULTS The final sample comprised 29 patients, 15 in the placebo group and 14 in the testosterone group (aged 65 ± 8, 62% with an ischemic etiology, left ventricular ejection fraction [LVEF] 30% ± 6%, 69% New York Heart Association functional [NYHA II]). After 12 months, testosterone replacement increased testosterone levels ( P = .002) but was not associated with benefit in terms of clinical symptoms and functional capacity including NYHA class, Framingham score, Minnesota Living Heart Failure Questionnaire, 6-minute walk test, or LVEF and N-terminal pro-B-type natriuretic peptide levels. No significant side effects associated with testosterone treatment were observed. No effects were found in other hormonal, metabolic, and bone turnover biomarkers. CONCLUSION In patients with HFrEF and testosterone deficiency, replacement therapy was not associated with any significant improvement.
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Affiliation(s)
| | | | - Manuel Gómez-Bueno
- 2 Hospital Universitario Puerta del Hierro, Madrid, Spain.,3 CIBERCV Instituto de Salud Carlos III, Madrid, Spain
| | - Pablo García-Pavía
- 2 Hospital Universitario Puerta del Hierro, Madrid, Spain.,3 CIBERCV Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Lupón-Rosés
- 4 Hospital Universitario Germans Trias i Pujol, Badalona, Spain.,5 Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | | | - Antoni Bayes-Genis
- 3 CIBERCV Instituto de Salud Carlos III, Madrid, Spain.,4 Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | - Jose A Noguera
- 5 Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Domingo A Pascual-Figal
- 3 CIBERCV Instituto de Salud Carlos III, Madrid, Spain.,8 Department of Cardiology, University of Murcia, IMIB-Arrixaca, Murcia, Spain
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36
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Bianchi VE, Locatelli V. Testosterone a key factor in gender related metabolic syndrome. Obes Rev 2018; 19:557-575. [PMID: 29356299 DOI: 10.1111/obr.12633] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 09/21/2017] [Indexed: 12/15/2022]
Abstract
Metabolic syndrome (MetS) is highly correlated with cardiovascular diseases. Although an excess of body fat is a determinant factor for MetS development, a reduced level of testosterone plays a fundamental role in its regulation. Low testosterone level is highly related to insulin resistance, visceral obesity and MetS. We have searched in Pubmed clinical trial with the password: testosterone and insulin resistance, and testosterone and MetS. We found 19 studies on the correlation between testosterone level with insulin resistance and 18 on the effect of testosterone therapy on MetS. A high correlation between low testosterone and insulin resistance has been found in men, but not in women. Testosterone administration in hypogonadal men improved MetS and reduced the mortality risk. Androgen and oestrogen receptors are expressed in adipocytes, muscle and liver tissue, and their activation is necessary to improve metabolic control. Normalization of testosterone level should be the primary treatment in men, along with caloric restriction and physical exercise. These findings come mainly from correlative data, and there remains a need for randomized trials to strengthen this evidence. This review will consider the effects of testosterone on the regulation and development of MetS in men and women.
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Affiliation(s)
- V E Bianchi
- Nutrition and Metabolism, Clinical Center Stella Maris, Falciano, San Marino
| | - V Locatelli
- Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
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37
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Abstract
Precision (P4) medicine represents a new medical paradigm that focuses on Personalized, Predictive, Preventive and Participatory approaches. The P4 paradigm is particularly appropriate for moving the care of persons with myopenia forward. Muscular dystrophies are clearly a set of genetically different diseases where genomics are the basis of diagnosis, and genetic modulation via DNA, oligonucleotides and clustered regularly interspaced short palendronic repeats hold great potential for a cure. The utility of personalized genomics for sarcopenia coupled with utilizing a predictive approach for the diagnosis with early preventive strategies is a key to improving sarcopenic outcomes. The importance of understanding different levels of patient enthusiasm and different responses to exercise should guide the participatory phase of sarcopenic treatment. In the case of cachexia, understanding the effects of the different therapies now available through the P4 approach on muscle wasting is a key to management strategies.
