Testosterone Supplementation in Heart Failure: A Meta-Analysis
Background—Low testosterone is an independent predictor of reduced exercise capacity and poor clinical outcomes in patients with heart failure (HF). We sought to determine if testosterone therapy improves exercise capacity in patients with stable chronic HF.
Methods and Results—We searched MEDLINE, EMBASE, Web of Science and Cochrane CENTRAL (1980 to 2010). Eligible studies included randomized trials reporting the effects of testosterone on exercise capacity in HF patients. Reviewers determined the methodological quality of studies and collected descriptive, quality, and outcome data. Four trials (n=198 patients, 84% male, mean age 67 years) were identified reporting the 6-minute walk test (6MWT, 2 RCT), incremental shuttle walk test (ISWT, 2 RCT) or peak VO2 (2 RCT) to assess exercise capacity after up to 52 weeks of treatment. Testosterone therapy was associated with a significant improvement in exercise capacity compared to placebo. The mean increase in the 6MWT, ISWT, and peak VO2 between the testosterone and placebo groups were 54.0 m (95% CI 43.0-65.0m), 46.7m (95% CI 12.6-80.9m), and 2.70 ml/kg/min (95% CI 2.68-2.72 ml/kg/min), respectively. Testosterone therapy was associated with a significant increase in exercise capacity as measured by units of pooled standard deviations (net effect 0.52 SD, 95% CI 0.10-0.94). No significant adverse cardiovascular events were noted.
Conclusions—Given the unmet clinical needs, testosterone appears to be a promising therapy to improve functional capacity in HF patients. Adequately powered RCT are required to assess the benefits of testosterone in this high-risk population assessing quality of life, clinical events and safety.
- Received November 13, 2011.
- Accepted February 27, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited