Injection testosterone and adverse cardiovascular events: A case-crossover analysis.
Injection testosterone and adverse cardiovascular events: A case-crossover analysis.
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DOI：
10.1111/cen.13574
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发表时间：
2018-05
影响因子：
3.2
通讯作者：
Brookhart MA
中科院分区：
文献类型：
--
作者：
Layton JB;Li D;Meier CR;Sharpless JL;Stürmer T;Brookhart MA
外源性睾酮可能会影响凝血，红细胞增多症，并可能增加动脉粥样硬化，但与心血管事件的任何关联尚不清楚。虽然文献尚无定论，但一些研究表明，使用睾酮可能会增加心血管事件和中风的短期风险，并且注射睾酮可能比其他剂型具有更高的风险。我们试图评估接受注射睾酮的短期心血管风险。我们进行了一项病例交叉分析，将结局事件发生前7天内的注射睾酮暴露与过去的参考窗口进行比较，以估计心血管结局与接受睾酮注射的急性相关性。我们在美国商业索赔（2000-2013）或医疗保险（2007-2010）数据库中确定了因心肌梗死（MI）、卒中或MI、卒中或不稳定型心绞痛的复合疾病住院的成年男性睾酮使用者。我们从药房配药索赔或保险账单数据中的办公室程序代码中确定了患者使用睾酮的情况。我们确定了2,898名有事件和最近使用睾酮的商业保险男性，以及339名来自医疗保险。注射睾酮与注射后即刻发生不良事件（心肌梗死、卒中或不稳定型心绞痛的复合结局）的风险增加相关，仅老年医疗保险人群：商业保险，OR=0.98（95%CI：0.86-1.12）;医疗保险，OR=1.45（1.07，1.98）。当评估接受任何睾酮剂型（注射剂、凝胶剂、贴剂、植入剂）时，这种关联要么大大减弱，要么不存在：商业保险，OR=1.01（0.92，1.11）;医疗保险，OR=1.26（95% CI：0.98-1.63）。在老年男性中，替尼泊苷注射与接受注射后急性心脑血管事件的短期风险唯一相关。
Exogenous testosterone administration may affect blood clotting, polycythemia, and may increase atherosclerosis, though any association with cardiovascular events is unclear. While the literature is inconclusive, some studies have suggested testosterone use may increase short-term risk of cardiovascular events and stroke, and injection testosterone may convey higher risks than other dosage forms. We sought to evaluate the short-term cardiovascular risk of receiving injection testosterone. We conducted a case-crossover analysis comparing injection testosterone exposure in the seven days prior to an outcome event to referent windows in the past to estimate the acute association of cardiovascular outcomes with the receipt of testosterone injections. We identified adult male testosterone users hospitalized with myocardial infarction (MI), stroke, or a composite of MI, stroke, or unstable angina in US commercial claims (2000–2013) or Medicare (2007–2010) databases. We identified testosterone use for the patients from pharmacy dispensing claims or in-office procedure codes in the insurance billing data. We identified 2,898 commercially-insured men with events and recent testosterone use, and 339 from Medicare. Injected testosterone was associated with an increased risk of adverse events (composite outcome of myocardial infarction, stroke, or unstable angina) in the immediate post-injection period for the older, Medicare population only: commercial insurance, OR=0.98 (95% CI: 0.86–1.12); Medicare, OR=1.45 (1.07, 1.98). This association was either greatly attenuated or not present when evaluating receipt of any testosterone dosage forms (injection, gel, patch, implant): commercial insurance, OR=1.01 (0.92, 1.11); Medicare, OR=1.26 (95% CI: 0.98–1.63). Testosterone injections were uniquely associated with short-term risk of acute cardio- and cerebrovascular events in older adult men following injection receipt.
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DOI：
10.1056/nejmoa1000485
发表时间：
2010-07-08
期刊：
The New England journal of medicine
影响因子：
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作者：
Basaria S;Coviello AD;Travison TG;Storer TW;Farwell WR;Jette AM;Eder R;Tennstedt S;Ulloor J;Zhang A;Choong K;Lakshman KM;Mazer NA;Miciek R;Krasnoff J;Elmi A;Knapp PE;Brooks B;Appleman E;Aggarwal S;Bhasin G;Hede-Brierley L;Bhatia A;Collins L;LeBrasseur N;Fiore LD;Bhasin S
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发表时间：
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期刊：
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