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Ayele HT, Brunetti VC, Renoux C, Tagalakis V, Filion KB. Testosterone replacement therapy and the risk of venous thromboembolism: A systematic review and meta-analysis of randomized controlled trials. Thromb Res 2021; 199:123-131. [PMID: 33486321 DOI: 10.1016/j.thromres.2020.12.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The cardiovascular safety of testosterone replacement therapy (TRT) is controversial. While several studies have investigated the association between TRT and the risk of arterial thrombosis, limited information is available regarding its risk of venous thromboembolism (VTE). We aimed to compare the risk of VTE in men randomized to TRT versus placebo or active-comparator in a systematic review. METHODS We searched Medline, EMBASE, CINAHL, CENTRAL, and clinical trial registries to identify randomized controlled trials (RCTs) comparing TRT to placebo in men aged ≥18 years. We assessed study quality using the Cochrane Risk of Bias assessment tool and the overall quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Data were pooled across RCTs using random-effects models. RESULTS A total of 13 RCTs (n = 5050) were included in our meta-analysis. In all, 2636 men were randomized to testosterone, and 2414 men to placebo. Sample sizes ranged from 101 to 790 men, and TRT duration from 3 to 36 months. Five studies had a high risk of bias, largely driven by unclear randomization and outcome assessment. When data were pooled across RCTs, testosterone therapy was not associated with VTE compared with placebo (RR: 1.03, 95% CI: 0.49-2.14; I2: 0%; low-quality evidence). Similar estimates were obtained for deep vein thrombosis and pulmonary embolism outcomes. CONCLUSIONS Our systematic review suggests that TRT is not associated with an increased risk of VTE. However, estimates were accompanied by a wide 95% CIs, and a clinically important increased risk cannot be ruled out.
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Affiliation(s)
- Henok Tadesse Ayele
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, H3T 1E2, Canada; Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Cote Ste-Catherine, Montreal, Quebec, H3T 1E2, Canada.
| | - Vanessa C Brunetti
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, H3T 1E2, Canada; Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Cote Ste-Catherine, Montreal, Quebec, H3T 1E2, Canada.
| | - Christel Renoux
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, H3T 1E2, Canada; Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Cote Ste-Catherine, Montreal, Quebec, H3T 1E2, Canada; Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.
| | - Vicky Tagalakis
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, H3T 1E2, Canada; Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Cote Ste-Catherine, Montreal, Quebec, H3T 1E2, Canada; Division of General Internal Medicine, Department of Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, H3T 1E2, Canada.
| | - Kristian B Filion
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, H3T 1E2, Canada; Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Cote Ste-Catherine, Montreal, Quebec, H3T 1E2, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada.
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Zhang B, Miller VM, Miller JD. Influences of Sex and Estrogen in Arterial and Valvular Calcification. Front Endocrinol (Lausanne) 2019; 10:622. [PMID: 31620082 PMCID: PMC6763561 DOI: 10.3389/fendo.2019.00622] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/27/2019] [Indexed: 01/14/2023] Open
Abstract
Vascular and cardiac valvular calcification was once considered to be a degenerative and end stage product in aging cardiovascular tissues. Over the past two decades, however, a critical mass of data has shown that cardiovascular calcification can be an active and highly regulated process. While the incidence of calcification in the coronary arteries and cardiac valves is higher in men than in age-matched women, a high index of calcification associates with increased morbidity, and mortality in both sexes. Despite the ubiquitous portending of poor outcomes in both sexes, our understanding of mechanisms of calcification under the dramatically different biological contexts of sex and hormonal milieu remains rudimentary. Understanding how the critical context of these variables inform our understanding of mechanisms of calcification-as well as innovative strategies to target it therapeutically-is essential to advancing the fields of both cardiovascular disease and fundamental mechanisms of aging. This review will explore potential sex and sex-steroid differences in the basic biological pathways associated with vascular and cardiac valvular tissue calcification, and potential strategies of pharmacological therapy to reduce or slow these processes.
