Ageless Forever Anti-Aging News Blog

Testosterone Therapy and Cardiovascular Risk - Advances and Controversies

One of the most debated issues related to testosterone therapy is its effects on cardiovascular risk and clinical events, like for example heart attack.
 
January 27th, 2015 a comprehensive medical review paper was published, addressing the controversial topic of testosterone therapy and cardiovascular risk.[65] It was written by the Androgen Study Group academicians and published in Mayo Clinic Proceedings.
 
Here I summarizes key conclusions from this milestone medical review.
 
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Video Summary of Testosterone Replacement Therapy and Cardiovascular Risk

One of the most controversial and debated issue related to testosterone replacement therapy is its effects on cardiovascular risk and related clinical outcomes.
 
In the February 2015 issue of Mayo Clinic Proceedings a comprehensive medical review paper, written by Dr. Abraham Morgentaler and his coauthors of the Androgen Study Group – www.AndrogenStudyGroup.org - was published.[1]
 
The aim of the review was to analyze all available studies on testosterone replacement therapy and cardiovascular effects, and to clarify the grossly misleading conclusions from two recent studies that caused a tremendous media scare.
 
In this 8 minute video, Dr. Morgentaler presents the key results from this comprehensive analysis…
 
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Testosterone Treatment and Hormonophobia – Cardiovascular risk, the Media, and the Authorities

 
One of the most controversial and debated issue related to testosterone replacement therapy is its effects on cardiovascular risk and related clinical outcomes.
 
In this video presentation, Dr. Morgentaler clarifies misperceptions of testosterone replacement therapy and cardiovascular disease risk, which have created unwarranted concerns and distorted public discussion of testosterone replacement therapy as a medical treatment.
 
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Aspirin – can it save you from heart disease or cancer?

 

In people with pre-existing cardiovascular disease, it has long been well documented that long-term use of aspirin is an effective anti-platelet treatment that significantly reduces the risk of serious cardiovascular events (such as heart attacks and strokes) by 30% and cardiovascular death by 15%.[1, 2] 
 
This benefit greatly exceeds the potential risk of increased bleeding events, which is a side effect of aspirin.[3] Therefore clinical guidelines recommend that people with cardiovascular disease take low dose aspirin (75 to 162 mg) daily to prevent recurrence of cardiovascular events.[4-6]
 
More recently, the use of aspirin in healthy people for prevention of cardiovascular disease, as well as cancer, has been getting more and more attention. However, research on prophylactic use of aspirin conflicting and clinical guidelines are contradictory. Here I will shed some light on new research to help you make an informed decision whether aspirin may protect you…
 
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Fish Oil for Fat Loss - can it really help you get in shape?

Fish oil is most known for its beneficial heart and cardiovascular effects, and continues to top the list of health promoting supplements. Fish oil is unique in its ability to protect against heart disease and promote cardiovascular health in all people, regardless of age or baseline health status [1, 2].
 
Fish oil improves the blood lipid profile and is especially effective at lowering triglycerides (a.k.a. blood fats).[3] It also has beneficial effects on blood platelet activity, blood thickness, as well as blood vessel (endothelial) function [4-11], blood vessel elasticity [12], and blood pressure [13, 14], among other things.
 
In 2004 FDA approved a prescription fish oil preparation for treatment of high triglycerides (hypertriglyceridemia) [3, 15, 16]. Accumulating research shows that fish oil also has other beneficial effects, which are more visually notable… notably, fat loss!
 
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Why you need to look beyond your LDL - “bad cholesterol” - level

In the United States, cardiovascular diseases account for about 1 of every 3 deaths.[1] The cornerstone in heart disease treatment is reducing elevations of LDL, popularly known as the “bad cholesterol” (see table below “What do the terms mean?”) [2, 3], primarily with statins, the most widely used cholesterol/ heart disease drug.[4]  
 
However, when one looks at the aggregate effectiveness of statin treatment in all studies, morbidity and mortality rates among statin-treated patients still remain approximately two thirds to three quarters of those found in patients randomized to placebo.[5, 6] In the “Treating to New Targets” study there were still 80% cases of cardiovascular disease, despite intensive treatment with high-dose statins.[7]
 
Thus, many patients – even those treated aggressively with statins to meet LDL goals - have residual cardiovascular risk.[8-13] This remaining risk is associated with low levels of HDL, increased levels of triglycerides, and elevated numbers of small, dense, atherogenic LDL particles.[8, 10, 11, 14-17] and other common metabolic abnormalities that you will find out about in this article...
 