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Affiliation(s)
- John E. Morley
- Division of Geriatric MedicineSaint Louis University School of Medicine1402 S. Grand Blvd., M238St. LouisMO63104USA
| | - Stefan D. Anker
- Division of Innovative Clinical Trials, Department of Cardiology and PneumologyUniversity Medical Centre GöttingenRobert‐Koch‐Straße 40, D‐37075GöttingenGermany
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38
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Han Y, Sun W, Sun G, Hou X, Gong Z, Xu J, Bai X, Fu L. A 3-year observation of testosterone deficiency in Chinese patients with chronic heart failure. Oncotarget 2017; 8:79835-79842. [PMID: 29108365 PMCID: PMC5668098 DOI: 10.18632/oncotarget.19816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/12/2017] [Indexed: 12/11/2022] Open
Abstract
Testosterone deficiency is present in a certain proportion men with chronic heart failure (CHF). Low testosterone levels in American and European patients with CHF lead to the high mortality and readmission rates. Interestingly, this relationship has not been studied in Chinese patients. To this end, 167 Chinese men with CHF underwent clinical and laboratory evaluations associated with determinations of testosterone levels. Total testosterone (TT) levels and sex hormone-binding globulin were measured by chemiluminescence or immunoassays assays and free testosterone (FT) levels were calculated, Based upon results from these assays, patients were divided into either a low testosterone (LT; n = 93) or normal testosterone (NT; n = 74) group. Subsequently, records from each patient were reviewed over a follow-up duration of at least 3 years. Patients in the LT group experienced worse cardiac function and a higher prevalence of etiology (ischemic vs. no ischemic) and comorbidity (both P < 0.05). In addition, readmission rates of patients in the LT group were higher than that of patients in the NT group (3.32 ± 1.66 VS 1.57 ± 0.89). Overall, deficiencies in FT levels were accompanied with increased mortalities (HR = 6.301, 95% CI 3.187–12.459, P < .0001).
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Affiliation(s)
- Ying Han
- Cardiovascular Department, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Weiju Sun
- Cardiovascular Department, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Guizhi Sun
- Cardiovascular Department, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Xiaolu Hou
- Cardiovascular Department, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Zhaowei Gong
- Cardiovascular Department, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Jing Xu
- Cardiovascular Department, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Xiuping Bai
- Cardiovascular Department, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Lu Fu
- Cardiovascular Department, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
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von Haehling S, Ebner N, Dos Santos MR, Springer J, Anker SD. Muscle wasting and cachexia in heart failure: mechanisms and therapies. Nat Rev Cardiol 2017; 14:323-341. [PMID: 28436486 DOI: 10.1038/nrcardio.2017.51] [Citation(s) in RCA: 215] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Body wasting is a serious complication that affects a large proportion of patients with heart failure. Muscle wasting, also known as sarcopenia, is the loss of muscle mass and strength, whereas cachexia describes loss of weight. After reaching guideline-recommended doses of heart failure therapies, the most promising approach to treating body wasting seems to be combined therapy that includes exercise, nutritional counselling, and drug treatment. Nutritional considerations include avoiding excessive salt and fluid intake, and replenishment of deficiencies in trace elements. Administration of omega-3 polyunsaturated fatty acids is beneficial in selected patients. High-calorific nutritional supplements can also be useful. The prescription of aerobic exercise training that provokes mild or moderate breathlessness has good scientific support. Drugs with potential benefit in the treatment of body wasting that have been tested in clinical studies in patients with heart failure include testosterone, ghrelin, recombinant human growth hormone, essential amino acids, and β2-adrenergic receptor agonists. In this Review, we summarize the pathophysiological mechanisms of muscle wasting and cachexia in heart failure, and highlight the potential treatment strategies. We aim to provide clinicians with the relevant information on body wasting to understand and treat these conditions in patients with heart failure.
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Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Centre and DZHK (German Centre for Cardiovascular Research), Robert-Koch-Strasse 40, D-37075 Göttingen, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Centre and DZHK (German Centre for Cardiovascular Research), Robert-Koch-Strasse 40, D-37075 Göttingen, Germany
| | - Marcelo R Dos Santos
- Department of Cardiology and Pneumology, University of Göttingen Medical Centre and DZHK (German Centre for Cardiovascular Research), Robert-Koch-Strasse 40, D-37075 Göttingen, Germany.,Heart Institute (InCor), University of Sao Paulo Medical School, Dr. Arnaldo Avenue, 455 Cerqueira César, 01246903 Sao Paulo, Brazil
| | - Jochen Springer
- Department of Cardiology and Pneumology, University of Göttingen Medical Centre and DZHK (German Centre for Cardiovascular Research), Robert-Koch-Strasse 40, D-37075 Göttingen, Germany
| | - Stefan D Anker
- Department of Cardiology and Pneumology, University of Göttingen Medical Centre and DZHK (German Centre for Cardiovascular Research), Robert-Koch-Strasse 40, D-37075 Göttingen, Germany.,Division of Cardiology and Metabolism: Heart Failure, Cachexia and Sarcopenia, Department of Internal Medicine and Cardiology, Berlin-Brandenburg Centre for Regenerative Therapies, Charité Medical School, Augustenburger Platz 1, 13353 Berlin, Germany
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Alexander GC, Iyer G, Lucas E, Lin D, Singh S. Cardiovascular Risks of Exogenous Testosterone Use Among Men: A Systematic Review and Meta-Analysis. Am J Med 2017; 130:293-305. [PMID: 27751897 DOI: 10.1016/j.amjmed.2016.09.017] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/20/2016] [Accepted: 09/20/2016] [Indexed: 01/23/2023]
Abstract
PURPOSE We sought to evaluate whether exogenous testosterone therapy is associated with increased risk of serious cardiovascular events as compared with other treatments or placebo. METHODS Study selection included randomized controlled trials (RCTs) and observational studies that enrolled men aged 18 years or older receiving exogenous testosterone for 3 or more days. The primary outcomes were death due to all causes, myocardial infarction, and stroke. Secondary outcomes were other hard clinical outcomes such as heart failure, arrhythmia, and cardiac procedures. Peto odds ratio was used to pool data from RCTs. Risk of bias was assessed using Cochrane Collaboration tool and Newcastle and Ottawa scale, respectively. The strength of evidence was evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation Working Group approach. RESULTS A total of 39 RCTs and 10 observational studies were included. Meta-analysis was done using data from 30 RCTs. Compared with placebo, exogenous testosterone treatment did not show any significant increase in risk of myocardial infarction (odds ratio [OR] 0.87; 95% CI, 0.39-1.93; 16 RCTs), stroke (OR 2.17; 95% CI, 0.63-7.54; 9 RCTs), or mortality (OR 0.88; 95% CI, 0.55-1.41; 20 RCTs). Observational studies showed marked clinical and methodological heterogeneity. The evidence was rated as very low quality due to the high risk of bias, imprecision, and inconsistency. CONCLUSIONS We did not find any significant association between exogenous testosterone treatment and myocardial infarction, stroke, or mortality in randomized controlled trials. The very low quality of the evidence precludes definitive conclusion on the cardiovascular effects of testosterone.
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Affiliation(s)
- G Caleb Alexander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md; Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, Md; Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medicine, Baltimore, Md.
| | - Geetha Iyer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md; Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, Md
| | - Eleanor Lucas
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md; Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, Md
| | - Dora Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md; Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, Md
| | - Sonal Singh
- Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, Md; Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medicine, Baltimore, Md
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Abstract
With aging and other muscle wasting diseases, men and women undergo similar pathological changes in skeletal muscle: increased inflammation, enhanced oxidative stress, mitochondrial dysfunction, satellite cell senescence, elevated apoptosis and proteasome activity, and suppressed protein synthesis and myocyte regeneration. Decreased food intake and physical activity also indirectly contribute to muscle wasting. Sex hormones also play important roles in maintaining skeletal muscle homeostasis. Testosterone is a potent anabolic factor promoting muscle protein synthesis and muscular regeneration. Estrogens have a protective effect on skeletal muscle by attenuating inflammation; however, the mechanisms of estrogen action in skeletal muscle are less well characterized than those of testosterone. Age- and/or disease-induced alterations in sex hormones are major contributors to muscle wasting. Hence, men and women may respond differently to catabolic conditions because of their hormonal profiles. Here we review the similarities and differences between men and women with common wasting conditions including sarcopenia and cachexia due to cancer, end-stage renal disease/chronic kidney disease, liver disease, chronic heart failure, and chronic obstructive pulmonary disease based on the literature in clinical studies. In addition, the responses in men and women to the commonly used therapeutic agents and their efficacy to improve muscle mass and function are also reviewed.
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Kulej-Lyko K, Majda J, von Haehling S, Doehner W, Lopuszanska M, Szklarska A, Banasiak W, Anker SD, Ponikowski P, Jankowska EA. Could gonadal and adrenal androgen deficiencies contribute to the depressive symptoms in men with systolic heart failure? Aging Male 2016; 19:221-230. [PMID: 27650467 DOI: 10.1080/13685538.2016.1208166] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Testosterone (TT) and dehydroepiandrosterone sulphate (DHEAS) are neurosteroids and their deficiencies constitute the hormone risk factors promoting the development of depression in elderly otherwise healthy men. We investigated the link between hypogonadism and depression in accordance with age and concomitant diseases in men with systolic HF using the novel scale previously dedicated for elderly population. METHODS We analysed the prevalence of depression and severity of depressive symptoms in population of 226 men with systolic HF (40-80 years) compared to 379 healthy peers. The severity of depression was assessed using the Polish long version of Geriatric Depression Scale (GDS). RESULTS In men aged 40-59 years the severity of depressive symptoms was greater in NYHA classes III-IV compared to NYHA classes I-II and reference group. In men aged 60-80 years depressive symptoms were more severe in NYHA class III-IV compared to controls (all p ≤ 0.001). In multivariate logistic regression model in men aged 40-59 years advanced NYHA class was associated with higher prevalence of mild depression (OR = 2.14, 95%CI: 1.07-4.29) and chronic obstructive pulmonary disease (COPD) with higher prevalence of severe depression (OR = 69.1, 95%CI: 2.11-2264.3). In men aged 60-80 years advanced NYHA class and TT deficiency were related to higher prevalence of mild depression (respectively: OR = 2.9, 95%CI: 1.3-6.4; OR = 3.6, 95%CI: 1.2-10.63). CONCLUSION TT deficiency, COPD and advanced NYHA class were associated with higher prevalence of depression in men with systolic HF.
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Affiliation(s)
| | - Jacek Majda
- b Laboratory Department , Military Hospital , Wroclaw , Poland
| | - Stephan von Haehling
- c Applied Cachexia Research, Department of Cardiology, Charité Medical School , Berlin , Germany
| | - Wolfram Doehner
- c Applied Cachexia Research, Department of Cardiology, Charité Medical School , Berlin , Germany
- d Center for Stroke Research Berlin, Charité Medical School , Berlin , Germany
| | - Monika Lopuszanska
- e Polish Academy of Sciences, Institute of Anthropology , Wroclaw , Poland
| | - Alicja Szklarska
- e Polish Academy of Sciences, Institute of Anthropology , Wroclaw , Poland
| | | | - Stefan D Anker
- c Applied Cachexia Research, Department of Cardiology, Charité Medical School , Berlin , Germany
- f Centre for Clinical and Basic Research, IRCCS San Raffaele , Rome , Italy , and
| | - Piotr Ponikowski
- a Centre for Heart Diseases, Military Hospital , Wroclaw , Poland
- g Laboratory for Applied Research on Cardiovascular System , Department of Heart Diseases, Wroclaw Medical University , Wroclaw , Poland
| | - Ewa A Jankowska
- a Centre for Heart Diseases, Military Hospital , Wroclaw , Poland
- e Polish Academy of Sciences, Institute of Anthropology , Wroclaw , Poland
- g Laboratory for Applied Research on Cardiovascular System , Department of Heart Diseases, Wroclaw Medical University , Wroclaw , Poland
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Abstract
Chronic heart failure (CHF) is a highly prevalent condition among the elderly and is associated with considerable morbidity, institutionalization and mortality. In its advanced stages, CHF is often accompanied by the loss of muscle mass and strength. Sarcopenia is a geriatric syndrome that has been actively studied in recent years due to its association with a wide range of adverse health outcomes. The goal of this review is to discuss the relationship between CHF and sarcopenia, with a focus on shared pathophysiological pathways and treatments. Malnutrition, systemic inflammation, endocrine imbalances, and oxidative stress appear to connect sarcopenia and CHF. At the muscular level, alterations of the ubiquitin proteasome system, myostatin signaling, and apoptosis have been described in both sarcopenia and CHF and could play a role in the loss of muscle mass and function. Possible therapeutic strategies to impede the progression of muscle wasting in CHF patients include protein and vitamin D supplementation, structured physical exercise, and the administration of angiotensin-converting enzyme inhibitors and β-blockers. Hormonal supplementation with growth hormone, testosterone, and ghrelin is also discussed as a potential treatment.
