Testosterone Replacement May Lower Cardiovascular Risks

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Testosterone replacement therapy (TRT) is associated with a lower risk of adverse cardiovascular (CV) events among men with testosterone deficiency, according to a new study.

Researchers led by T. Craig Cheetham, PharmD, MS, of the Southern California Permanente Medical Group, identified a retrospective cohort of 44,335 men aged 40 years and older with evidence of testosterone deficiency. The cohort included 8808 men who had ever been dispensed testosterone (ever-TRT group) and 35,527 men never dispensed testosterone (never-TRT group). The primary outcome was a composite of cardiovascular endpoints that included acute myocardial infarction (AMI), coronary revascularization, unstable angina, stroke, transient ischemic attack (TIA), and sudden cardiac death (SCD).

After a median follow-up of 3.2 years in the never-TRT group and 4.2 years in the ever-TRT group, the rates of the composite endpoint were significantly higher in the never-TRT than ever-TRT group (23.9 vs 16.9 per 1000 person-years), Dr Cheetham and colleagues reported online ahead of print in JAMA Internal Medicine. After adjusting for potential confounders, the ever-TRT group had a significant 33% lower risk of the primary outcome compared with the never-TRT group. The investigators found similar results when looking separately at combined cardiac events (AMI, SCD, unstable angina, coronary revascularization) and combined stroke events (stroke and TIA). The ever-TRT group had a significant 34% and 28% lower risk of cardiac events and stroke events compared with the never-TRT group, respectively.

“While these findings differ from those of recently published observational studies of TRT, they are consistent with other evidence of CV risk and the benefits of TRT in androgen-deficient men,” the investigators wrote.

Previous studies have found an association between low serum testosterone levels in aging men and an increased risk of coronary artery disease as well as an inverse relationship between serum testosterone and carotid intima thickness, Dr Cheetham’s team pointed out.

The never-TRT and ever TRT groups had a mean age of 59.8 and 58.4 years, respectively. In the never-TRT group, 13,824 men (38.9%) were aged 40 to 55 years, 10,902 (30.7%) were aged 56 to 65 years, and 10,801 (30.4%) were older than 65 years. In the ever-TRT group, 3746 men (42.5%) were aged 40 to 55, 2899 (32.9%) were aged 56 to 65 years, and 2163 (24.6%) were older than 65 years. The groups were similar with respect to race and ethnicity composition.

The researchers defined testosterone deficiency as a coded diagnosis and/or a morning serum total testosterone level below 300 ng/dL.

With regard to study limitations, the investigators noted that their criterion for identifying men with testosterone deficiency (a diagnosis or at least 1 morning testosterone measurement) does not meet the strict criteria established by the Endocrine Society. “Therefore some individuals in the study could be misclassified as being androgen-deficient.” In addition, as the study was observational in design, “unmeasured confounding may have had an influence on the results; unmeasured confounders could possibly influence clinicians to selectively use testosterone in healthier patients.”

In an accompanying editorial, Eric Orwoll, MD, of Oregon Health & Sciences University in Portland, commented that while the study by Dr Cheetham’s group “provides reassuring data concerning the effects of testosterone on cardiovascular health, convincing answers about this question—and other safety issues like prostate health—remain elusive and will require large, prospective randomized trials.

“At this point, clinicians and their patients should remain aware that the cardiovascular risks and benefits of testosterone replacement in older hypogonadal men have not been adequately resolved.”

Reference

1. Cheetham TC, An JJ, Jacobsen SJ et al. Assocation of testosterone replacement therapy with cardiovascular outcomes among men with androgen deficiency. JAMA Intern Med 2017; published online ahead of print. doi: 10.1001/jamainternmed.2016.9546

Jody A. Charnow, Editor

Article Source: http://www.renalandurologynews.com/hypogonadism/testosterone-deficiency-treated-trt-may-reduce-cardiovascular-events/article/639486/

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Beet juice boosts muscle power in heart patients

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Scientists have evidence that Popeye was right: Spinach makes you stronger. But it’s the high nitrate content in the leafy greens — not the iron — that creates the effect.

Building on a growing body of work that suggests dietary nitrate improves muscle performance in many elite athletes, researchers at Washington University School of Medicine in St. Louis found that drinking concentrated beet juice — also high in nitrates — increases muscle power in patients with heart failure.

“It’s a small study, but we see robust changes in muscle power about two hours after patients drink the beet juice,” said senior author Linda R. Peterson, MD, associate professor of medicine. “A lot of the activities of daily living are power-based — getting out of a chair, lifting groceries, climbing stairs. And they have a major impact on quality of life. We want to help make people more powerful because power is such an important predictor of how well people do, whether they have heart failure, cancer or other conditions. In general, physically more powerful people live longer.”

Based on research in elite athletes, especially cyclists who use beet juice to boost performance, the study’s corresponding author, Andrew R. Coggan, PhD, assistant professor of radiology, suggested trying the same strategy in patients with heart failure.

In the September issue of the journal Circulation: Heart Failure, the scientists reported data from nine patients with heart failure. Two hours after the treatment, patients demonstrated a 13 percent increase in power in muscles that extend the knee. The researchers observed the most substantial benefit when the muscles moved at the highest velocities. The increase in muscle performance was significant in quick, power-based actions, but researchers saw no improvements in performance during longer tests that measure muscle fatigue.

Patients in the study served as their own controls, with each receiving the beet juice treatment and an identical beet juice placebo that had only the nitrate content removed. There was a one- to two-week period between trial sessions to be sure any effects of the first treatment did not carry over to the second. Neither the trial participants nor the investigators knew the order in which patients received the treatment and placebo beet juice.

The researchers also pointed out that participants experienced no major side effects from the beet juice, including no increase in heart rates or drops in blood pressure, which is important in patients with heart failure.

Heart failure can have various triggers, from heart valve problems to viral infections, but the result is the heart’s gradual loss of pumping capacity.

“The heart can’t pump enough in these patients, but that’s just where the problems start,” said Peterson, a cardiologist and director of Cardiac Rehabilitation at Washington University and Barnes-Jewish Hospital. “Heart failure becomes a whole-body problem because of the metabolic changes that happen, increasing the risk of conditions such as insulin resistance and diabetes and generally leading to weaker muscles overall.”

While the trial was not designed to find out whether patients noticed an improved ability to function in daily life, the researchers estimated the size of the benefit by comparing the improvement in muscle power with what is seen from an exercise program.

“I have compared the beet-juice effect to Popeye eating his spinach,” said Coggan, who specializes in exercise physiology. “The magnitude of this improvement is comparable to that seen in heart failure patients who have done two to three months of resistance training.”

The nitrates in beet juice, spinach and other leafy green vegetables such as arugula and celery are processed by the body into nitric oxide, which is known to relax blood vessels and have other beneficial effects on metabolism.

With the growing evidence of a positive effect from dietary nitrates in healthy people, elite athletes and now heart failure patients, the researchers also are interested in studying dietary nitrates in elderly populations.

“One problem in aging is the muscles get weaker, slower and less powerful,” Coggan said. “Beyond a certain age, people lose about 1 percent per year of their muscle function. If we can boost muscle power like we did in this study, that could provide a significant benefit to older individuals.”

###

http://www.eurekalert.org/pub_releases/2015-09/wuso-bjb091615.php

This work was supported by The Foundation for Barnes-Jewish Hospital, the Washington University Mentors in Medicine and C-STAR programs, and Washington University Institute of Clinical and Translational Sciences grant UL1 TR000448 from the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH).

Coggan AR, Leibowitz JL, Spearie CA, Kadkhodayan A, Thomas DP, Ramamurthy S, Mahmood K, Park S, Waller S, Farmer M, Peterson LR. Acute dietary nitrate intake improves muscle contractile function in patients with heart failure: a double-blind, placebo-controlled, randomized trial. Circulation: Heart Failure. September 2015.

Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient-care institutions in the nation, currently ranked sixth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.

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Vitamin E Keeps Muscles Healthy

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A study in Free Radical Biology & Medicine provides an explanation of how vitamin E helps maintain muscle.*

Previous research conducted by Paul McNeil and colleagues demonstrated that vitamin E promoted membrane repair in cultured cells and that oxidants inhibited it. For the current study, rats were given normal rodent chow, chow lacking vitamin E, or deficient chow plus supplemental vitamin E, then were tested in their ability to run downhill on a treadmill. Deficient animals demonstrated reduced running ability compared to normal rats and showed increased muscle cell plasma membrane permeability. Examination of their quadriceps muscle fibers revealed diminished size and greater inflammation.

