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Pan Z, Xu X, Xu X, Wu S, Zhang Z, Liu S, Liu Z, Tu B, Chen C, Qin Y, He J. Prevalence and outcomes of atrial fibrillation in patients suffering prostate cancer: a national analysis in the United States. Front Cardiovasc Med 2024; 11:1382166. [PMID: 38638883 PMCID: PMC11025351 DOI: 10.3389/fcvm.2024.1382166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
Purpose Although the adverse effects of atrial fibrillation (AF) on cancers have been well reported, the relationship between the AF and the adverse outcomes in prostate cancer (PC) remains inconclusive. This study aimed to explore the prevalence of AF and evaluate the relationship between AF and clinical outcomes in PC patients. Methods Patients diagnosed with PC between 2008 and 2017 were identified from the National Inpatient Sample database. The trends in AF prevalence were compared among PC patients and their subgroups. Multivariable regression models were used to assess the associations between AF and in-hospital mortality, length of hospital stay, total cost, and other clinical outcomes. Results 256,239 PC hospitalizations were identified; 41,356 (83.8%) had no AF and 214,883 (16.2%) had AF. AF prevalence increased from 14.0% in 2008 to 20.1% in 2017 (P < .001). In-hospital mortality in PC inpatients with AF increased from 5.1% in 2008 to 8.1% in 2017 (P < .001). AF was associated with adverse clinical outcomes, such as in-hospital mortality, congestive heart failure, pulmonary circulation disorders, renal failure, fluid and electrolyte disorders, cardiogenic shock, higher total cost, and longer length of hospital stay. Conclusions The prevalence of AF among inpatients with PC increased from 2008 to 2017. AF was associated with poor prognosis and higher health resource utilization. Better management strategies for patients with comorbid PC and AF, particularly in older individuals, are required.
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Affiliation(s)
- Zhemin Pan
- Tongji University School of Medicine, Shanghai, China
| | - Xiao Xu
- Tongji University School of Medicine, Shanghai, China
| | - Xi Xu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shengyong Wu
- Department of Military Health Statistics, Naval Medical University, Shanghai, China
| | - Zhensheng Zhang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Suxuan Liu
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhijian Liu
- Department of Nursing, The 940 Hospital of Joint Logistic Support Force of PLA, Lanzhou, China
| | - Boxiang Tu
- Department of Military Health Statistics, Naval Medical University, Shanghai, China
| | - Chenxin Chen
- Department of Military Health Statistics, Naval Medical University, Shanghai, China
| | - Yingyi Qin
- Department of Military Health Statistics, Naval Medical University, Shanghai, China
| | - Jia He
- Tongji University School of Medicine, Shanghai, China
- Department of Military Health Statistics, Naval Medical University, Shanghai, China
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Li W, Cheng X, Zhu G, Hu Y, Wang Y, Niu Y, Li H, Aierken A, Li J, Feng L, Liu G. A review of chemotherapeutic drugs-induced arrhythmia and potential intervention with traditional Chinese medicines. Front Pharmacol 2024; 15:1340855. [PMID: 38572424 PMCID: PMC10987752 DOI: 10.3389/fphar.2024.1340855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/05/2024] [Indexed: 04/05/2024] Open
Abstract
Significant advances in chemotherapy drugs have reduced mortality in patients with malignant tumors. However, chemotherapy-related cardiotoxicity increases the morbidity and mortality of patients, and has become the second leading cause of death after tumor recurrence, which has received more and more attention in recent years. Arrhythmia is one of the common types of chemotherapy-induced cardiotoxicity, and has become a new risk related to chemotherapy treatment, which seriously affects the therapeutic outcome in patients. Traditional Chinese medicine has experienced thousands of years of clinical practice in China, and has accumulated a wealth of medical theories and treatment formulas, which has unique advantages in the prevention and treatment of malignant diseases. Traditional Chinese medicine may reduce the arrhythmic toxicity caused by chemotherapy without affecting the anti-cancer effect. This paper mainly discussed the types and pathogenesis of secondary chemotherapeutic drug-induced arrhythmia (CDIA), and summarized the studies on Chinese medicine compounds, Chinese medicine Combination Formula and Chinese medicine injection that may be beneficial in intervention with secondary CDIA including atrial fibrillation, ventricular arrhythmia and sinus bradycardia, in order to provide reference for clinical prevention and treatment of chemotherapy-induced arrhythmias.
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Affiliation(s)
- Weina Li
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaozhen Cheng
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guanghui Zhu
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ying Hu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine (National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion), Tianjin, China
| | - Yunhan Wang
- Henan Province Hospital of Traditional Chinese Medicine (The Second Affiliated Hospital of Henan University of Traditional Chinese Medicine), Zhengzhou, Henan, China
| | - Yueyue Niu
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hongping Li
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Aikeremu Aierken
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jie Li
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ling Feng
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guifang Liu
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Tamargo J, Villacastín J, Caballero R, Delpón E. Drug-induced atrial fibrillation. A narrative review of a forgotten adverse effect. Pharmacol Res 2024; 200:107077. [PMID: 38244650 DOI: 10.1016/j.phrs.2024.107077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/22/2023] [Accepted: 01/12/2024] [Indexed: 01/22/2024]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with an increased morbidity and mortality. There is clinical evidence that an increasing number of cardiovascular and non-cardiovascular drugs, mainly anticancer drugs, can induce AF either in patients with or without pre-existing cardiac disorders, but drug-induced AF (DIAF) has not received the attention that it might deserve. In many cases DIAF is asymptomatic and paroxysmal and patients recover sinus rhythm spontaneously, but sometimes, DIAF persists, and it is necessary to perform a cardioversion. Furthermore, DIAF is not mentioned in clinical guidelines on the treatment of AF. The risk of DIAF increases in elderly and in patients treated with polypharmacy and with risk factors and comorbidities that commonly coexist with AF. This is the case of cancer patients. Under these circumstances ascribing causality of DIAF to a given drug often represents a clinical challenge. We review the incidence, the pathophysiological mechanisms, risk factors, clinical relevance, and treatment of DIAF. Because of the limited information presently available, further research is needed to obtain a deeper insight into DIAF. Meanwhile, it is important that clinicians are aware of the problem that DIAF represents, recognize which drugs may cause DIAF, and consider the possibility that a drug may be responsible for a new-onset AF episode.
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Affiliation(s)
- Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, 28040 Madrid, Spain
| | - Julián Villacastín
- Hospital Clínico San Carlos, CardioRed1, Universidad Complutense de Madrid, CIBERCV, 28040 Madrid, Spain
| | - Ricardo Caballero
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, 28040 Madrid, Spain.
| | - Eva Delpón
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, 28040 Madrid, Spain
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4
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Xu B, Mo W, Tan X, Zhang P, Huang J, Huang C, Guo D, Wei X, Liu Y, Lei X, Dou W, Lin J, Liu D, Yang L, Huang Y, Zhang H, Liao Y. Associations of Serum Testosterone and Sex Hormone-binding Globulin With Incident Arrhythmias in Men From UK Biobank. J Clin Endocrinol Metab 2024; 109:e745-e756. [PMID: 37665960 DOI: 10.1210/clinem/dgad526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/06/2023]
Abstract
CONTEXT Sex hormones have been identified as cardiovascular risk factors, whereas the relationship between sex hormones and the risk of arrhythmias in men has not yet been well studied in the prospective cohort study. OBJECTIVE To analyze associations of serum testosterone and SHBG concentrations and calculate free testosterone (cFT) with arrhythmias in men. METHODS Sex hormones were measured at baseline from UK Biobank. Main outcomes were incidence of atrial fibrillation/flutter (AF), ventricular arrhythmia (VA), and bradyarrhythmia (BA). RESULTS Of 173 498 men (aged 37-73 years, followed for 11 years), 11 368 had incident AF, 1646 had incident VA, and 4788 had incident BA. Compared with the third quartiles, the lowest category of serum testosterone was associated with increased risks of AF (hazard ratio [HR], 1.06; 95% CI, 1.00-1.12) and BA (HR, 1.11; 95% CI, 1.02-1.20) after multivariable adjustment, but no VA. Likewise, similar associations were found between cFT values and AF and BA events. Furthermore, higher levels of cFT were associated with increased risks of AF (HR, 1.07; 95% CI, 1.02-1.13) and VA (HR, 1.18; 95% CI, 1.01-1.37). Higher SHBG concentrations were associated with increased risks of AF (HR, 1.44; 95% CI, 1.34-1.54), VA (HR, 1.27; 95% CI, 1.07-1.52), and BA (HR, 1.17; 95% CI ,1.05-1.29). CONCLUSIONS Lower levels of testosterone and cFT were associated with increased risk of AF and BA. Higher cFT levels were associated with increased risk of AF and VA. Higher SHBG levels were associated with increased risk of AF, VA, and BA.
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Affiliation(s)
- Bingyan Xu
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Wei Mo
- Department of Endocrinology & Metabolism, Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou 510095, China
| | - Xiangliang Tan
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Peizhen Zhang
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Junlin Huang
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Chensihan Huang
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Dan Guo
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Xueyun Wei
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Yating Liu
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Xuzhen Lei
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Weijuan Dou
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Jiayang Lin
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Deying Liu
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Linjie Yang
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Yan Huang
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Huijie Zhang
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
- Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Yunfei Liao
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Traish AM. Major cardiovascular disease risk in men with testosterone deficiency (hypogonadism): appraisal of short, medium and long-term testosterone therapy - a narrative review. Sex Med Rev 2023; 11:384-394. [PMID: 37587664 DOI: 10.1093/sxmrev/qead031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Low testosterone (T) levels are associated with obesity, metabolic syndrome, type 2 diabetes mellitus and altered lipid profiles, thus contributing to increased cardiovascular disease risk. Hence T deficiency has a detrimental effect on men's vascular health, quality of life and increased mortality. OBJECTIVES This review aims to present summary of data in the contemporary clinical literature pertaining to the benefits of T therapy in clinical studies with varying durations on vascular health in men with T deficiency. METHODS A Medline search using PubMed and EMBASE was performed using the following key words: "testosterone deficiency," "testosterone therapy," major cardiovascular adverse events", "cardiovascular disease". Relevant studies were extracted, evaluated, and analyzed. We evaluated findings from clinical trials, observational studies and systematic reviews and meta-analyses to develop a comprehensive account of the critical role of T in maintaining vascular health. RESULTS Considerable evidence beginning with studies published in 1940s concomitant with findings from the utmost recent clinical studies suggests a clinical value of T therapy in maintaining vascular health and reducing cardiovascular mortality. The current scientific and clinical evidence demonstrates strong relationship between low circulating T levels and risk of cardiovascular disease and T therapy is deemed safe in men with hypogonadism when given in the physiological range with no apparent harm. CONCLUSION What emerges from the current clinical literature is that, irrespective of the length of study durations, testosterone therapy provides significant health benefits and reduces risk of cardiovascular disease. More important is that data from many observational and registry studies, demonstrated that longer durations of testosterone therapy were associated with greater health benefits and reduced cardiovascular risk. T therapy in men with T deficiency reduces the incidence of major adverse cardiovascular events attributed to improving overall metabolic function.