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Niacin – a.k.a vitamin B3 – the neglected broad spectrum cholesterol drug!

 

Niacin - vitamin B3 - when taken in high dose acts as a powerful cholesterol drug. Niacin is unique among all available cholesterol drugs because it has beneficial effects across the entire lipid/lipoprotein spectrum, including the three components of atherogenic dyslipidemia. 
 
To learn the basics about atherogenic dyslipidemia, see my previous article "Why you need to look beyond your LDL - “bad cholesterol” - level". 
 
Niacin is especially noteworthy because it is the most potent drug available for raising HDL levels.[1, 2] Besides boosting  HDL levels, niacin also markedly lowers triglyceride levels while reducing LDL to a smaller degree.[1]
 
The table below provides an overview of the effects of popular drugs and supplements on blood lipids.[3]
 
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Niacin Supplements - what you need to know about niacin products

In a previous article I presented the wide array of health benefit of niacin – a.k.a vitamin B3 – supplementation, related to both its lipid and non-lipid effects "Niacin – a.k.a vitamin B3 – the Neglected Broad Spectrum Cholesterol Drug! "
 
In this article you will get critical information about the different niacin products and names, and what to look for when shopping niacin supplements…
 
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Effects of Testosterone Treatment in Older Men

The so called double-blind randomized controlled trial (RCT) is accepted by medicine as the gold standard objective scientific methodology, and provides the highest strength of evidence for the effectiveness of a treatment.[1-4]
 
An accumulating body of evidence shows that treating hypogonadal men with testosterone therapy provides a number of wide-ranging benefits beyond mere relief of symptoms, including improvements in muscle mass, insulin sensitivity, fat mass (both total body fat and visceral fat), endothelial function, blood pressure, lipid profile and bone mineral density.[5, 6]
 
Recent clinical practice guidelines state that testosterone therapy is safe if treatment and monitoring are appropriately executed [7-9], and the totality of available evidence to date does not support alleged concerns regarding risk of cardiovascular disease [10] and prostate cancer.[11] Despite this, opponents state that the clinical benefits and potential long-term risks of testosterone therapy have not been adequately assessed in large RCTs, and that therefore a general policy of testosterone replacement in all older men with age-related decline in testosterone levels is not justified.[12]
 
To address the lack of large RCTs on testosterone therapy, the US National Institute of Health has funded The Testosterone Trials, which is a coordinated set of 7 large double-blind RCTs. Here I report the first results from The Testosterone Trials,  which were released February 18, 2016.[13]
 
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Testosterone treatment is NOT associated with risk of adverse cardiovascular events – the RHYME study

It is well-documented that testosterone therapy effectively restores testosterone levels in hypogonadal men and improves many health outcomes, such as quality of life [1-4], libido [4, 5], metabolic parameters [5-9] and body composition.[4, 5, 9, 10]
 
However, a few conflicting studies raised concerns about the cardiovascular safety of testosterone therapy [11, 12], which in 2015 prompted the FDA to issue warnings to physicians and patients about potential cardiovascular risks of testosterone therapy.
 
In contrast, the European Medicines Agency (EMA) acknowledged the flaws of the conflicting studies and concluded that there is no consistent evidence of harm associated with testosterone therapy, regardless of mode of delivery.[13]
 
Here I summarize the cardiovascular results of the notable RHYME (The Registry of Hypogonadism in Men) study, which contrary to prior clinical trials, enrolled men with a wide range of comorbid illnesses and cardiovascular risk factors.[14] The aim was to evaluate the safety of testosterone therapy in a sufficiently diverse population to reflect real-world, clinical experience.[14]
 
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Dr. Pierce's Medical Organization Affiliations

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