Acute anti-ischemic effect of testosterone in men with coronary artery disease

Background-The role of testosterone on the development of coronary artery d isease in men is controversial. The evidence that men have a greater incide nce of coronary artery disease than women of a similar age suggests a possi ble 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 effe ct of acute administration of testosterone on exercise-induced myocardial i schemia in men. Methods and Results-After withdrawal of antianginal therapy, 14 men (mean a ge, 58+/-4 years) with coronary artery disease underwent 3 exercise tests a ccording to the modified Bruce protocol on 3 different days(baseline and ei ther testosterone or placebo given in a random order). The exercise tests w ere pei formed 30 minutes after administration of testosterone (2.5 mg IV i n 5 minutes) or placebo. All patients showed at least l-mm ST-segment depre ssion 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, testoste rone increased time to I-mm ST-segment depression (579+/-204 versus 471+/-2 10 seconds; P<0.01) and total exercise time (631+/-180 versus 542+/-204seco nds; P<0.01). Testosterone significantly increased heart rate at the onset of l-mm ST-segment depression(135+/-12 versus 123+/-14 bpm; P<0.01)and at p eak exercise (140+/-12 versus 132+/-12 bpm; P<0.01) and the rate-pressure p roduct at the onset of l-mm ST-segment depression (24213+/-3750 versus 2161 9+/-3542 mm HgXbpm; P<0.05) and at peak exercise (26746+/-3109 versus 22527 +/-5443 mm NgXbpm; 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.