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Affiliation(s)
- Abdulmaged M Traish
- Department of Biochemistry & Department of Urology, Boston University School of Medicine, Boston, MA 02118, United States
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6
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Oh AR, Kwon JH, Park J, Lee JH. Age-Related Association between Sex and Postoperative Atrial Fibrillation in Non-Cardiac Surgery Patients: Observational Cohort Study. Rev Cardiovasc Med 2023; 24:271. [PMID: 39076407 PMCID: PMC11270114 DOI: 10.31083/j.rcm2409271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 07/31/2024] Open
Abstract
Background Postoperative atrial fibrillation (POAF) is a common complication that has shown conflicting results regarding sex differences. The potential effect of age on this association has not been adequately explored. We hypothesized that younger males would have a higher risk of POAF than females and that this difference would vary by age group. Methods In this observational cohort study, we enrolled consecutive patients who underwent non-cardiac surgery between January 2011 and June 2019 at our institution and excluded those with preoperative atrial fibrillation and those undergoing sex-specific surgery. We stratified the patients into four groups based on their sex and age: females younger than 50 years, females older than 50 years, males younger than 50 years, and males older than 50 years. The primary outcome was the incidence of POAF. Results Of the 141,337 patients included in the study, 6414 (4.5%) were treated for POAF. The incidence of POAF was highest in males older than 50 years (7.4%), followed by females older than 50 years (4.6%), males younger than 50 years (2.1%), and females younger than 50 years (1.9%). After adjusting for potential confounding factors, the risk of POAF was significantly increased in all groups compared with females younger than 50 years, with an odds ratio (OR) of 2.43 (95% confidence interval [CI]: 2.17-2.73, p < 0.001) for females older than 50 years, 1.19 (95% CI: 1.05-1.35, p = 0.01) for males younger than 50 years, and 4.39 (95% CI: 3.91-4.94, p < 0.001) for males older than 50 years. The OR for POAF risk according to sex peaked between 60 and 70 years old and decreased gradually thereafter. Conclusions Our study suggests that sex and age are important factors associated with the risk of POAF in non-cardiac surgery patients and that sex-specific and age-specific risk stratification and interventions might be needed to prevent and manage POAF in non-cardiac surgery patients. Further studies are needed to better understand the underlying mechanisms of sex and age differences in POAF and to develop more targeted and effective interventions to reduce the incidence of this common postoperative complication.
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Affiliation(s)
- Ah Ran Oh
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center,
Sungkyunkwan University School of Medicine, 06351 Seoul, Republic of Korea
| | - Ji-Hye Kwon
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center,
Sungkyunkwan University School of Medicine, 06351 Seoul, Republic of Korea
| | - Jungchan Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center,
Sungkyunkwan University School of Medicine, 06351 Seoul, Republic of Korea
| | - Jong-Hwan Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center,
Sungkyunkwan University School of Medicine, 06351 Seoul, Republic of Korea
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7
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Lincoff AM, Bhasin S, Flevaris P, Mitchell LM, Basaria S, Boden WE, Cunningham GR, Granger CB, Khera M, Thompson IM, Wang Q, Wolski K, Davey D, Kalahasti V, Khan N, Miller MG, Snabes MC, Chan A, Dubcenco E, Li X, Yi T, Huang B, Pencina KM, Travison TG, Nissen SE. Cardiovascular Safety of Testosterone-Replacement Therapy. N Engl J Med 2023; 389:107-117. [PMID: 37326322 DOI: 10.1056/nejmoa2215025] [Citation(s) in RCA: 88] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND The cardiovascular safety of testosterone-replacement therapy in middle-aged and older men with hypogonadism has not been determined. METHODS In a multicenter, randomized, double-blind, placebo-controlled, noninferiority trial, we enrolled 5246 men 45 to 80 years of age who had preexisting or a high risk of cardiovascular disease and who reported symptoms of hypogonadism and had two fasting testosterone levels of less than 300 ng per deciliter. Patients were randomly assigned to receive daily transdermal 1.62% testosterone gel (dose adjusted to maintain testosterone levels between 350 and 750 ng per deciliter) or placebo gel. The primary cardiovascular safety end point was the first occurrence of any component of a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke, assessed in a time-to-event analysis. A secondary cardiovascular end point was the first occurrence of any component of the composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or coronary revascularization, assessed in a time-to-event analysis. Noninferiority required an upper limit of less than 1.5 for the 95% confidence interval of the hazard ratio among patients receiving at least one dose of testosterone or placebo. RESULTS The mean (±SD) duration of treatment was 21.7±14.1 months, and the mean follow-up was 33.0±12.1 months. A primary cardiovascular end-point event occurred in 182 patients (7.0%) in the testosterone group and in 190 patients (7.3%) in the placebo group (hazard ratio, 0.96; 95% confidence interval, 0.78 to 1.17; P<0.001 for noninferiority). Similar findings were observed in sensitivity analyses in which data on events were censored at various times after discontinuation of testosterone or placebo. The incidence of secondary end-point events or of each of the events of the composite primary cardiovascular end point appeared to be similar in the two groups. A higher incidence of atrial fibrillation, of acute kidney injury, and of pulmonary embolism was observed in the testosterone group. CONCLUSIONS In men with hypogonadism and preexisting or a high risk of cardiovascular disease, testosterone-replacement therapy was noninferior to placebo with respect to the incidence of major adverse cardiac events. (Funded by AbbVie and others; TRAVERSE ClinicalTrials.gov number, NCT03518034.).
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Affiliation(s)
- A Michael Lincoff
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Shalender Bhasin
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Panagiotis Flevaris
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Lisa M Mitchell
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Shehzad Basaria
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - William E Boden
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Glenn R Cunningham
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Christopher B Granger
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Mohit Khera
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Ian M Thompson
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Qiuqing Wang
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Kathy Wolski
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Deborah Davey
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Vidyasagar Kalahasti
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Nader Khan
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Michael G Miller
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Michael C Snabes
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Anna Chan
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Elena Dubcenco
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Xue Li
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Tingting Yi
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Bidan Huang
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Karol M Pencina
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Thomas G Travison
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Steven E Nissen
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
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8
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Font J, Milliez P, Ouazar AB, Klok FA, Alexandre J. Atrial fibrillation, cancer and anticancer drugs. Arch Cardiovasc Dis 2023; 116:219-226. [PMID: 37002156 DOI: 10.1016/j.acvd.2023.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 04/18/2023]
Abstract
Active cancer is associated with an increased risk of atrial fibrillation (AF), which varies depending on the pre-existing substrate (particularly in older patients), the cancer type and stage, and the anticancer therapeutics being taken. To date, studies have not been able to identify the individual contribution of each factor. During anticancer drug therapy, AF may occur with a frequency of ≈ 15-20% according to several factors, including the patient's baseline cardiovascular toxicity risk and the AF-detection strategies used. Many anticancer drugs have been associated with AF or AF reporting, both in terms of incident and recurrent AF, but robust data are lacking. Only bruton tyrosine kinase inhibitor associated AF (mainly ibrutinib) has a high level of evidence, with a ≈ 3-4-fold higher risk of AF. AF in patients with active cancer is associated with a twofold higher risk of systemic thromboembolism or stroke, and the "TBIP" (Thromboembolic risk, Bleeding risk, drug-drug Interactions, Patient preferences) structured approach must be used to evaluate the need for anticoagulation therapy. AF in patients with active cancer is also associated with a sixfold higher risk of heart failure, and optimal symptom control must be targeted, usually with rate-control drugs (beta-blockers), but a rhythm-control strategy may be proposed in patients remaining symptomatic despite optimal rate-control. AF is generally manageable, with the continuation of anticancer drugs (including ibrutinib); interruption of cancer drugs must be avoided whenever possible and weighed against the risk of cancer progression.
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Affiliation(s)
- Jonaz Font
- Normandie University, UNICAEN, Inserm U1086 Anticipe, avenue du Général-Harris, 14000 Caen, France; CHU de Caen-Normandie, Department of Cardiology, avenue de la Côte de Nacre, 14000 Caen, France
| | - Paul Milliez
- CHU de Caen-Normandie, Department of Cardiology, avenue de la Côte de Nacre, 14000 Caen, France; Normandie University, UNICAEN, Inserm U1237 PhIND, GIP Cyceron, boulevard Henri-Becquerel, 14000 Caen, France
| | | | - Frederikus A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, Netherlands
| | - Joachim Alexandre
- Normandie University, UNICAEN, Inserm U1086 Anticipe, avenue du Général-Harris, 14000 Caen, France; CHU de Caen-Normandie, PICARO Cardio-Oncology Program, Department of Pharmacology, avenue de la Côte de Nacre, 14000 Caen, France.
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9
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Berni AC, Wamboldt R, Baranchuk A. Arrhythmias in transgender individuals. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2023; 93:18-22. [PMID: 37992702 PMCID: PMC10665108 DOI: 10.24875/acm.m23000089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 11/24/2023] Open
Abstract
The need to improve access to health services for the transgender community has become evident, especially concerning cardiovascular risk, which is higher compared to the general population. Surgical procedures and hormone therapies are common in this population to affirm gender identity, but they pose challenges as they are associated with disruptions in lipid metabolism, body fat concentration, and insulin resistance. Additionally, there is an increased risk of adverse cardiovascular events such as venous thromboembolism, stroke, and myocardial infarction. The influence of sex hormones on the electrophysiological properties of the heart has been studied, highlighting gender differences that may predispose the transgender population to cardiac arrhythmias. Exogenous hormone therapy, for both transgender women and men, can affect the QT interval and increase the risk of arrhythmias, including atrial fibrillation. Although the incidence of arrhythmias in the transgender population is not entirely clear, evidence suggests the need for careful cardiovascular monitoring and consideration of risk factors before initiating hormone therapies.
