Normalization of Testosterone Levels After Testosterone Replacement Therapy Is Not Associated With Reduced Myocardial Infarction in Smokers.
Normalization of Testosterone Levels After Testosterone Replacement Therapy Is Not Associated With Reduced Myocardial Infarction in Smokers.
复制标题
DOI：
10.1016/j.mayocpiqo.2017.05.003
复制
发表时间：
2017-07
期刊：
影响因子：
--
通讯作者：
Barua RS
中科院分区：
文献类型：
--
作者：
Oni OA;Sharma R;Chen G;Sharma M;Gupta K;Dawn B;Sharma R;Parashara D;Savin VJ;Cherian G;Ambrose JA;Barua RS
在男性吸烟者和无心肌梗死和卒中病史的非吸烟者中，研究睾酮替代治疗（TRT）后吸烟（CS）状态和总睾酮（TT）水平对全因死亡率、心肌梗死（MI）和卒中的影响。来自1999年12月1日至2014年5月31日期间在退伍军人健康管理局接受TRT的18，055名已知CS状态和低TT水平的男性的数据被分为（1）TT正常化的当前吸烟者，（2）TT非正常化的当前吸烟者，（3）TT正常化的非吸烟者，和（4）TT非正常化的非吸烟者。采用倾向评分加权考克斯比例风险模型比较TRT后CS状态和TT水平正常化对全因死亡率、MI和卒中的联合作用。非吸烟者血清TT水平正常化与全因死亡率（风险比[HR]=0.526; 95%CI，0.477-0.581; P<0.001）和MI（HR=0.717; 95%CI，0.522-0.986; P<0.001）显著降低相关。在当前吸烟者中，血清TT水平正常化仅与全因死亡率显著降低相关（HR=0.563; 95% CI，0.488-0.649; P<0.001），而MI无获益（HR=1.096; 95% CI，0.698-1.720; P= 0.69）。重要的是，与TT正常化的非吸烟者相比，（HR=1.242; 95% CI，1.104-1.396; P<.001），MI TT正常化的当前吸烟者中，卒中（HR=1.706; 95% CI，1.242-2.342; P=.001）和卒中（HR=1.590; 95% CI，1.013-2.495; P=.04）的发生率显著较高。我们的结论是，积极的CS可能会否定TRT后睾酮水平正常化对全因死亡率和MI的保护作用。
To examine the effect of cigarette smoking (CS) status and total testosterone (TT) levels after testosterone replacement therapy (TRT) on all-cause mortality, myocardial infarction (MI), and stroke in male smokers and nonsmokers without history of MI and stroke. Data from 18,055 males with known CS status and low TT levels who received TRT at the Veterans Health Administration between December 1, 1999, and May 31, 2014, were grouped into (1) current smokers with normalized TT, (2) current smokers with nonnormalized TT, (3) nonsmokers with normalized TT, and (4) nonsmokers with nonnormalized TT. Combined effect of CS status and TT level normalization after TRT on all-cause mortality, MI, and stroke was compared using propensity score–weighted Cox proportional hazard models. Normalization of serum TT levels in nonsmokers was associated with a significant decrease in all-cause mortality (hazard ratio [HR]=0.526; 95% CI, 0.477-0.581; P<.001) and MI (HR=0.717; 95% CI, 0.522-0.986; P<.001). Among current smokers, normalization of serum TT levels was associated with a significant decrease in only all-cause mortality (HR=0.563; 95% CI, 0.488-0.649; P<.001) without benefit in MI (HR=1.096; 95% CI, 0.698-1.720; P=.69). Importantly, compared with nonsmokers with normalized TT, all-cause mortality (HR=1.242; 95% CI, 1.104-1.396; P<.001), MI (HR=1.706; 95% CI, 1.242-2.342; P=.001), and stroke (HR=1.590; 95% CI, 1.013-2.495; P=.04) were significantly higher in current smokers with normalized TT. We conclude that active CS may negate the protective effect of testosterone level normalization on all-cause mortality and MI after TRT.