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De Spiegeleer A, Petrovic M, Boeckxstaens P, Van Den Noortgate N. Treating sarcopenia in clinical practice: where are we now? Acta Clin Belg 2016; 71:197-205. [PMID: 27112427 DOI: 10.1080/17843286.2016.1168064] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Sarcopenia - or the loss of muscle mass, strength and function with ageing - represents an important health issue of the twenty-first century because of its devastating effects in addition to an increased prevalence of aged people. The devastating health effects of sarcopenia are multiple: an increased falls risk, a decreased physical ability and quality of life and an independent increase of all-cause mortality. Although the ultimate remedy for sarcopenia yet has to be found, some interventions have proven their merit and might be of practical use in clinical practice, especially for geriatricians, who deal most with sarcopenia. This review intends to summarize the current therapeutic interventions, their proposed mechanism of action as well as their clinical value. The results of our review highlight the importance of exercise (50% resistance training, 50% endurance training), nutrition (25-30 g proteins with essential amino acids every meal and long-chain ω-3 fatty acids) and limitation of alcohol and smoking. In addition, studies also suggest a place for vitamin D (aim serum levels >30 ng/L), testosterone (aim serum levels >300 ng/dL) and creatine (15-20 g/d for five days, thereafter 3-5 g/d). In conclusion, although more studies are needed to elucidate the exact effectiveness and safety of many sarcopenia interventions, the current evidence already provides clinically useful information, which might benefit the patient with (pre-)sarcopenia.
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Sansone A, Sansone M, Lenzi A, Romanelli F. Testosterone Replacement Therapy: The Emperor's New Clothes. Rejuvenation Res 2016; 20:9-14. [PMID: 27124096 DOI: 10.1089/rej.2016.1818] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The mean age of the world population has steadily increased in the last decades, as a result of increased life expectancy and reduced birth rate. Global aging has led to a greater worldwide cost for healthcare: hormonal alterations contribute to the pathogenesis of several conditions and might cause a significant reduction in the perceived sense of well-being. Menopause is archetypal of hormonal alterations occurring during aging: in males, sex hormones do not decrease abruptly, yet testosterone levels decrease steadily and continuously during aging, ultimately resulting in late-onset hypogonadism. Treatment of this condition might mitigate most symptoms; however, testosterone replacement therapy (TRT) should be prescribed only in selected patients and it should not be considered as an antiaging treatment. In recent years, different authors have questioned health risks associated with testosterone treatment; while position statements from many scientific societies seem to be reassuring, the Food and Drug Administration has issued a warning in regard to the possible side effects of this therapy. We aim to review recent controversies and discoveries in regard to TRT.
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Affiliation(s)
- Andrea Sansone
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome , Rome, Italy
| | - Massimiliano Sansone
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome , Rome, Italy
| | - Andrea Lenzi
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome , Rome, Italy
| | - Francesco Romanelli
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome , Rome, Italy
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Storer TW, Bhasin S, Travison TG, Pencina K, Miciek R, McKinnon J, Basaria S. Testosterone Attenuates Age-Related Fall in Aerobic Function in Mobility Limited Older Men With Low Testosterone. J Clin Endocrinol Metab 2016; 101:2562-9. [PMID: 27050869 PMCID: PMC4891791 DOI: 10.1210/jc.2015-4333] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Testosterone increases skeletal muscle mass and strength, but the effects of testosterone on aerobic performance in mobility-limited older men have not been evaluated. OBJECTIVE To determine the effects of testosterone supplementation on aerobic performance, assessed as peak oxygen uptake (V̇O2peak) and gas exchange lactate threshold (V̇O2θ), during symptom-limited incremental cycle ergometer exercise. DESIGN Subgroup analysis of the Testosterone in Older Men with Mobility Limitations Trial. SETTING Exercise physiology laboratory in an academic medical center. PARTICIPANTS Sixty-four mobility-limited men 65 years or older with low total (100-350 ng/dL) or free (<50 pg/dL) testosterone. INTERVENTIONS Participants were randomized to receive 100-mg testosterone gel or placebo gel daily for 6 months. MAIN OUTCOME MEASURES V̇O2peak and V̇O2θ from a symptom-limited cycle exercise test. RESULTS Mean (SD) baseline V̇O2peak was 20.5 (4.3) and 19.9 (4.7) mL/kg/min for testosterone and placebo, respectively. V̇O2peak increased by 0.83 (2.4) mL/kg/min in testosterone but decreased by -0.89 (2.5) mL/kg/min in placebo (P = .035); between group difference in change in V̇O2peak was significant (P = .006). This 6-month reduction in placebo was greater than the expected -0.4-mL/kg/min/y rate of decline in the general population. V̇O2θ did not change significantly in testosterone but decreased by 1.1 (1.8) mL/kg/min in placebo, P = .011 for between-group comparisons. Hemoglobin increased by 1.0 ± 3.5 and 0.1 ± 0.8 g/dL in testosterone and placebo groups, respectively. CONCLUSION Testosterone supplementation in mobility-limited older men increased hemoglobin and attenuated the age-related declines in V̇O2peak and V̇O2θ. Long-term intervention studies are needed to determine the durability of this effect.