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Affiliation(s)
- Ana C. Berni
- Departamento de Cardiología, Laboratorio de Arritmias, Hospital Ángeles Pedregal, Ciudad de México, México
| | - Rachel Wamboldt
- Departamento de Cardiología, Kingston Health Science Center, Queen’s University, Kingston, Canada
| | - Adrián Baranchuk
- Departamento de Cardiología, Kingston Health Science Center, Queen’s University, Kingston, Canada
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10
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Yerly A, van der Vorst EPC, Baumgartner I, Bernhard SM, Schindewolf M, Döring Y. Sex-specific and hormone-related differences in vascular remodelling in atherosclerosis. Eur J Clin Invest 2023; 53:e13885. [PMID: 36219492 DOI: 10.1111/eci.13885] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/04/2022] [Indexed: 12/24/2022]
Abstract
Atherosclerosis, a lipid-driven inflammatory disease, is the main underlying cause of cardiovascular diseases (CVDs) both in men and women. Sex-related dimorphisms regarding CVDs and atherosclerosis were observed since more than a decade ago. Inflammatory mediators such as cytokines, but also endothelial dysfunction, vascular smooth muscle cell migration and proliferation lead to vascular remodelling but are differentially affected by sex. Each year a greater number of men die of CVDs compared with women and are also affected by CVDs at an earlier age (40-70 years old) while women develop atherosclerosis-related complications mainly after menopause (60+ years). The exact biological reasons behind this discrepancy are still not well-understood. From the numerous animal studies on atherosclerosis, only a few include both sexes and even less investigate and highlight the sex-specific differences that may arise. Endogenous sex hormones such as testosterone and oestrogen modulate the atherosclerotic plaque composition and the frequency of such plaques. In men, testosterone seems to act like a double-edged sword as its decrease with ageing correlates with an increased risk of atherosclerotic CVDs, while testosterone is also reported to promote inflammatory immune cell recruitment into the atherosclerotic plaque. In premenopausal women, oestrogen exerts anti-atherosclerotic effects, which decline together with its level after menopause resulting in increased CVD risk in ageing women. However, the interplay of sex hormones, sex-specific immune responses and other sex-related factors is still incompletely understood. This review highlights reported sex differences in atherosclerotic vascular remodelling and the role of endogenous sex hormones in this process.
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Affiliation(s)
- Anaïs Yerly
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland.,Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Emiel P C van der Vorst
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University Munich (LMU), Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.,Institute for Molecular Cardiovascular Research (IMCAR) and Interdisciplinary Center for Clinical Research (IZKF), RWTH Aachen University, Aachen, Germany
| | - Iris Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Sarah Maike Bernhard
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Marc Schindewolf
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Yvonne Döring
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland.,Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University Munich (LMU), Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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11
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Morgentaler A, Traish A, Barua RS, Dandona P, Dhindsa S, Khera M, Saad F. Recognizing the True Value of Testosterone Therapy in Health Care. ANDROGENS: CLINICAL RESEARCH AND THERAPEUTICS 2022; 3:217-223. [PMID: 36643964 PMCID: PMC9814113 DOI: 10.1089/andro.2022.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 12/30/2022]
Abstract
There has been little recognition within the medical community of the health impact of testosterone (T) deficiency (TD), also known as hypogonadism, and the substantial benefits of testosterone therapy (TTh) on health and quality of life despite high-level clinical evidence. In a roundtable symposium, investigators summarized the contemporary evidence in several key clinical areas. TD negatively impacts human health and quality of life and is associated with increased mortality. Several studies have demonstrated that TTh in men with TD reduced all-cause and cardiovascular mortality. The longstanding belief that TTh is associated with increased prostate cancer (PCa) risk is contradicted by recent evidence, including multiple studies showing that TTh is associated with reduced PCa risk. Similarly, the weight of current evidence indicates the purported concern that TTh is associated with increased cardiovascular risk is incorrect. Normalization of physiological T reduces myocardial infarction, stroke, and deaths compared with men whose testosterone levels failed to normalize. In diabetic men TTh improves insulin resistance, and a large 2-year controlled study in men with abnormal glucose tolerance showed a substantially reduced rate of diabetes among men treated with TTh compared with untreated controls. Long-term TTh in diabetic men resulted in progressive improvements in obesity and insulin requirements, including a substantial number who experienced complete remission of diabetes. Finally, TTh has been shown to reduce severe outcomes with Covid-19 infection. These lines of evidence argue strongly for the need for greater awareness in the medical community of the impact of TD on health, and of the health benefits of TTh.
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Affiliation(s)
- Abraham Morgentaler
- Department of Surgery (Urology), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Abdulmaged Traish
- Departments of Urology and Biochemistry, Boston University School of Medicine, Boston, Massachusetts, USA.,Medical Affairs, Bayer AG, Leverkusen, Germany
| | - Rajat S Barua
- Department of Cardiology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Paresh Dandona
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Buffalo, New York, USA
| | - Sandeep Dhindsa
- Division of Endocrinology, Diabetes and Metabolism, Saint Louis University, St. Louis, Missouri, USA
| | - Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA
| | - Farid Saad
- Medical Affairs, Bayer AG, Berlin, Germany
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12
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Thirumalai A, Anawalt BD. Relationships between endogenous and exogenous testosterone and cardiovascular disease in men. Rev Endocr Metab Disord 2022; 23:1305-1322. [PMID: 36219323 DOI: 10.1007/s11154-022-09752-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 01/11/2023]
Abstract
In this narrative review, we discuss the evidence about the controversy about the cardiovascular effects of endogenous and exogenous testosterone in men. Prospective cohort studies with follow-up of ~5-15 years generally indicate no association or a possible inverse relationship between serum endogenous testosterone concentrations and composite major cardiovascular events, cardiovascular deaths and overall mortality. Pharmacoepidemiological studies of large databases generally show no association between testosterone therapy and incident major cardiovascular events, and some pharmacoepidemiological studies demonstrate an association with decreased overall mortality. Randomized, placebo-controlled trials indicate that there is no increased incidence of overall major cardiovascular events with 1-3 years of testosterone therapy. These placebo-controlled trials have major limitations including small numbers of participants, short duration of testosterone therapy and follow-up, and lack of systematic adjudication of cardiovascular events. Overall, the evidence indicates that endogenous testosterone concentrations and testosterone therapy at physiological dosages confer no or minimal effects on the incidence of cardiovascular outcomes. There is insufficient evidence to make conclusions about testosterone therapy for patients at high risk of cardiovascular events (e.g., men with recent myocardial infarctions or stroke and men with recurrent idiopathic deep venous thromboses). In general, clinicians should avoid prescribing supraphysiological testosterone therapy to hypogonadal men or men with slightly low to low-normal serum testosterone concentrations and no identified disorder of the hypothalamus-pituitary-testicular axis because of the uncertain cardiovascular risks and the lack of proven health benefits. For most men with bona fide hypogonadism, benefits of testosterone therapy exceed the potential risk of adverse cardiovascular effects.
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Affiliation(s)
- Arthi Thirumalai
- Department of Medicine, University of Washington School of Medicine, Box 356420 Department of Medicine, 1959 NE Pacific Avenue, Seattle, WA, 98195, USA
| | - Bradley D Anawalt
- Department of Medicine, University of Washington School of Medicine, Box 356420 Department of Medicine, 1959 NE Pacific Avenue, Seattle, WA, 98195, USA.
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13
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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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14
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Gonçalves-Teixeira P, Costa T, Fragoso I, Ferreira D, Brandão M, Leite-Moreira A, Sampaio F, Ribeiro J, Fontes-Carvalho R. Screening, Diagnosis and Management of Atrial Fibrillation in Cancer Patients: Current Evidence and Future Perspectives. Arq Bras Cardiol 2022; 119:328-341. [PMID: 35946695 PMCID: PMC9363048 DOI: 10.36660/abc.20201362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/12/2021] [Indexed: 11/18/2022] Open
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the general population, carrying a high morbimortality burden, and this also holds true in cancer patients. The association between AF and cancer goes even further, with some studies suggesting that AF can be a marker of occult cancer. There is, however, a remarkable paucity of data concerning specific challenges of AF management in cancer patients. AF prompt recognition and management in this special population can lessen the arrhythmia-related morbidity and have an important prognostic benefit. This review will focus on current AF diagnosis and management challenges in cancer patients, with special emphasis on AF screening strategies and devices, and anticoagulation therapy with non-vitamin K antagonist oral anti-coagulants (NOACs) for thromboembolic prevention in these patients. Some insights concerning future perspectives for AF prevention, diagnosis, and treatment in this special population will also be addressed.