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Affiliation(s)
- Bin Zhang
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, United States
| | - Virginia M. Miller
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
| | - Jordan D. Miller
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, United States
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Jordan D. Miller
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Curran AM, Fogarty Draper C, Scott-Boyer MP, Valsesia A, Roche HM, Ryan MF, Gibney MJ, Kutmon M, Evelo CT, Coort SL, Astrup A, Saris WH, Brennan L, Kaput J. Sexual Dimorphism, Age, and Fat Mass Are Key Phenotypic Drivers of Proteomic Signatures. J Proteome Res 2017; 16:4122-4133. [DOI: 10.1021/acs.jproteome.7b00501] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Aoife M. Curran
- Institute
of Food and Health, Food for Health Ireland, University College Dublin, Dublin 4, Republic of Ireland
| | - Colleen Fogarty Draper
- Nestlé Institute of Health Sciences, 1015 Lausanne, Switzerland
- Leiden
Academic Centre for Drug Research, Analytical BioSciences, Leiden University, 2311 EZ Leiden, The Netherlands
| | - Marie-Pier Scott-Boyer
- The Microsoft Research − University of Trento Centre for Computational and Systems Biology (COSBI), 38068 Rovereto, Italy
| | - Armand Valsesia
- Nestlé Institute of Health Sciences, 1015 Lausanne, Switzerland
| | - Helen M. Roche
- Institute
of Food and Health, Food for Health Ireland, University College Dublin, Dublin 4, Republic of Ireland
- Nutrigenomics
Research Group, UCD Conway Institute of Biomolecular and Biomedical
Research and UCD Institute of Food and Health, School of Public Health,
Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4 Republic of Ireland
| | - Miriam F. Ryan
- Institute
of Food and Health, Food for Health Ireland, University College Dublin, Dublin 4, Republic of Ireland
| | - Michael J. Gibney
- Institute
of Food and Health, Food for Health Ireland, University College Dublin, Dublin 4, Republic of Ireland
| | - Martina Kutmon
- Department
of Bioinformatics − BiGCaT, School of Nutrition and Translational
Research in Metabolism and Maastricht
Centre for Systems Biology (McCSBio), Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Chris T. Evelo
- Department
of Bioinformatics − BiGCaT, School of Nutrition and Translational
Research in Metabolism and Maastricht
Centre for Systems Biology (McCSBio), Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Susan L. Coort
- Department
of Bioinformatics − BiGCaT, School of Nutrition and Translational
Research in Metabolism and Maastricht
Centre for Systems Biology (McCSBio), Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Arne Astrup
- Department
of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1165 Copenhagen, Denmark
| | - Wim H. Saris
- Department
of Human Biology, School of Nutrition and Translational Research in
Metabolism, Maastricht University Medical Centre, 6211 LK Maastricht, The Netherlands
| | - Lorraine Brennan
- Institute
of Food and Health, Food for Health Ireland, University College Dublin, Dublin 4, Republic of Ireland
| | - Jim Kaput
- Nestlé Institute of Health Sciences, 1015 Lausanne, Switzerland
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Jetty V, Glueck CJ, Freiberg RA, Wang P. Venous Thromboembolism After Knee Arthroscopy in Undiagnosed Familial Thrombophilia. Orthopedics 2016; 39:e1052-e1057. [PMID: 27459142 DOI: 10.3928/01477447-20160719-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 05/27/2016] [Indexed: 02/03/2023]
Abstract
Venous thromboembolism is uncommon after knee arthroscopy, and there are no guidelines for thromboprophylaxis in elective routine knee arthroscopy. Preoperative evaluation of common thrombophilias should provide guidance for postarthroscopy thromboprophylaxis in otherwise healthy patients who are at high risk for venous thromboembolism. This study assessed 10 patients with venous thromboembolism after total hip or knee arthroplasty. Patients were assessed if venous thromboembolism occurred within 6 months after knee arthroscopy (n=10) or total hip or knee arthroplasty (n=21). This study assessed gene mutations (factor V Leiden, prothrombin G20210A, plasminogen activator inhibitor, methylenetetrahydrofolate reductase) and serologic thrombophilias (high levels of factors VIII and XI, homocysteine, anticardiolipin immunoglobulin G and immunoglobulin M antibodies, and lupus anticoagulant; low antigenic protein C, S, and free S; and antithrombin III deficiency). The same coagulation data were obtained for normal subjects (n=110). The major thrombophilias in the arthroscopy group were factor V Leiden heterozygosity (40%), high factor VIII level (50%), and high homocysteine (30%). The respective values in control subjects were 2% (P=.0004), 7% (P=.0011), and 5% (P=.02). When the arthroscopy group was compared with the 21 patients who had venous thromboembolism after total hip or knee arthroplasty, the sole difference was factor V Leiden heterozygosity, which was 40% vs 0%, respectively (P=.007). Although venous thromboembolism after knee arthroscopy is uncommon, to identify high-risk patients and guide postoperative thromboprophylaxis, the authors suggest routine preoperative measurement of 3 common familial thrombophilias: factor V Leiden, factor VIII, and homocysteine. [Orthopedics. 2016; 39(6):e1052-e1057.].