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Affiliation(s)
- Thomas W Storer
- Research Program in Men's Health: Aging and Metabolism (T.W.S., S.Bh., T.G.T., K.P., J.M., S.Ba.), Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health (R.M.), Boston, Massachusetts 02115; and Hebrew SeniorLife Institute for Aging Research (T.G.T.), Roslindale, Massachusetts 02131
| | - Shalender Bhasin
- Research Program in Men's Health: Aging and Metabolism (T.W.S., S.Bh., T.G.T., K.P., J.M., S.Ba.), Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health (R.M.), Boston, Massachusetts 02115; and Hebrew SeniorLife Institute for Aging Research (T.G.T.), Roslindale, Massachusetts 02131
| | - Thomas G Travison
- Research Program in Men's Health: Aging and Metabolism (T.W.S., S.Bh., T.G.T., K.P., J.M., S.Ba.), Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health (R.M.), Boston, Massachusetts 02115; and Hebrew SeniorLife Institute for Aging Research (T.G.T.), Roslindale, Massachusetts 02131
| | - Karol Pencina
- Research Program in Men's Health: Aging and Metabolism (T.W.S., S.Bh., T.G.T., K.P., J.M., S.Ba.), Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health (R.M.), Boston, Massachusetts 02115; and Hebrew SeniorLife Institute for Aging Research (T.G.T.), Roslindale, Massachusetts 02131
| | - Renee Miciek
- Research Program in Men's Health: Aging and Metabolism (T.W.S., S.Bh., T.G.T., K.P., J.M., S.Ba.), Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health (R.M.), Boston, Massachusetts 02115; and Hebrew SeniorLife Institute for Aging Research (T.G.T.), Roslindale, Massachusetts 02131
| | - Jennifer McKinnon
- Research Program in Men's Health: Aging and Metabolism (T.W.S., S.Bh., T.G.T., K.P., J.M., S.Ba.), Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health (R.M.), Boston, Massachusetts 02115; and Hebrew SeniorLife Institute for Aging Research (T.G.T.), Roslindale, Massachusetts 02131
| | - Shehzad Basaria
- Research Program in Men's Health: Aging and Metabolism (T.W.S., S.Bh., T.G.T., K.P., J.M., S.Ba.), Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health (R.M.), Boston, Massachusetts 02115; and Hebrew SeniorLife Institute for Aging Research (T.G.T.), Roslindale, Massachusetts 02131
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Wang W, Jiang T, Li C, Chen J, Cao K, Qi LW, Li P, Zhu W, Zhu B, Chen Y. Will testosterone replacement therapy become a new treatment of chronic heart failure? A review based on 8 clinical trials. J Thorac Dis 2016; 8:E269-77. [PMID: 27162680 DOI: 10.21037/jtd.2016.03.39] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND According to the present evidences suggesting association between low testosterone level and prediction of reduced exercise capacity as well as poor clinical outcome in patients with heart failure, we sought to determine if testosterone replacement therapy (TRT) improves clinical and cardiovascular conditions as well as quality of life status in patients with stable chronic heart failure (CHF). METHODS We carried out a review based on 8 published clinical trials to determine whether TRT will benefit patients with CHF. Information of exercise capacity, hemodynamic parameters, electrocardiogram indicators, muscle strength, echocardiography guidelines and laboratory indexes were collected to assess clinical outcomes. RESULTS We found that TRT could improve significantly exercise capacity, muscle strength and electrocardiogram indicators but no significant changes in ejection fraction (EF), systolic blood pressure (SBP), diastolic blood pressure (DBP), N-terminal pro-brain natriuretic peptide (NT-proBNP), tumor necrosis factor-α (TNF-α), high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6). CONCLUSIONS High-quality studies are required to better understand the clinical effects of testosterone.