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Affiliation(s)
- Pedro Gonçalves-Teixeira
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal.,Departamento de Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto - Portugal.,Clínica Cardio-Oncológica, Centro Hospitalar Vila Nova de Gaia, Gaia - Portugal
| | - Telma Costa
- Clínica Cardio-Oncológica, Centro Hospitalar Vila Nova de Gaia, Gaia - Portugal.,Departamento de Oncologia, Centro Hospitalar Vila Nova de Gaia, Gaia - Portugal
| | - Isabel Fragoso
- Unidade de Atenção Primária à Saúde Aracetti, Arazede - Portugal
| | - Diogo Ferreira
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal.,Departamento de Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto - Portugal
| | - Mariana Brandão
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal
| | - Adelino Leite-Moreira
- Departamento de Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto - Portugal.,Departamento de Cirurgia Cardiotorácica, Hospital Universitário São João, Porto - Portugal.,Unidade de Pesquisa Cardiovascular (UnIC), Faculdade de Medicina, Universidade do Porto, Porto - Portugal
| | - Francisco Sampaio
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal.,Departamento de Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto - Portugal
| | - José Ribeiro
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal.,Clínica Cardio-Oncológica, Centro Hospitalar Vila Nova de Gaia, Gaia - Portugal
| | - Ricardo Fontes-Carvalho
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal.,Departamento de Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto - Portugal
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15
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Hu P, Huang J, Lu Y, Zheng M, Li H, Duan X, Deng H, Zhao W, Liu X. Circulating sex hormones and risk of atrial fibrillation: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:952430. [PMID: 36072857 PMCID: PMC9441879 DOI: 10.3389/fcvm.2022.952430] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/28/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Sex hormones are associated with many cardiovascular risk factors, but their effects on atrial fibrillation (AF) incidence remain unclear. This systematic review and meta-analysis aimed to evaluate the association of circulating sex hormones with AF risk by pooling available data from observational studies. METHODS A systematic literature search for pertinent articles with case-control and cohort designs was conducted via five databases up to 7 July 2021. A meta-analysis with six cohort studies was conducted separately on men and women. Adjusted relative risk (RR) with a 95% confidence interval (CI) was derived by comparing the highest with the lowest levels of a specific sex hormone and by using a random-effect or fixed-effect model. Heterogeneity was tested using the I 2 statistic and the Q-test. RESULTS A total of six cohort studies and four case-control studies were included. In a meta-analysis of cohort studies, dehydroepiandrosterone sulfate (DHEAS) was associated with a decreased risk of AF in men (RR: 0.729, 95% CI: 0.559-0.952, I 2 = 50.0%, P -heterogeneity = 0.157) after combining results from two cohort studies; total testosterone was not associated with any risk of AF in men and postmenopausal women, and AF risk was not associated with estradiol in men after synthesizing available studies. CONCLUSION This study indicates that a higher endogenous DHEAS level was associated with a lower AF risk in men, whereas total testosterone and estradiol were not associated with AF risk. Longitudinal studies with multiple monitoring are needed to further promulgate the relationship between various circulating sex hormones and AF risk.
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Affiliation(s)
- Peng Hu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Jun Huang
- Department of Geriatrics, Institute of Geriatrics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Yi Lu
- Health Effects Institute, Boston, MA, United States
| | - Murui Zheng
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Haiyi Li
- Shantou University Medical College, Shantou, China
| | - Xueru Duan
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Hai Deng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Science, Guangzhou, China
- Hai Deng,
| | - Wenjing Zhao
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
- Wenjing Zhao,
| | - Xudong Liu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
- *Correspondence: Xudong Liu,
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16
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Shores MM, Walsh TJ, Korpak A, Krakauer C, Forsberg CW, Fox AE, Moore KP, Heckbert SR, Thompson ML, Smith NL, Matsumoto AM. Association Between Testosterone Treatment and Risk of Incident Cardiovascular Events Among US Male Veterans With Low Testosterone Levels and Multiple Medical Comorbidities. J Am Heart Assoc 2021; 10:e020562. [PMID: 34423650 PMCID: PMC8649267 DOI: 10.1161/jaha.120.020562] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Testosterone treatment is common in men, although risks for major cardiovascular events are unclear. Methods and Results A study was conducted in US male veterans, aged ≥40 years, with low serum testosterone and multiple medical comorbidities and without history of myocardial infarction, stroke, venous thromboembolism, prostate cancer, or testosterone treatment in the prior year. For the primary outcome, we examined if testosterone treatment was associated with a composite cardiovascular outcome (incident myocardial infarction, ischemic stroke, or venous thromboembolism). Testosterone use was modeled as intramuscular or transdermal and as current use, former use, and no use. Current testosterone users were compared with former users to reduce confounding by indication. The cohort consisted of 204 857 men with a mean (SD) age of 60.9 (9.9) years and 4.7 (3.5) chronic medical conditions. During follow‐up of 4.3 (2.8) years, 12 645 composite cardiovascular events occurred. In adjusted Cox regression analyses, current use of transdermal testosterone was not associated with risk for the composite cardiovascular outcome (hazard ratio [HR], 0.89; 95% CI, 0.76–1.05) in those without prevalent cardiovascular disease, and in those with prevalent cardiovascular disease was associated with lower risk (HR, 0.80; 95% CI, 0.70–0.91). In similar analyses, current use of intramuscular testosterone was not associated with risk for the composite cardiovascular outcome in men without or with prevalent cardiovascular disease (HR, 0.91; 95% CI, 0.80–1.04; HR, 0.98; 95% CI, 0.89–1.09, respectively). Conclusions In a large cohort of men without a history of myocardial infarction, stroke, or venous thromboembolism, testosterone treatment was not associated with increased risk for incident composite cardiovascular events.
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Affiliation(s)
- Molly M Shores
- Department of Psychiatry and Behavioral Sciences University of Washington Seattle WA.,VA Puget Sound Health Care System (VAPSHCS) Seattle WA
| | - Thomas J Walsh
- Department of Urology University of Washington Seattle WA
| | - Anna Korpak
- VA Puget Sound Health Care System (VAPSHCS) Seattle WA.,Seattle Epidemiologic Research and Information Center (ERIC) VAPSHCS Seattle WA
| | - Chloe Krakauer
- Kaiser Permanente Washington Health Research Institute Seattle WA
| | - Christopher W Forsberg
- VA Puget Sound Health Care System (VAPSHCS) Seattle WA.,Seattle Epidemiologic Research and Information Center (ERIC) VAPSHCS Seattle WA
| | - Alexandra E Fox
- VA Puget Sound Health Care System (VAPSHCS) Seattle WA.,Seattle Epidemiologic Research and Information Center (ERIC) VAPSHCS Seattle WA
| | - Kathryn P Moore
- VA Puget Sound Health Care System (VAPSHCS) Seattle WA.,Seattle Epidemiologic Research and Information Center (ERIC) VAPSHCS Seattle WA
| | - Susan R Heckbert
- Kaiser Permanente Washington Health Research Institute Seattle WA.,Department of Epidemiology University of Washington Seattle WA
| | - Mary Lou Thompson
- Seattle Epidemiologic Research and Information Center (ERIC) VAPSHCS Seattle WA.,Kaiser Permanente Washington Health Research Institute Seattle WA.,Department of Biostatistics University of Washington Seattle WA
| | - Nicholas L Smith
- VA Puget Sound Health Care System (VAPSHCS) Seattle WA.,Seattle Epidemiologic Research and Information Center (ERIC) VAPSHCS Seattle WA.,Kaiser Permanente Washington Health Research Institute Seattle WA.,Department of Epidemiology University of Washington Seattle WA
| | - Alvin M Matsumoto
- VA Puget Sound Health Care System (VAPSHCS) Seattle WA.,Department of Medicine University of Washington School of Medicine Seattle WA.,Geriatric Research Education and Clinical Center (GRECC) VAPSHCS Seattle WA
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17
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Revealing the Influences of Sex Hormones and Sex Differences in Atrial Fibrillation and Vascular Cognitive Impairment. Int J Mol Sci 2021; 22:ijms22168776. [PMID: 34445515 PMCID: PMC8396287 DOI: 10.3390/ijms22168776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 12/25/2022] Open
Abstract
The impacts of sex differences on the biology of various organ systems and the influences of sex hormones on modulating health and disease have become increasingly relevant in clinical and biomedical research. A growing body of evidence has recently suggested fundamental sex differences in cardiovascular and cognitive function, including anatomy, pathophysiology, incidence and age of disease onset, symptoms affecting disease diagnosis, disease severity, progression, and treatment responses and outcomes. Atrial fibrillation (AF) is currently recognized as the most prevalent sustained arrhythmia and might contribute to the pathogenesis and progression of vascular cognitive impairment (VCI), including a range of cognitive deficits, from mild cognitive impairment to dementia. In this review, we describe sex-based differences and sex hormone functions in the physiology of the brain and vasculature and the pathophysiology of disorders therein, with special emphasis on AF and VCI. Deciphering how sex hormones and their receptor signaling (estrogen and androgen receptors) potentially impact on sex differences could help to reveal disease links between AF and VCI and identify therapeutic targets that may lead to potentially novel therapeutic interventions early in the disease course of AF and VCI.
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18
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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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19
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Cone EB, Reese S, Marchese M, Nabi J, McKay RR, Kilbridge KL, Trinh QD. Cardiovascular toxicities associated with abiraterone compared to enzalutamide-A pharmacovigilance study. EClinicalMedicine 2021; 36:100887. [PMID: 34308305 PMCID: PMC8257986 DOI: 10.1016/j.eclinm.2021.100887] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/16/2021] [Accepted: 04/19/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Androgen deprivation therapy (ADT) is standard-of-care for advanced prostate cancer. Studies have generally found increased cardiovascular risks associated with ADT, but the comparative risk of newer agents is under-characterized. We defined the cardiac risks of abiraterone and enzalutamide, using gonadotropic releasing hormone (GnRH) agonists to establish baseline ADT risk. METHODS We used VigiBase, the World Health Organization pharmacovigilance database, to identify cardiac adverse drug reactions (ADRs) in a cohort taking GnRH agonists, abiraterone, or enzalutamide therapy for prostate cancer, comparing them to all other patients. To examine the relationship, we used an empirical Bayes estimator to screen for significance, then calculated the reporting odds ratio (ROR), a surrogate measure of association. A lower bound of a 95% confidence interval (CI) of ROR > 1 reflects a disproportionality signal that more ADRs are observed than expected due to chance. FINDINGS We identified 2,433 cardiac ADRs, with higher odds for abiraterone compared to all other VigiBase drugs for overall cardiac events (ROR 1•59, 95% CI 1•48-1•71), myocardial infarction (1•35, 1•16-1•58), arrythmia (2•04, 1•82-2•30), and heart failure (3•02, 2•60-3•51), but found no signal for enzalutamide. Patients on GnRH agonists also had increased risk of cardiac events (ROR 1•21, 95% CI 1•12-1•30), myocardial infarction (1•80, 1•61-2•03) and heart failure (2•06, 1•76-2•41). INTERPRETATION We found higher reported odds of cardiac events for abiraterone but not enzalutamide. Our data may suggest that patients with significant cardiac comorbidities may be better-suited for therapy with enzalutamide over abiraterone. FUNDING None.