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Abstract
BACKGROUND Postoperative portomesenteric venous thrombosis (PMVT) is a rare but potentially serious complication of gastric surgery. This study analyzed the incidence, characteristics, risk factors, and outcomes of PMVT following gastric surgery. METHODS Medical records of patients who underwent gastric surgery between January 2007 and December 2012 were reviewed retrospectively. The risk factors of PMVT were analyzed by a logistic regression analysis with control group matched 1:4 by age, sex, and cancer stage and by a Poisson regression analysis with unmatched control group. The resolution rate of PMVT in 12 months was compared between the treatment group and the nontreatment group. RESULTS The total incidence of PMVT after gastric surgery was 0.67 % (31/4611). Most (54.84 %) PMVT cases were detected within 1 month postoperatively. No accompanying deep vein thrombosis (DVT) was noted. Multivariate comparison with 1:4 matched control showed that combined splenectomy, synchronous malignancy, and intra-abdominal complication were independent risk factors. Advanced stage, combined splenectomy, and synchronous malignancy were independent risk factors in Poisson regression analysis using unmatched controls. The resolution rate of PMVT was not different from patients treated with anticoagulation (n = 6) or antiplatelet therapy (n = 1) and were not significantly different with those of the untreated group [85.7 % (6/7) vs. 82.3 % (14/17), p = 0.935] during 1-year follow up. CONCLUSIONS PMVT after gastric surgery was associated with advanced cancer stage, combined splenectomy, and synchronous malignancy, but it was not related to laparoscopy or DVT. Significant differences in the natural course of PMVT were not found between the treatment group and observation group.
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Glueck CJ, Jetty V, Goldenberg N, Shah P, Wang P. Thrombophilia in Klinefelter Syndrome With Deep Venous Thrombosis, Pulmonary Embolism, and Mesenteric Artery Thrombosis on Testosterone Therapy: A Pilot Study. Clin Appl Thromb Hemost 2016; 23:973-979. [PMID: 27582022 DOI: 10.1177/1076029616665923] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
We compared thrombophilia and hypofibrinolysis in 6 men with Klinefelter syndrome (KS), without previously known familial thrombophilia, who had sustained deep venous thrombosis (DVT)-pulmonary emboli (PE) or mesenteric artery thrombosis on testosterone replacement therapy (TRT). After the diagnosis of KS, TRT had been started in the 6 men at ages 11, 12, 13, 13, 19, and 48 years. After starting TRT, DVT-PE or mesenteric artery thrombosis was developed in 6 months, 1, 11, 11, 12, and 49 years. Of the 6 men, 4 had high (>150%) factor VIII (177%, 192%, 263%, and 293%), 3 had high (>150%) factor XI (165%, 181%, and 193%), 1 was heterozygous for the factor V Leiden mutation, and 1 was heterozygous for the G20210A prothrombin gene mutation. None of the 6 men had a precipitating event before their DVT-PE. We speculate that the previously known increased rate of DVT-PE and other thrombi in KS reflects an interaction between prothrombotic, long-term TRT with previously undiagnosed familial thrombophilia. Thrombophilia screening in men with KS before starting TRT would identify a cohort at increased risk for subsequent DVT-PE, providing an optimally informed estimate of the risk/benefit ratio of TRT.