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Affiliation(s)
- Weiwei Wang
- 1 Emergency Center, 2 Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 3 State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China ; 4 Department of Oncology, the First Affiliated Hospital of Medical University, Nanjing 210029, China ; 5 Institute of Occupational Disease Prevention and Treatment, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210028, China
| | - Ting Jiang
- 1 Emergency Center, 2 Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 3 State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China ; 4 Department of Oncology, the First Affiliated Hospital of Medical University, Nanjing 210029, China ; 5 Institute of Occupational Disease Prevention and Treatment, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210028, China
| | - Chunyu Li
- 1 Emergency Center, 2 Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 3 State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China ; 4 Department of Oncology, the First Affiliated Hospital of Medical University, Nanjing 210029, China ; 5 Institute of Occupational Disease Prevention and Treatment, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210028, China
| | - Jun Chen
- 1 Emergency Center, 2 Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 3 State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China ; 4 Department of Oncology, the First Affiliated Hospital of Medical University, Nanjing 210029, China ; 5 Institute of Occupational Disease Prevention and Treatment, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210028, China
| | - Kejiang Cao
- 1 Emergency Center, 2 Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 3 State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China ; 4 Department of Oncology, the First Affiliated Hospital of Medical University, Nanjing 210029, China ; 5 Institute of Occupational Disease Prevention and Treatment, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210028, China
| | - Lian-Wen Qi
- 1 Emergency Center, 2 Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 3 State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China ; 4 Department of Oncology, the First Affiliated Hospital of Medical University, Nanjing 210029, China ; 5 Institute of Occupational Disease Prevention and Treatment, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210028, China
| | - Ping Li
- 1 Emergency Center, 2 Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 3 State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China ; 4 Department of Oncology, the First Affiliated Hospital of Medical University, Nanjing 210029, China ; 5 Institute of Occupational Disease Prevention and Treatment, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210028, China
| | - Wei Zhu
- 1 Emergency Center, 2 Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 3 State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China ; 4 Department of Oncology, the First Affiliated Hospital of Medical University, Nanjing 210029, China ; 5 Institute of Occupational Disease Prevention and Treatment, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210028, China
| | - Baoli Zhu
- 1 Emergency Center, 2 Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 3 State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China ; 4 Department of Oncology, the First Affiliated Hospital of Medical University, Nanjing 210029, China ; 5 Institute of Occupational Disease Prevention and Treatment, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210028, China
| | - Yan Chen
- 1 Emergency Center, 2 Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 3 State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China ; 4 Department of Oncology, the First Affiliated Hospital of Medical University, Nanjing 210029, China ; 5 Institute of Occupational Disease Prevention and Treatment, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210028, China
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Dos Santos MR, Sayegh ALC, Bacurau AVN, Arap MA, Brum PC, Pereira RMR, Takayama L, Barretto ACP, Negrão CE, Alves MJDNN. Effect of Exercise Training and Testosterone Replacement on Skeletal Muscle Wasting in Patients With Heart Failure With Testosterone Deficiency. Mayo Clin Proc 2016; 91:575-86. [PMID: 27040087 DOI: 10.1016/j.mayocp.2016.02.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/03/2016] [Accepted: 02/17/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To examine whether combined testosterone replacement and exercise training (ET) therapies would potentiate the beneficial effects of isolated therapies on neurovascular control and muscle wasting in patients with heart failure (HF) with testosterone deficiency. PATIENTS AND METHODS From January 10, 2010, through July 25, 2013, 39 male patients with HF, New York Heart Association functional class III, total testosterone level less than 249 ng/dL (to convert to nmol/L, multiply by .03467), and free testosterone level less than 131 pmol/L were randomized to training (4-month cycloergometer training), testosterone (intramuscular injection of testosterone undecylate for 4 months), and training + testosterone groups. Muscle sympathetic nerve activity was measured using microneurography, forearm blood flow using plethysmography, body composition using dual X-ray absorptiometry, and functional capacity using cardiopulmonary test. Skeletal muscle biopsy was performed in the vastus lateralis. RESULTS Muscle sympathetic nerve activity decreased in ET groups (training, P<.01; training + testosterone, P<.01), whereas no changes were observed in the testosterone group (P=.89). Forearm blood flow was similar in all groups. Lean mass increased in ET groups (training, P<.01; training + testosterone, P<.01), whereas lean mass decreased in the testosterone group (P<.01). The response of cross-sectional area of type I (P<.01) and type II (P<.05) fibers increased in the training + testosterone group as compared with the isolated testosterone group. CONCLUSION Our findings provide evidence for a superior effect of combined ET and testosterone replacement therapies on muscle sympathetic nerve activity, muscle wasting, and functional capacity in patients with HF with testosterone deficiency.