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Affiliation(s)
- Eugene B. Cone
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
- Corresponding author.
| | - Stephen Reese
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Maya Marchese
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Junaid Nabi
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Rana R. McKay
- Division of Hematology/Oncology, University of California, San Diego, CA, United States
| | - Kerry L. Kilbridge
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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20
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Environmental Factors-Induced Oxidative Stress: Hormonal and Molecular Pathway Disruptions in Hypogonadism and Erectile Dysfunction. Antioxidants (Basel) 2021; 10:antiox10060837. [PMID: 34073826 PMCID: PMC8225220 DOI: 10.3390/antiox10060837] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 01/09/2023] Open
Abstract
Hypogonadism is an endocrine disorder characterized by inadequate serum testosterone production by the Leydig cells of the testis. It is triggered by alterations in the hypothalamic–pituitary–gonadal axis. Erectile dysfunction (ED) is another common disorder in men that involves an alteration in erectile response–organic, relational, or psychological. The incidence of hypogonadism and ED is common in men aged over 40 years. Hypogonadism (including late-onset hypogonadism) and ED may be linked to several environmental factors-induced oxidative stresses. The factors mainly include exposure to pesticides, radiation, air pollution, heavy metals and other endocrine-disrupting chemicals. These environmental risk factors may induce oxidative stress and lead to hormonal dysfunctions. To better understand the subject, the study used many keywords, including “hypogonadism”, “late-onset hypogonadism”, “testosterone”, “erectile dysfunction”, “reactive oxygen species”, “oxidative stress”, and “environmental pollution” in major online databases, such as SCOPUS and PUBMED to extract relevant scientific information. Based on these parameters, this review summarizes a comprehensive insight into the important environmental issues that may have a direct or indirect association with hypogonadism and ED in men. The study concludes that environmental factors-induced oxidative stress may cause infertility in men. The hypothesis and outcomes were reviewed critically, and the mechanistic approaches are applied through oxidant-sensitive pathways. This study also provides reccomendations on future therapeutic interventions and protective measures against such adverse environmental factors-induced hypogonadism and ED.
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21
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Presence of non-pulmonary vein foci in patients with atrial fibrillation undergoing standard ablation of pulmonary vein isolation: Clinical characteristics and long-term ablation outcome. IJC HEART & VASCULATURE 2021; 32:100717. [PMID: 33532545 PMCID: PMC7822950 DOI: 10.1016/j.ijcha.2021.100717] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 11/21/2022]
Abstract
Background The clinical characteristics of atrial fibrillation (AF) resulting from non-pulmonary vein (PV) triggers remain unknown. This study aimed to evaluate the clinical characteristics of patients with AF caused by non-PV triggers, localization of non-PV foci, clinical differences, and clinical outcomes after catheter ablation in each AF focus. Methods A total of 2967 patients who underwent initial catheter ablation for paroxysmal or persistent AF were examined. After PV isolation, all patients underwent high-dose isoproterenol infusion to assess the existence of non-PV foci. Results Non-PV foci were identified in 564 patients (19.2%). The localization of successfully ablated non-PV foci in 514 patients were the superior vena cava (SVC: 213 cases), interatrial septum (IAS: 125 cases), coronary sinus (CS: 98 cases), right atrium (RA: 125 cases), left atrium (LA: 114 cases), and unmappable (50 cases). Multivariate analysis revealed that female gender, low body mass index (BMI), non-paroxysmal AF (PAF), and sick sinus syndrome were independent and significant indicators of non-PV foci. In the multivariate analysis of each AF focus, female gender, low BMI, and non-PAF were significant predictors of IAS and CS foci, RA and IAS foci, and CS foci, respectively. In addition, dilatation of the LA was significantly associated with LA foci, whereas RA, LA, IAS, and CS foci were associated with AF recurrence. Conclusion These findings could help to identify patients at a higher risk of AF caused by non-PV triggers and clarify the clinical difference according to the localization of non-PV foci.
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22
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Grouthier V, Moey MYY, Gandjbakhch E, Waintraub X, Funck-Brentano C, Bachelot A, Salem JE. Sexual Dimorphisms, Anti-Hormonal Therapy and Cardiac Arrhythmias. Int J Mol Sci 2021; 22:ijms22031464. [PMID: 33540539 PMCID: PMC7867204 DOI: 10.3390/ijms22031464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/21/2021] [Accepted: 01/27/2021] [Indexed: 02/07/2023] Open
Abstract
Significant variations from the normal QT interval range of 350 to 450 milliseconds (ms) in men and 360 to 460 ms in women increase the risk for ventricular arrhythmias. This difference in the QT interval between men and women has led to the understanding of the influence of sex hormones on the role of gender-specific channelopathies and development of ventricular arrhythmias. The QT interval, which represents the duration of ventricular repolarization of the heart, can be affected by androgen levels, resulting in a sex-specific predilection for acquired and inherited channelopathies such as acquired long QT syndrome in women and Brugada syndrome and early repolarization syndrome in men. Manipulation of the homeostasis of these sex hormones as either hormonal therapy for certain cancers, recreational therapy or family planning and in transgender treatment has also been shown to affect QT interval duration and increase the risk for ventricular arrhythmias. In this review, we highlight the effects of endogenous and exogenous sex hormones in the physiological and pathological states on QTc variation and predisposition to gender-specific pro-arrhythmias.
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Affiliation(s)
- Virginie Grouthier
- Department of Endocrinology, Diabetes and Nutrition, Centre Hospitalier Universitaire de Bordeaux, Haut Leveque Hospital, F-33000 Bordeaux, France;
| | - Melissa Y. Y. Moey
- Department of Cardiovascular Disease, Vidant Medical Center/East Carolina University, Greenville, NC 27834, USA;
| | - Estelle Gandjbakhch
- APHP, Pitié-Salpêtrière Hospital, Institute of Cardiology, Centre de Référence des Maladies Cardiaques Héréditaires, Institute of Cardiometabolism and Nutrition (ICAN), UPMC Univ Paris 06, INSERM 1166, Sorbonne Universités, F-75013 Paris, France; (E.G.); (X.W.)
| | - Xavier Waintraub
- APHP, Pitié-Salpêtrière Hospital, Institute of Cardiology, Centre de Référence des Maladies Cardiaques Héréditaires, Institute of Cardiometabolism and Nutrition (ICAN), UPMC Univ Paris 06, INSERM 1166, Sorbonne Universités, F-75013 Paris, France; (E.G.); (X.W.)
| | - Christian Funck-Brentano
- INSERM, CIC-1901, AP-HP, Pitié-Salpêtrière Hospital, Regional Pharmacovigilance Center, UNICO-GRECO Cardio-Oncology Program, Department of Pharmacology and Clinical Investigation Center, CLIP2 Galilée, Sorbonne Université, F-75013 Paris, France;
| | - Anne Bachelot
- AP-HP, Pitié-Salpêtrière Hospital, IE3M, and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, and Centre de Référence des Pathologies Gynécologiques Rares, Department of Endocrinology and Reproductive Medicine, Sorbonne Université, F-75013 Paris, France;
| | - Joe-Elie Salem
- INSERM, CIC-1901, AP-HP, Pitié-Salpêtrière Hospital, Regional Pharmacovigilance Center, UNICO-GRECO Cardio-Oncology Program, Department of Pharmacology and Clinical Investigation Center, CLIP2 Galilée, Sorbonne Université, F-75013 Paris, France;
- Cardio-Oncology Program, Department of Medicine and Pharmacology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Correspondence: ; Tel.: +33-1-42-17-85-31 or +1-(615)-322-0067
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23
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Kharaba ZJ, Buabeid MA, Ibrahim NA, Jirjees FJ, Obaidi HJA, Kaddaha A, Khajehkarimoddini L, Alfoteih Y. Testosterone therapy in hypogonadal patients and the associated risks of cardiovascular events. Biomed Pharmacother 2020; 129:110423. [PMID: 32570122 DOI: 10.1016/j.biopha.2020.110423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/06/2020] [Accepted: 06/13/2020] [Indexed: 10/24/2022] Open
Abstract
Since the male secondary sex characters, libido and fertility are attributed to their major androgen hormone testosterone, the sub-optimum levels of testosterone in young adults may cause infertility and irregularities in their sexual behaviour. Such deficiency is often secondary to maladies involving testes, pituitary or hypothalamus that could be treated with an administration of exogenous testosterone. In the last few decades, the number of testosterone prescriptions has markedly increased to treat sub-optimal serum levels even though its administration in such conditions is not yet approved. On account of its associated cardiovascular hazards, the food and drug authority in the United States has issued safety alerts on testosterone replacement therapy (TRT). Owing to a great degree of conflict among their findings, the published clinical trials seem struggling in presenting a decisive opinion on the matter. Hence, the clinicians remain uncertain about the possible cardiovascular adversities while prescribing TRT in hypogonadal men. The uncertainty escalates even further while prescribing such therapy in older men with a previous history of cardiovascular ailments. In the current review, we analysed the pre-clinical and clinical studies to evaluate the physiological impact of testosterone on cardiovascular and related parameters. We have enlisted studies on the association of cardiovascular health and endogenous testosterone levels with a comprehensive analysis of epidemiological studies, clinical trials, and meta-analyses on the cardiovascular risk of TRT. The review is aimed to assist clinicians in making smart decisions regarding TRT in their patients.
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Affiliation(s)
- Zelal Jaber Kharaba
- Department of Clinical Sciences, College of Pharmacy, Al-Ain University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Manal Ali Buabeid
- Department of Clinical Sciences, Ajman University, Ajman, 346, United Arab Emirates
| | - Nihal A Ibrahim
- Department of Clinical Sciences, Ajman University, Ajman, 346, United Arab Emirates
| | | | | | | | | | - Yassen Alfoteih
- City University College of Ajman, Ajman, 18484, United Arab Emirates.
