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

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 pei formed 30 minutes after administration of testosterone (2.5 mg IV in 5 minutes) or placebo. All patients showed at least l-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 I-mm ST-segment depression (579+/-204 versus 471+/-210 seconds; P<0.01) and total exercise time (631+/-180 versus 542+/-204seconds; 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 peak exercise (140+/-12 versus 132+/-12 bpm; P<0.01) and the rate-pressure product at the onset of l-mm ST-segment depression (24213+/-3750 versus 21619+/-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.