在既定的男性性腺机能减退的背景下,睾酮治疗(TTh)已被用于恢复循环睾酮的生理水平,改善性功能和整体生活质量。
目的评估治疗与未治疗的性腺功能低下男性的心血管疾病风险和死亡率随时间的变化。
对所有纳入研究的每个结果进行使用加权时间相关风险度量(风险比(HRs))的荟萃分析。研究调查男性成人(≥18岁)被诊断为性腺功能减退症并分为2组(治疗组[任何TTh]和对照组[观察或安慰剂]),并评估死亡和/或心血管事件的风险。单臂,非比较研究以及未报告所选结局的HR的研究被排除.该系统审查在PROSPERO(CRD42022301592)上注册,并根据MOOSE和PRISMA指南进行。
任何类型的总死亡率和心血管事件。
总的来说,10项研究纳入荟萃分析,涉及179,631名性腺功能减退男性。发现接受TTh治疗的性腺机能减退男性相对于对照组(观察或对照组)组的所有原因的死亡风险较低(HR:0.70;95%置信区间[CI]:0.54-0.90;P<0.01),而与未治疗/观察到的性腺功能减退男性相比,TTh对性腺功能减退男性的心血管事件有任何不利影响(HR:0.98;95%CI0.73~1.33;P=.89).
在性腺功能减退的男性中,TTh可能在降低总体死亡风险而不增加心血管事件风险方面发挥作用。
就纳入人群而言,研究之间的高度异质性代表了主要限制,性腺功能减退的定义,TTh的类型,使用的心血管事件的定义,以及后续行动的长度。
仅根据与时间相关的风险度量,描述了未经治疗的性腺功能减退症男性的长期发病率和早期死亡率增加的风险,进一步概述了TTh在真正性腺机能减退男性中的临床重要性和安全性,迫切需要收集长期随访数据。FallaraG,PozziE,贝拉德利F,etal.男性心血管疾病发病率和死亡率-来自外源性睾酮风险的时间相关测量的荟萃分析结果。JSexMed2022;19:1243-1254。
In the context of established male hypogonadism, testosterone therapy (TTh) has been employed to regain physiologic levels of circulating testosterone and improve sexual function and overall quality of life.
To assess the risk of cardiovascular disease and mortality as time-dependent outcomes in treated vs TTh untreated hypogonadal men.
A meta-analysis using weighted time-related measure of risk (hazard ratios (HRs)) for each of the outcome for all included studies was performed. Studies investigating male adults (≥18 years old) diagnosed with hypogonadism and divided into 2 arms (a treatment arm [any TTh] and a control arm [observation or placebo]) and assessing the risk of death and/or cardiovascular events were included. Single arm, non-comparative studies were excluded as well as studies that did not report the HRs for the chosen outcomes. This systemic review was registered on PROSPERO (CRD42022301592) and performed according to MOOSE and PRISMA guidelines.
Overall mortality and cardiovascular events of any type.
Overall, 10 studies were included in the meta-analysis, involving 179,631 hypogonadal men. Hypogonadal men treated with TTh were found to be at lower mortality risk from all causes relative to the control (observation or palcebo) arm (HR: 0.70; 95% Confidence Interval [CI]: 0.54-0.90; P < .01), whilst any unfavorable effect of TTh in hypogonadal men in terms of cardiovascular events compared to untreated/observed hypogonadal men was found (HR: 0.98; 95% CI 0.73-1.33; P = .89).
TTh in hypogonadal men might play a role in reducing the overall risk of death without increasing cardiovascular events risk.
Main limitations are represented by the high heterogeneity among the studies in terms of included population, definition for hypogonadism, type of TTh, definition of cardio-vascular event used, and the length of follow-up.
According to time-related measures of risk only, an increased risk of long-term morbidity and early mortality for untreated hypogonadal men was depicted, further outlining the clinical importance and safety of TTh in true hypogonadal men, with the urgent need of collecting long-term follow-up data. Fallara G, Pozzi E, Belladelli F, et al. Cardiovascular Morbidity and Mortality in Men - Findings From a Meta-analysis on the Time-related Measure of Risk of Exogenous Testosterone. J Sex Med 2022;19:1243-1254.