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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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Kharaba ZJ, Buabeid MA, Alfoteih YA. Effectiveness of testosterone therapy in hypogonadal patients and its controversial adverse impact on the cardiovascular system. Crit Rev Toxicol 2020; 50:491-512. [PMID: 32689855 DOI: 10.1080/10408444.2020.1789944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Testosterone is the major male hormone produced by testicles which are directly associated with man's appearance and secondary sexual developments. Androgen deficiency starts when the male hormonal level falls from its normal range though, in youngsters, the deficiency occurs due to disruption of the normal functioning of pituitary, hypothalamus glands, and testes. Thus, testosterone replacement therapy was already known for the treatment of androgen deficiency with lesser risks of producing cardiovascular problems. Since from previous years, the treatment threshold in the form of testosterone replacement therapy has effectively increased to that extent that it was prescribed for those conditions which it was considered as inappropriate. However, there are some research studies and clinical trials available that proposed the higher risk of inducing cardiovascular disease with the use of testosterone replacement therapy. Thus under the light of these results, the FDA has published the report of the increased risk of cardiovascular disease with the increased use of testosterone replacement therapy. Nevertheless, there is not a single trial available or designed that could evaluate the risk of cardiovascular events with the use of testosterone replacement therapy. As a result, the use of testosterone still questioned the cardiovascular safety of this replacement therapy. Thus, this literature outlines the distribution pattern of disease by investigating the data and link between serum testosterone level and the cardiovascular disease, also the prescription data of testosterone replacement therapy patients and their tendency of inducing cardiovascular disease, meta-analysis and the trials regarding testosterone replacement therapy and its connection with the risks of causing cardiovascular disease and lastly, the possible effects of testosterone replacement therapy on the cardiovascular system. This study aims to evaluate the available evidence regarding the use of testosterone replacement therapy when choosing it as a treatment plan for their patients.
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Affiliation(s)
- Zelal Jaber Kharaba
- Department of Clinical Sciences, College of Pharmacy, Al-Ain University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Manal Ali Buabeid
- Department of Clinical Sciences, Ajman University, Ajman, United Arab Emirates
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Predictors of non-pulmonary vein foci in paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2020; 61:71-78. [PMID: 32468323 DOI: 10.1007/s10840-020-00779-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Progress of balloon devices for pulmonary vein (PV) isolation in atrial fibrillation (AF) has been remarkable. However, these techniques were specialized in pulmonary vein treatment; predicting non-PV foci in advance is important to decide the treatment strategy. In this study, we investigate the predictors for paroxysmal AF. METHODS Subjects were consecutive paroxysmal AF patients who underwent high-dose isoproterenol provocation after PV isolation in the first session. The PV group (n = 102) and non-PV group (n = 222) were defined as the patients with and without non-PV ablation, respectively. Non-PV ablation was performed when frequent repetitive premature atrial contractions or triggered AF occurred spontaneously or by isoproterenol provocation. Predictors of non-PV origin in paroxysmal AF patients were examined using clinical characteristics and preoperative echocardiography. RESULTS In the multivariate logistic regression analysis, female sex, body mass index (BMI < 23.8), absence of hypertension, and higher ratio of mitral early diastolic peak (E-wave) to early diastolic mitral annulus peak (e') velocity (E/e' > 8.44) were significant independent predictors of non-PV foci (hazard ratio 2.04, 1.88, 3.63, and 2.33; 95% confidence interval 1.17-3.55, 1.05-3.39, 1.72-7.67, and 1.34-4.05; p = 0.011, 0.035, < 0.001, and 0.003, respectively). If a patient had these four factors, non-PV was detected with 96.8% specificity. CONCLUSION Female sex, lower BMI, absence of hypertension, and higher E/e' were significant indicators of non-PV foci in patients with paroxysmal AF. Reviewing these factors in advance may be useful for selecting a device to perform pulmonary vein isolation.
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Barber M, Nguyen LS, Wassermann J, Spano JP, Funck-Brentano C, Salem JE. Cardiac arrhythmia considerations of hormone cancer therapies. Cardiovasc Res 2020; 115:878-894. [PMID: 30698686 DOI: 10.1093/cvr/cvz020] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/14/2018] [Accepted: 01/24/2019] [Indexed: 12/28/2022] Open
Abstract
Breast and prostate cancers are among the most prevalent cancers worldwide. Oestradiol and progesterone are major drivers for breast cancer proliferation, and androgens for prostate cancer. Endocrine therapies are drugs that interfere with hormone-activated pathways to slow cancer progression. Multiple new breakthrough drugs improving overall survival have recently been developed within this class. As the use of these latter drugs grows, incidence of cardiac arrhythmias has emerged as an unappreciated complication. These changes are not surprising given that sex hormones alter ventricular repolarization. Testosterone shortens action potential duration and QT interval duration, while oestradiol has an opposite effect. In patients with breast cancer, selective oestrogen receptor modulators are associated with more reports for long QT and torsade de pointes (TdP) than aromatase inhibitors, likely through an oestradiol-like effect on the heart. Cyclin-dependent kinase 4/6 inhibitors, a new class of anticancer drugs used in combination with endocrine therapies in hormone receptor positive breast cancer, are also variably associated with drug-induced long QT, particularly with ribociclib. In prostate cancer, androgen deprivation therapy is associated with long QT and TdP, and possibly atrial fibrillation for abiraterone. In this review, we have summarized the clinical and preclinical data focusing on cardiac arrhythmia considerations of hormone cancer therapies.
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Affiliation(s)
- Mary Barber
- Department of Medicine and Clinical Pharmacology, Cardio-Oncology Program, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, USA
| | - Lee S Nguyen
- Department of Pharmacology, Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Paris F-75013, France
| | - Johanna Wassermann
- Department of Oncology, Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Paris F-75013, France
| | - Jean-Philippe Spano
- Department of Oncology, Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Paris F-75013, France
| | - Christian Funck-Brentano
- Department of Pharmacology, Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Paris F-75013, France
| | - Joe-Elie Salem
- Department of Medicine and Clinical Pharmacology, Cardio-Oncology Program, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, USA.,Department of Pharmacology, Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Paris F-75013, France
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Abstract
Testosterone is the main male sex hormone and is essential for the maintenance of male secondary sexual characteristics and fertility. Androgen deficiency in young men owing to organic disease of the hypothalamus, pituitary gland or testes has been treated with testosterone replacement for decades without reports of increased cardiovascular events. In the past decade, the number of testosterone prescriptions issued for middle-aged or older men with either age-related or obesity-related decline in serum testosterone levels has increased exponentially even though these conditions are not approved indications for testosterone therapy. Some retrospective studies and randomized trials have suggested that testosterone replacement therapy increases the risk of cardiovascular disease, which has led the FDA to release a warning statement about the potential cardiovascular risks of testosterone replacement therapy. However, no trials of testosterone replacement therapy published to date were designed or adequately powered to assess cardiovascular events; therefore, the cardiovascular safety of this therapy remains unclear. In this Review, we provide an overview of epidemiological data on the association between serum levels of endogenous testosterone and cardiovascular disease, prescription database studies on the risk of cardiovascular disease in men receiving testosterone therapy, randomized trials and meta-analyses evaluating testosterone replacement therapy and its association with cardiovascular events and mechanistic studies on the effects of testosterone on the cardiovascular system. Our aim is to help clinicians to make informed decisions when considering testosterone replacement therapy in their patients.
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Kato N, Nitta J, Sato A, Inamura Y, Takamiya T, Inaba O, Negi K, Takahashi Y, Goya M, Sasano T. Characteristics of the nonpulmonary vein foci induced after second‐generation cryoballoon ablation for paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2019; 31:174-184. [DOI: 10.1111/jce.14314] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Nobutaka Kato
- Department of CardiologyJapanese Red Cross Saitama Hospital Saitama Japan
- Department of Cardiovascular MedicineTokyo Medical and Dental University Tokyo Japan
| | - Junichi Nitta
- Department of CardiologySakakibara Heart Institute Fuchu Japan
| | - Akira Sato
- Department of CardiologyJapanese Red Cross Saitama Hospital Saitama Japan
| | - Yukihiro Inamura
- Department of CardiologyJapanese Red Cross Saitama Hospital Saitama Japan
| | - Tomomasa Takamiya
- Department of CardiologyJapanese Red Cross Saitama Hospital Saitama Japan
| | - Osamu Inaba
- Department of CardiologyJapanese Red Cross Saitama Hospital Saitama Japan
| | - Ken Negi
- Department of CardiologyJapanese Red Cross Saitama Hospital Saitama Japan
| | - Yoshihide Takahashi
- Department of Cardiovascular MedicineTokyo Medical and Dental University Tokyo Japan
| | - Masahiko Goya
- Department of Cardiovascular MedicineTokyo Medical and Dental University Tokyo Japan
| | - Tetuo Sasano
- Department of Cardiovascular MedicineTokyo Medical and Dental University Tokyo Japan
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Kuck KH, Brugada J, Fürnkranz A, Chun KRJ, Metzner A, Ouyang F, Schlüter M, Elvan A, Braegelmann KM, Kueffer FJ, Arentz T, Albenque JP, Kühne M, Sticherling C, Tondo C. Impact of Female Sex on Clinical Outcomes in the FIRE AND ICE Trial of Catheter Ablation for Atrial Fibrillation. Circ Arrhythm Electrophysiol 2019; 11:e006204. [PMID: 29700058 DOI: 10.1161/circep.118.006204] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/06/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data on predictors of long-term clinical outcomes after catheter ablation of atrial fibrillation (AF) are limited. We sought to assess the association of baseline covariates with clinical outcomes in the 750 patients with drug-refractory paroxysmal AF enrolled in FIRE AND ICE. METHODS In a 2-part analysis, univariate and multivariable Cox regression models were first used to identify baseline patient characteristics predictive of catheter ablation efficacy determined by the clinical end points of (1) atrial arrhythmia recurrence (primary efficacy failure), (2) cardiovascular rehospitalization, and (3) repeat ablation. Propensity score stratification methods were then used to account for differences in baseline characteristics between sexes. RESULTS Female sex (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.08-1.73; P=0.010) and prior direct current cardioversion (HR, 1.40; 95% CI, 1.07-1.82; P=0.013) were independently associated with atrial arrhythmia recurrence. Female sex (HR, 1.36; 95% CI, 1.02-1.80; P=0.035) and hypertension (HR, 1.48; 95% CI, 1.09-2.00; P=0.013) independently predicted cardiovascular rehospitalization. A longer history of AF (HR, 1.03; 95% CI, 1.00-1.06; P=0.039) increased the rate of repeat ablation. Women continued to have higher rates of primary efficacy failure and cardiovascular rehospitalization after propensity score adjustment, with adjusted HRs of 1.51 (95% CI, 1.16-2.18; P<0.05) and 1.40 (95% CI, 1.15-2.17; P<0.05), respectively. CONCLUSIONS After catheter ablation of paroxysmal AF, female sex was associated with an almost 40% increase in the risks of primary efficacy failure and cardiovascular rehospitalization. Primary efficacy failure was also adversely impacted by a history of direct current cardioversion, whereas hypertension had a negative impact on cardiovascular rehospitalization. History of AF was the only predictor of repeat ablation. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01490814.