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Affiliation(s)
- Marcelo R Dos Santos
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Ana L C Sayegh
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Aline V N Bacurau
- School of Physical Education and Sports, University of São Paulo, São Paulo, Brazil
| | - Marco A Arap
- Division of Urology, University of São Paulo Medical School, São Paulo, Brazil
| | - Patrícia C Brum
- School of Physical Education and Sports, University of São Paulo, São Paulo, Brazil
| | - Rosa M R Pereira
- Bone Metabolism Laboratory, Rheumatology Division, University of São Paulo Medical School, São Paulo, Brazil
| | - Liliam Takayama
- Bone Metabolism Laboratory, Rheumatology Division, University of São Paulo Medical School, São Paulo, Brazil
| | - Antônio C P Barretto
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Carlos E Negrão
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; School of Physical Education and Sports, University of São Paulo, São Paulo, Brazil
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49
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Abstract
Sarcopenia is now clinically defined as a loss of muscle mass coupled with functional deterioration (either walking speed or distance or grip strength). Based on the FRAX studies suggesting that the questions without bone mineral density can be used to screen for osteoporosis, there is now a valid simple questionnaire to screen for sarcopenia, i.e., the SARC-F. Numerous factors have been implicated in the pathophysiology of sarcopenia. These include genetic factors, mitochondrial defects, decreased anabolic hormones (e.g., testosterone, vitamin D, growth hormone and insulin growth hormone-1), inflammatory cytokine excess, insulin resistance, decreased protein intake and activity, poor blood flow to muscle and deficiency of growth derived factor-11. Over the last decade, there has been a remarkable increase in our understanding of the molecular biology of muscle, resulting in a marked increase in potential future targets for the treatment of sarcopenia. At present, resistance exercise, protein supplementation, and vitamin D have been established as the basic treatment of sarcopenia. High-dose testosterone increases muscle power and function, but has a number of potentially limiting side effects. Other drugs in clinical development include selective androgen receptor molecules, ghrelin agonists, myostatin antibodies, activin IIR antagonists, angiotensin converting enzyme inhibitors, beta antagonists, and fast skeletal muscle troponin activators. As sarcopenia is a major predictor of frailty, hip fracture, disability, and mortality in older persons, the development of drugs to treat it is eagerly awaited.
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO, 63104, USA.
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50
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Abstract
PURPOSE OF REVIEW Despite major advances in medical treatments, survival rates of chronic heart failure (CHF) have not significantly changed in the past 50 years, making it imperative to search for novel pathophysiological mechanisms and therapeutic targets. In this article, we summarize the current knowledge regarding the possibility to treat such anabolic deficiencies with hormone replacement therapy (HRT). RECENT FINDINGS Mounting evidence supports the concept that CHF is a disease characterized not only by excessive neurohormonal activation but also by a reduced anabolic drive that carries functional and prognostic significance. The recent demonstration of overall beneficial effects of HRT in CHF may pave the way to slow the disease progression in patients with coexisting CHF and hormone deficiencies. The hypothesis is to identify a considerable subset of CHF patients also affected with hormone deficiency and to treat them with HRT. SUMMARY Single or multiple HRT may in theory be performed in CHF. Such a novel approach may improve left ventricular architecture, function, and physical capacity as well as quality of life. Larger randomized, controlled trials are needed to confirm this working hypothesis.
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