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Affiliation(s)
- Charles J Glueck
- 1 The Jewish Hospital of Cincinnati, Dept. of Internal Medicine, Cincinnati, Ohio, USA.,2 The Cholesterol, Metabolism, and Thrombosis Center, Cincinnati, OH, USA
| | - Vybhav Jetty
- 1 The Jewish Hospital of Cincinnati, Dept. of Internal Medicine, Cincinnati, Ohio, USA.,2 The Cholesterol, Metabolism, and Thrombosis Center, Cincinnati, OH, USA
| | - Naila Goldenberg
- 1 The Jewish Hospital of Cincinnati, Dept. of Internal Medicine, Cincinnati, Ohio, USA.,2 The Cholesterol, Metabolism, and Thrombosis Center, Cincinnati, OH, USA
| | - Parth Shah
- 1 The Jewish Hospital of Cincinnati, Dept. of Internal Medicine, Cincinnati, Ohio, USA.,2 The Cholesterol, Metabolism, and Thrombosis Center, Cincinnati, OH, USA
| | - Ping Wang
- 2 The Cholesterol, Metabolism, and Thrombosis Center, Cincinnati, OH, USA
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Prince M, Glueck CJ, Shah P, Kumar A, Goldenberg M, Rothschild M, Motayar N, Jetty V, Lee K, Wang P. Hospitalization for pulmonary embolism associated with antecedent testosterone or estrogen therapy in patients found to have familial and acquired thrombophilia. BMC HEMATOLOGY 2016; 16:6. [PMID: 26958344 PMCID: PMC4782383 DOI: 10.1186/s12878-016-0045-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 02/27/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND In patients hospitalized over a 4 year period for pulmonary embolism (PE), we assessed relationships of testosterone (TT) and estrogen therapy (ET) anteceding PE in patients found to have familial-acquired thrombophilia. METHODS From 2011 through 2014, 347 patients were hospitalized in Cincinnati Mercy Hospitals with PE. Retrospective chart review was used to identify patients receiving TT or ET before PE; coagulation studies were done prospectively if necessary. RESULTS Preceding hospitalization for PE, 8 of 154 men (5 %) used TT, and 24 of 193 women (12 %) used ET. The median number of months from the initiation of TT or ET to development of PE was 7 months in men and 18 months in women. Of the 6 men having coagulation measures, all had ≥ 1 thrombophilia, and of the 18 women having measures of coagulation, 16 had ≥ 1 thrombophilia. The sensitivity of a previous history of thrombosis to predict PE was low, 25 % (2/8 men), 4 % (1/24 women). CONCLUSIONS Of 154 men hospitalized for PE, 8 (5 %) used TT, and of 193 women, 24 (12 %) used ET. Our data suggests that PE is an important complication of TT in men and ET in women, in part reflecting an interaction between familial and acquired thrombophilia and exogenous hormone use.
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Affiliation(s)
- Marloe Prince
- From the Internal Medicine Residency Program, Cholesterol, Metabolism, and Thrombosis Center of the Jewish Hospital of Cincinnati, 2135 Dana Avenue, Suite 430, Cincinnati, OH 45207 USA
| | - Charles J. Glueck
- From the Internal Medicine Residency Program, Cholesterol, Metabolism, and Thrombosis Center of the Jewish Hospital of Cincinnati, 2135 Dana Avenue, Suite 430, Cincinnati, OH 45207 USA
| | - Parth Shah
- From the Internal Medicine Residency Program, Cholesterol, Metabolism, and Thrombosis Center of the Jewish Hospital of Cincinnati, 2135 Dana Avenue, Suite 430, Cincinnati, OH 45207 USA
| | - Ashwin Kumar
- From the Internal Medicine Residency Program, Cholesterol, Metabolism, and Thrombosis Center of the Jewish Hospital of Cincinnati, 2135 Dana Avenue, Suite 430, Cincinnati, OH 45207 USA
| | - Michael Goldenberg
- From the Internal Medicine Residency Program, Cholesterol, Metabolism, and Thrombosis Center of the Jewish Hospital of Cincinnati, 2135 Dana Avenue, Suite 430, Cincinnati, OH 45207 USA
| | - Matan Rothschild
- From the Internal Medicine Residency Program, Cholesterol, Metabolism, and Thrombosis Center of the Jewish Hospital of Cincinnati, 2135 Dana Avenue, Suite 430, Cincinnati, OH 45207 USA
| | - Nasim Motayar
- From the Internal Medicine Residency Program, Cholesterol, Metabolism, and Thrombosis Center of the Jewish Hospital of Cincinnati, 2135 Dana Avenue, Suite 430, Cincinnati, OH 45207 USA
| | - Vybhav Jetty
- From the Internal Medicine Residency Program, Cholesterol, Metabolism, and Thrombosis Center of the Jewish Hospital of Cincinnati, 2135 Dana Avenue, Suite 430, Cincinnati, OH 45207 USA
| | - Kevin Lee
- From the Internal Medicine Residency Program, Cholesterol, Metabolism, and Thrombosis Center of the Jewish Hospital of Cincinnati, 2135 Dana Avenue, Suite 430, Cincinnati, OH 45207 USA
| | - Ping Wang
- From the Internal Medicine Residency Program, Cholesterol, Metabolism, and Thrombosis Center of the Jewish Hospital of Cincinnati, 2135 Dana Avenue, Suite 430, Cincinnati, OH 45207 USA
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