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Affiliation(s)
- Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M., F.O., M.S.).
| | - Josep Brugada
- Hospital Clinic, University of Barcelona, Spain (J.B.)
| | - Alexander Fürnkranz
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany (A.F., K.R.J.C.).,Dr Fürnkranz's current affiliation: Department of Cardiology, Pneumology, and Angiology, University Hospital Düsseldorf, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany (A.F., K.R.J.C.)
| | - Andreas Metzner
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M., F.O., M.S.)
| | - Feifan Ouyang
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M., F.O., M.S.)
| | - Michael Schlüter
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M., F.O., M.S.)
| | - Arif Elvan
- Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A.E.)
| | | | | | - Thomas Arentz
- Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg - Bad Krozingen, Bad Krozingen, Germany (T.A.)
| | | | - Michael Kühne
- Abteilung für Kardiologie, Universitätsspital Basel, Switzerland (M.K., C.S.)
| | | | - Claudio Tondo
- Monzino Sport Center Arrhythmia Unit, Centro Cardiologico Monzino, University of Milan, Italy (C.T.)
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Kaufman JM, Lapauw B, Mahmoud A, T'Sjoen G, Huhtaniemi IT. Aging and the Male Reproductive System. Endocr Rev 2019; 40:906-972. [PMID: 30888401 DOI: 10.1210/er.2018-00178] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 12/27/2018] [Indexed: 12/21/2022]
Abstract
This narrative review presents an overview of current knowledge on fertility and reproductive hormone changes in aging men, the factors driving and modulating these changes, their clinical consequences, and the benefits and risks of testosterone (T) therapy. Aging is accompanied by moderate decline of gamete quality and fertility. Population mean levels show a mild total T decline, an SHBG increase, a steeper free T decline, and a moderate LH increase with important contribution of comorbidities (e.g., obesity) to these changes. Sexual symptoms and lower hematocrit are associated with low T and are partly responsive to T therapy. The relationship of serum T with body composition and metabolic health is bidirectional; limited beneficial effects of T therapy on body composition have only marginal effects on metabolic health and physical function. Skeletal changes are associated primarily with estradiol and SHBG. Cognitive decline is not consistently linked to low T and is not improved by T therapy. Although limited evidence links moderate androgen decline with depressive symptoms, T therapy has small beneficial effects on mood, depressive symptoms, and vitality in elderly patients with low T. Suboptimal T (and/or DHT) has been associated with increased risk of stroke, but not of ischemic heart disease, whereas an association with mortality probably reflects that low T is a marker of poor health. Globally, neither severity of clinical consequences attributable to low T nor the nature and magnitude of beneficial treatment effects justify the concept of some broadly applied "T replacement therapy" in older men with low T. Moreover, long-term safety of T therapy is not established.
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Affiliation(s)
- Jean-Marc Kaufman
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Bruno Lapauw
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Ahmed Mahmoud
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Guy T'Sjoen
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Ilpo Tapani Huhtaniemi
- Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom.,Department of Physiology, Institute of Biomedicine, University of Turku, Turku, Finland
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Berger D, Folsom AR, Schreiner PJ, Chen LY, Michos ED, O'Neal WT, Soliman EZ, Alonso A. Plasma total testosterone and risk of incident atrial fibrillation: The Atherosclerosis Risk in Communities (ARIC) study. Maturitas 2019; 125:5-10. [PMID: 31133217 DOI: 10.1016/j.maturitas.2019.03.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 02/04/2019] [Accepted: 03/20/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Whether endogenous testosterone concentrations are associated with atrial fibrillation (AF) development is not well established. We assessed the association between plasma total testosterone concentrations and incident AF in a population-based longitudinal study. STUDY DESIGN Using data from the prospective Atherosclerosis Risk in Communities (ARIC) study, we identified incident AF among 9282 participants who had plasma total testosterone measured by liquid chromatography tandem mass spectrometry at Visit 4 (1996-1998). MAIN OUTCOME MEASURES AF cases were identified by electrocardiograms performed during study visits, hospital records/discharge codes, and death certificates through 2013. We estimated hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incident AF across quartiles of plasma total testosterone, stratified by sex, with multivariable Cox models. RESULTS The mean age of the participant sample at ARIC Visit 4 was 63 years (range 52-75); 54.5% were women. Mean (SD) plasma total testosterone levels were 537 ng/dL (213) for men and 27.6 ng/dL (34.7) for women. Over a mean of 13.7 years of follow-up, 1664 incident cases of AF were identified. Comparing those in the highest quartile of plasma total testosterone concentration to those in the lowest quartile and after adjustment for potential confounding variables, there was a positive association between plasma total testosterone and incident AF in men (HR 1.33, 95% CI 1.07, 1.66), but no such association in women (HR 0.99, 95% CI 0.80, 1.22). Conclusion A higher plasma total testosterone concentration was associated with a modestly greater incidence rate of AF in men.
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Affiliation(s)
- Dylan Berger
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 South 2nd Street, Suite 300, Minneapolis, MN 55454, United States
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 South 2nd Street, Suite 300, Minneapolis, MN 55454, United States.
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 South 2nd Street, Suite 300, Minneapolis, MN 55454, United States
| | - Lin Y Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Mayo 8508A (Campus Delivery Code), Minneapolis, MN 55455, United States
| | - Erin D Michos
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD 21287, United States
| | - Wesley T O'Neal
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, Woodruff Memorial Building, Atlanta, GA 30322, United States
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, United States
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Odening KE, Deiß S, Dilling-Boer D, Didenko M, Eriksson U, Nedios S, Ng FS, Roca Luque I, Sanchez Borque P, Vernooy K, Wijnmaalen AP, Yorgun H. Mechanisms of sex differences in atrial fibrillation: role of hormones and differences in electrophysiology, structure, function, and remodelling. Europace 2018; 21:366-376. [DOI: 10.1093/europace/euy215] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/03/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Katja E Odening
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Hugstetter Str. 55, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, HX Maastricht, The Netherlands
| | - Sebastian Deiß
- Asklepios Medical Center Altona, Department of Cardiology, Arrhythmia Unit, Hamburg, Germany
| | | | - Maxim Didenko
- Department of Surgical and Interventional Arrhythmology, Kuprianov's Cardiovascular Surgery Clinic, Military Medical Academy, St. Petersburg, Russia
| | - Urs Eriksson
- Rhythmology Division, Department of Medicine, GZO Regional Health Center, Wetzikon, Switzerland
- Cardioimmunology, Center for Molecular Cardiology, University of Zurich, Zurich-Schlieren, Switzerland
| | - Sotirios Nedios
- Heart Center, University of Leipzig, Leipzig, Germany
- Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Fu Siong Ng
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Ivo Roca Luque
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, HX Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center, GA Nijmegen, The Netherlands
| | - Adrianus P Wijnmaalen
- Department of Cardiology, Leiden University Medical Center, ZA Leiden, The Netherlands
| | - Hikmet Yorgun
- Department of Cardiology, Electrophysiology Unit, Hacettepe University, Ankara, Turkey
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Sun YL, Li PH, Shi L, Su WZ, Li DS, Xue GL, Zhao Y, Li CZ, Li Y, Zhou Y, Li SX, Zhang Y, Lu YJ, Pan ZW. Valsartan reduced the vulnerability to atrial fibrillation by preventing action potential prolongation and conduction slowing in castrated male mice. J Cardiovasc Electrophysiol 2018; 29:1436-1443. [DOI: 10.1111/jce.13697] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/20/2018] [Accepted: 07/06/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Yi-Lin Sun
- Department of Pharmacology, Key Laboratory of Cardiovascular Medicine Research, State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Ministry of Education; College of Pharmacy, Harbin Medical University; Harbin China
| | - Peng-Hui Li
- Department of Pharmacology, Key Laboratory of Cardiovascular Medicine Research, State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Ministry of Education; College of Pharmacy, Harbin Medical University; Harbin China
| | - Ling Shi
- Department of Pharmacology, Key Laboratory of Cardiovascular Medicine Research, State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Ministry of Education; College of Pharmacy, Harbin Medical University; Harbin China
| | - Wan-Zhen Su
- Department of Pharmacology, Key Laboratory of Cardiovascular Medicine Research, State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Ministry of Education; College of Pharmacy, Harbin Medical University; Harbin China
| | - De-Sheng Li
- Department of Pharmacology, Key Laboratory of Cardiovascular Medicine Research, State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Ministry of Education; College of Pharmacy, Harbin Medical University; Harbin China
| | - Gen-Long Xue
- Department of Pharmacology, Key Laboratory of Cardiovascular Medicine Research, State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Ministry of Education; College of Pharmacy, Harbin Medical University; Harbin China
| | - Yue Zhao
- Department of Pharmacology, Key Laboratory of Cardiovascular Medicine Research, State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Ministry of Education; College of Pharmacy, Harbin Medical University; Harbin China
| | - Chang-Zhu Li
- Department of Pharmacology, Key Laboratory of Cardiovascular Medicine Research, State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Ministry of Education; College of Pharmacy, Harbin Medical University; Harbin China
| | - Ying Li
- Department of Pharmacology, Key Laboratory of Cardiovascular Medicine Research, State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Ministry of Education; College of Pharmacy, Harbin Medical University; Harbin China
| | - Yang Zhou
- Department of Pharmacology, Key Laboratory of Cardiovascular Medicine Research, State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Ministry of Education; College of Pharmacy, Harbin Medical University; Harbin China
| | - Shang-Xuan Li
- Department of Pharmacology, Key Laboratory of Cardiovascular Medicine Research, State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Ministry of Education; College of Pharmacy, Harbin Medical University; Harbin China
| | - Yang Zhang
- Department of Pharmacology, Key Laboratory of Cardiovascular Medicine Research, State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Ministry of Education; College of Pharmacy, Harbin Medical University; Harbin China
| | - Yan-Jie Lu
- Department of Pharmacology, Key Laboratory of Cardiovascular Medicine Research, State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Ministry of Education; College of Pharmacy, Harbin Medical University; Harbin China
| | - Zhen-Wei Pan
- Department of Pharmacology, Key Laboratory of Cardiovascular Medicine Research, State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Ministry of Education; College of Pharmacy, Harbin Medical University; Harbin China
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Miner M, Morgentaler A, Khera M, Traish AM. The state of testosterone therapy since the FDA's 2015 labelling changes: Indications and cardiovascular risk. Clin Endocrinol (Oxf) 2018; 89:3-10. [PMID: 29486065 DOI: 10.1111/cen.13589] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/17/2018] [Accepted: 02/22/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE A label change in testosterone (T) products in March 2015 followed a highly publicized FDA advisory committee meeting in September 2014. Changes included a warning of possible increased cardiovascular (CV) risks and restriction of indicated populations to younger men with a limited set of known aetiologies of testosterone deficiency (TD). These changes greatly impacted clinical practice and public perception of T therapy (TTh). Our aim was to review these changes in the light of subsequently published studies. DESIGN We identified 23 studies through June 2017, including 12 clinical trials and 11 observational studies. The Testosterone Trials included 790 men aged 65 years and older with TD without known aetiology, assigned to 1-year T gel or placebo. RESULTS Demonstrated benefits of T included sexual activity and desire, physical activity and mood. There were 9 major adverse CV events (MACE) in the T arm and 16 in the placebo arm. No study reported increased MACE with TTh. A 3-year RCT showed no difference in carotid atherosclerosis. Several large observational studies reported reduced CV events with TTh, including one showing progressively reduced CV and mortality risk with greater duration of TTh. Men whose serum T normalized with TTh had reduced risk of MI and death compared with men whose T levels failed to normalize. CONCLUSION We conclude that existing evidence fails to support increased CV risk with TTh; on the contrary, there is evidence suggestive of real-world CV benefits. Finally, existing evidence provides benefits of TTh in older men without known aetiology for T deficiency.
