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Testosterone replacement therapy not associated with higher heart risks

Testosterone replacement therapy appears safe in the short‐to‐medium term to treat hypogonadism, according to an analysis of the treatment, published in The Lancet Healthy Longevity. Researchers from the University of Melbourne and the University of Aberdeen conducted a systematic review identifying 35 eligible clinical trials published since 1992, of which 17 provided individual participant data. A blinded analysis by two independent clinicians enabled the classification of every cardiovascular event, allowing for a more robust analysis of the cardiovascular safety of testosterone treatment. The researchers performed a meta‐analysis using individual participant data from 17 studies and a further meta‐analysis integrating these data with the aggregate data provided by the 18 trials that did not provide individual participant data. Among the 17 trials with individual patient data, 1750 participants received testosterone and 1681 were given a placebo. The average length of testosterone treatment was 9.5 months. The average age of participants was 65years, and most were white and did not smoke. Participants’ average BMI was 30kg/m², which is considered obese. A meta‐analysis showed there were 120/1601 (7.5%) cardiovascular events in the testosterone group and 110/1519 (7.2%) in the placebo group across 13 trials that provided this information. Patient age, smoking or diabetes status did not affect cardiovascular risk. Similarly, there was no significant difference in mortality rate between the testosterone group (6/1621 deaths, 0.4%) and the placebo group (12/1537 deaths, 0.8%) across the 14 trials that provided individual patient data on mortality, but only limited data were available. Testosterone significantly reduced serum total cholesterol, high density lipoprotein, and triglyceride levels compared with placebo. However, there were no significant differences in serum low density lipoprotein, blood pressure, glycaemic parameters, diabetes incidence, and prostate adverse outcomes between the testosterone and placebo groups.

https://www.thelancet.com/journals/lanhl/article/PIIS2666‐7568(22)00096‐4/fulltext

Inconsistent sleep associated with hypertension risk

A Flinders University study, published in Sleep, of more than two million nights of sleep and blood pressure data found that irregularities in sleep timing and duration were associated with an increased risk of hypertension. Results showed that high sleep duration irregularity was associated with a 9% to 15% increase in hypertension risk. Furthermore, a 38‐minute increase in sleep midpoint irregularity was associated with an 11% risk increase, and a 31‐minute increase in sleep onset time irregularity was associated with a 29% increased risk of hypertension. The researchers analysed data collected over 9 months from 12300 participants who were aged between 18 and 90years. Metrics were recorded with an under‐mattress sleep device and a portable blood pressure monitor. Sleep duration regularity was assessed as the standard deviation via device‐assessed total sleep time. Sleep timing regularity was assessed as the standard deviation in sleep onset time and in sleep midpoint. Logistic regressions controlling for age, sex, body mass index, and mean total sleep time were conducted to investigate potential associations between sleep regularity and hypertension, which was found in 2499 participants. “These new insights into the potential adverse impact of irregular sleep timing and duration on heart health further highlight the importance of the role synchronising the body clock and prioritising enough sleep opportunity for optimal health and wellbeing,” said senior author Professor Danny Eckert, Director of the Adelaide Institute for Sleep Health.

https://academic.oup.com/sleep/article/45/Supplement_1/A93/6592269