“Every cell in your body has a plasma membrane, and every membrane can be torn,” Dr. McNeil explained. “Part of how we build muscle is a more natural tearing and repair process—that is the no pain, no gain portion—but if that repair doesn’t occur, what you get is muscle cell death.”

Editor’s Note: Dr. McNeil predicts that vitamin E supplementation will be used not only to improve muscle cell membrane repair in diseases such as muscular dystrophy, but as a protective measure for individuals at risk of injury.

Reference
* Free Radic Biol Med. 2015 Jul;84:246-53.

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Low Testosterone in Diabetic Men Tied to Vascular Risk

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Study finds Middle Aged Diabetic Men with Low Testosterone have a Sixfold Increase in Heart Disease.

In a cross-sectional study of men around 60 years old with type 2 diabetes, those with low total plasma testosterone levels had a sixfold higher risk for increased carotid artery intima media thickness (CIMT) and decreased endothelial function, compared with their peers with normal testosterone.

The study was published online October 16 in the Journal of Clinical Endocrinology & Metabolism.

The research identified that 31% of these middle-aged, overweight, diabetic men had low testosterone levels, and the latter was linked with a heightened level of atherosclerotic-disease risk markers, lead author Dr Javier Mauricio Farias told Medscape Medical News.

To read the full article click here: http://www.medscape.com/viewarticle/833642

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Boston Testosterone Partners – Testosterone Therapy Doctors Reviews and Testimonials

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We, at Boston Testosterone,have the best testosterone therapy testimonials in the Nation!

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From our Facebook Wall, May 29, 2013,

“I have been on your products for two weeks. Today was the start of my third week. Let me tell you, not only do I feel as strong as I did when I was 25, I’m forty now, but the way they give me energy, help me breathe better and heal faster is amazing to me!
I started playing softball again this year and have had semi pulled muscles in both legs each night after a game to the point I could hardly walk after the game. Since I’ve been on TRT and glutathione and ghrp-2, by the end of the following day I’m pretty much normal! Thank you for your products you are a godsend.
My regular physician suggested TRT but I am so glad I went to you guys before I went on some cream. The injections are painless and no need to worry about my son or wife contacting my cream sites. I feel great no more depression, very high energy, I sleep better, I have very vivid, colorful dreams, I can’t wait to play with my son, you guys are everything you claim.
Thank you Charlie, for answering all my bothersome questions no matter what time. You have a customer and a friend for life!”  CS from Wisconsin

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Men With Low Testosterone Not Receiving Treatment

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Study finds patients with deficiency more likely to be poorer and without insurance 

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Boston, Massachusetts –  (HealthDay News) — Many men with low testosterone levels don’t receive treatment, even though they have access to care, according to a U.S. study. The study, which received funding from drug maker GlaxoSmithKline, was published in the May 26 issue of the journal Archives of Internal Medicine. 

The research involved 97 Boston-area men with the low testosterone, also known as androgen deficiency. Only 11 were prescribed treatment. Treatments included: testosterone gel (one patient); testosterone patch (three patients); testosterone cream (one patient); an injectable form of testosterone called testosterone cypionate (one patient); and unspecified formulations of testosterone (five patients). 

“All of the unspecified forms of testosterone used were self-reported as administered in intervals defined in weeks, which suggests that these were injectable formulations,” wrote Susan A. Hall, of New England Research Institutes in Watertown, Mass., and colleagues. 

Men with untreated androgen deficiency were most likely to have low socioeconomic status, no health insurance and to rely on an emergency department or hospital outpatient clinic for primary care, the study authors said. 

They also found that all men with androgen deficiency (treated and untreated) were more likely than men without the condition to report receiving regular care and visiting their doctor more often — 15.1 visits per year for those with untreated androgen deficiency, 12 visits for those with treated androgen deficiency, and 6.7 visits for those without the condition. 

“Under our assumptions, a large majority (87.8 percent) of 97 men … with androgen deficiency were not receiving treatment despite adequate access to care. The reasons for this are unknown but could be due to unrecognized androgen deficiency or unwillingness to prescribe testosterone therapy,” the study authors wrote. 

Symptoms of androgen deficiency include low libido, erectile dysfunction, osteoporosis, sleep disturbance, depressed mood and tiredness.

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