Acute Anti-Ischemic Effect of Testosterone in Men With Coronary Artery Disease

Abstract

Background —The role of testosterone on the development of coronary artery disease in men is controversial. The evidence that men have a greater incidence of coronary artery disease than women of a similar age suggests a possible causal role of testosterone. Conversely, recent studies have shown that the hormone improves endothelium-dependent relaxation of coronary arteries in men. Accordingly, the aim of the present study was to evaluate the effect of acute administration of testosterone on exercise-induced myocardial ischemia in men. Methods and Results —After withdrawal of antianginal therapy, 14 men (mean age, 58±4 years) with coronary artery disease underwent 3 exercise tests according to the modified Bruce protocol on 3 different days (baseline and either testosterone or placebo given in a random order). The exercise tests were performed 30 minutes after administration of testosterone (2.5 mg IV in 5 minutes) or placebo. All patients showed at least 1-mm ST-segment depression during the baseline exercise test and after placebo, whereas only 10 patients had a positive exercise test after testosterone. Chest pain during exercise was reported by 12 patients during baseline and placebo exercise tests and by 8 patients after testosterone. Compared with placebo, testosterone increased time to 1-mm ST-segment depression (579±204 versus 471±210 seconds; P <0.01) and total exercise time (631±180 versus 541±204 seconds; P <0.01). Testosterone significantly increased heart rate at the onset of 1-mm ST-segment depression (135±12 versus 123±14 bpm; P <0.01) and at peak exercise (140±12 versus 132±12 bpm; P <0.01) and the rate-pressure product at the onset of 1-mm ST-segment depression (24 213±3750 versus 21 619±3542 mm Hg×bpm; P <0.05) and at peak exercise (26 746±3109 versus 22 527±5443 mm Hg×bpm; P <0.05). Conclusions —Short-term administration of testosterone induces a beneficial effect on exercise-induced myocardial ischemia in men with coronary artery disease. This effect may be related to a direct coronary-relaxing effect.