Cardiovascular risk and testosterone – from subclinical atherosclerosis to lipoprotein function to heart failure

The cardiovascular (CV) benefit and safety of treating low testosterone conditions is a matter of debate. Although testosteronedeficiency has been linked to a rise in major adverse CV events, most of the studies on testosterone replacement therapy were notdesigned to assess CV risk and thus excluded men with advanced heart failure or recent history of myocardial infarction or stroke.Besides considering observational, interventional and prospective studies, this review article evaluates the impact of testosteroneon atherosclerosis process, including lipoprotein functionality, progression of carotid intima media thickness, inflammation,coagulation and thromboembolism, quantification of plaque volume and vascular calcification. Until adequately powered studiesevaluating testosterone effects in hypogonadal men at increased CV risk are available (TRAVERSE trial), clinicians shouldponder the use of testosterone in men with atherosclerotic cardiovascular disease and discuss benefit and harms with the patients.