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Affiliation(s)
- Martin Miner
- Men's Health Center, Miriam Hospital, Providence, RI, USA
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Abraham Morgentaler
- Men's Health Boston, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mohit Khera
- Department of Urology, Baylor School of Medicine, Houston, TX, USA
| | - Abdulmaged M Traish
- Department of Urology, Boston University School of Medicine, Boston, MA, USA
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Rosenberg MA, Shores MM, Matsumoto AM, Bůžková P, Lange LA, Kronmal RA, Heckbert SR, Mukamal KJ. Serum androgens and risk of atrial fibrillation in older men: The Cardiovascular Health Study. Clin Cardiol 2018; 41:830-836. [PMID: 29671886 DOI: 10.1002/clc.22965] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/16/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Decline in serum androgens is common among older men and has been associated with cardiovascular disease, although its role in risk of atrial fibrillation (AF) has not been well defined. HYPOTHESIS Low serum androgens are associated with an increased risk of AF. METHODS We examined the prospective associations between testosterone, its more active metabolite dihydrotestosterone (DHT), and sex hormone-binding globulin (SHBG) with risk of AF among 1019 otherwise healthy men with average age 76.3 ±4.9 years in the Cardiovascular Health Study. RESULTS After median follow-up of 9.5 years, 304 (30%) men developed AF. We detected a nonlinear association with risk of incident AF in both free and total DHT, in which subjects with the lowest levels had a higher risk of incident AF. After adjustment for demographics, clinical risk factors, left atrial diameter, and serum NT-proBNP levels, men with free DHT <0.16 ng/dL were at increased risk compared with men with higher levels (hazard ratio: 1.48, 95% confidence interval: 1.01-2.17, P <0.05). Sensitivity analyses confirmed that the increased risk was not cutpoint-specific, with a significant association noted up to cutpoints <~0.2 ng/dL. We also detected a complex nonlinear association between SHBG and incident AF, in which subjects in the middle quintile (52.9-65.3 nmol/L) had increased risk. CONCLUSIONS Among older men, low free DHT is associated with an increased risk of incident AF. Further studies are needed to explore mechanisms for this association.
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Affiliation(s)
- Michael A Rosenberg
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado.,Division of Biomedical Informatics and Personalized Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Molly M Shores
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, VA Puget Sound Health Care System, Washington
| | - Alvin M Matsumoto
- Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Puget Sound Health Care System, Washington.,Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Petra Bůžková
- Department of Biostatistics, University of Washington, Seattle
| | - Leslie A Lange
- Division of Biomedical Informatics and Personalized Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | | | | | - Kenneth J Mukamal
- Department of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Clavell-Hernández J, Wang R. Emerging Evidences in the Long Standing Controversy Regarding Testosterone Replacement Therapy and Cardiovascular Events. World J Mens Health 2018; 36:92-102. [PMID: 29706034 PMCID: PMC5924961 DOI: 10.5534/wjmh.17050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 02/02/2023] Open
Abstract
The increasing rate of late-onset hypogonadism has led to an exceptional growth in the use of testosterone therapy (TTh). Even though TTh has been used for more than 70 years, there has been an emerging controversy in the past several years regarding its safety due to a suggested increased risk of cardiovascular (CV) disease among its users. Given the growing prevalence of testosterone deficiency in our population and the increased use of TTh, the goal of this review is to present the history and emerging evidence in regards to this controversy. CV safety concerns are mostly based on a few studies and trials that have been noted to have multiple flaws and limitations. However, the most recent data has found no association between TTh and the development of CV disease. Nevertheless, until this controversy is clarified with larger clinical trials, health-care professionals should continue to inform their patients about the possible CV risk when prescribing TTh products to patients.
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Affiliation(s)
- Jonathan Clavell-Hernández
- Division of Urology, University of Texas Health Science Center, McGovern Medical School at Houston, Houston, TX, USA
- Department of Surgery, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Run Wang
- Division of Urology, University of Texas Health Science Center, McGovern Medical School at Houston, Houston, TX, USA
- Department of Surgery, University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
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Alexandre J, Moslehi JJ, Bersell KR, Funck-Brentano C, Roden DM, Salem JE. Anticancer drug-induced cardiac rhythm disorders: Current knowledge and basic underlying mechanisms. Pharmacol Ther 2018; 189:89-103. [PMID: 29698683 DOI: 10.1016/j.pharmthera.2018.04.009] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Significant advances in cancer treatment have resulted in decreased cancer related mortality for many malignancies with some cancer types now considered chronic diseases. Despite these improvements, there is increasing recognition that many cancer patients or cancer survivors can develop cardiovascular diseases, either due to the cancer itself or as a result of anticancer therapy. Much attention has focused on heart failure; however, other cardiotoxicities, notably cardiac rhythm disorders, can occur without underlying cardiomyopathy. Supraventricular tachycardias occur in cancer patients treated with cytotoxic chemotherapy (anthracyclines, gemcitabine, cisplatin and alkylating-agents) or kinase-inhibitors (KIs) such as ibrutinib. Ventricular arrhythmias, with a subset of them being torsades-de-pointes (TdP) favored by QTc prolongation have been reported: this may be the result of direct hERG-channel inhibition or a more recently-described mechanism of phosphoinositide-3-kinase inhibition. The major anticancer drugs responsible for QTc prolongation in this context are KIs, arsenic trioxide, anthracyclines, histone deacetylase inhibitors, and selective estrogen receptor modulators. Anticancer drug-induced cardiac rhythm disorders remain an underappreciated complication even by experienced clinicians. Moreover, the causal relationship of a particular anticancer drug with cardiac arrhythmia occurrence remains challenging due in part to patient comorbidities and complex treatment regimens. For example, any cancer patient may also be diagnosed with common diseases such as hypertension, diabetes or heart failure which increase an individual's arrhythmia susceptibility. Further, anticancer drugs are generally usually used in combination, increasing the challenge around establishing causation. Thus, arrhythmias appear to be an underappreciated adverse effect of anticancer agents and the incidence, significance and underlying mechanisms are now being investigated.
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Affiliation(s)
- Joachim Alexandre
- CHU Caen, PICARO Cardio-oncology Program, Department of Pharmacology, F-14033 Caen, France; Normandie Univ, UNICAEN, CHU Caen, EA 4650, Signalisation, Électrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique, 14000 Caen, France
| | - Javid J Moslehi
- Vanderbilt University Medical Center, Cardio-oncology Program, Department of Medicine, Nashville, Tennessee, USA
| | - Kevin R Bersell
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christian Funck-Brentano
- Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Department of Pharmacology, F-75013 Paris, France
| | - Dan M Roden
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joe-Elie Salem
- Vanderbilt University Medical Center, Cardio-oncology Program, Department of Medicine, Nashville, Tennessee, USA; Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA; Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Department of Pharmacology, F-75013 Paris, France.
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Traish AM. Benefits and Health Implications of Testosterone Therapy in Men With Testosterone Deficiency. Sex Med Rev 2017; 6:86-105. [PMID: 29128268 DOI: 10.1016/j.sxmr.2017.10.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/06/2017] [Accepted: 10/06/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Testosterone (T) deficiency (TD; hypogonadism) has deleterious effects on men's health; negatively affects glycometabolic and cardiometabolic functions, body composition, and bone mineral density; contributes to anemia and sexual dysfunction; and lowers quality of life. T therapy (TTh) has been used for the past 8 decades to treat TD, with positive effects on signs and symptoms of TD. AIM To summarize the health benefits of TTh in men with TD. METHODS A comprehensive literature search was carried out using PubMed, articles relevant to TTh were accessed and evaluated, and a comprehensive summary was synthesized. MAIN OUTCOME MEASURES Improvements in signs and symptoms of TD reported in observational studies, registries, clinical trials, and meta-analyses were reviewed and summarized. RESULTS A large body of evidence provides significant valuable information pertaining to the therapeutic value of TTh in men with TD. TTh in men with TD provides real health benefits for bone mineral density, anemia, sexual function, glycometabolic and cardiometabolic function, and improvements in body composition, anthropometric parameters, and quality of life. CONCLUSION TTh in the physiologic range for men with TD is a safe and effective therapeutic modality and imparts great benefits on men's health and quality of life. Traish AM. Benefits and Health Implications of Testosterone Therapy in Men With Testosterone Deficiency. Sex Med Rev 2018;6:86-105.
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Affiliation(s)
- Abdulmaged M Traish
- Department of Urology, Boston University School of Medicine, Boson, MA, USA.
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Negative Impact of Testosterone Deficiency and 5α-Reductase Inhibitors Therapy on Metabolic and Sexual Function in Men. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1043:473-526. [DOI: 10.1007/978-3-319-70178-3_22] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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