NEW ORLEANS — Testosterone replacement therapy may be of cardiovascular benefit in a sizable proportion of men with coronary heart disease Dr. Chris J. Malkin said at the annual meeting of the American College of Cardiology.

Testosterone replacement reduced elevated levels of inflammatory cyto-kines in a group of men with CHD and symptomatic androgen deficiency in a randomized, placebo-controlled trial. This dialing-down of the systemic inflammatory state may have salutary stabilizing effects on atherosclerotic plaques, explained Dr. Malkin of Royal Hallamshire Hospital, Sheffield, England.

These observations, if confirmed in larger studies incorporating clinical event end points, could have broad implications. The prevalence of hypogonadism is known to be elevated in men with CHD; in one representative study, the rate was 23%.

Dr. Malkin reported on 20 men with CHD and androgen deficiency symptoms who were randomized to 1 month of testosterone replacement or placebo, then crossed over to the other arm for a second month. Baseline mean total testosterone in study participants was 6.7 nmol/L; the lower limit of normal is 8.3 nmol/L.

Of the inflammatory cytokines measured in the study, the greatest impact of testosterone replacement was on tumor necrosis factor (TNF)-[alpha]. Mean TNF-[alpha] decreased by 4.1 pg/mL during replacement therapy, compared with a 1.5 pg/mL increase during the placebo phase.

Interleukin (IL)-1[beta] levels decreased by 0.17 pg/mL during testosterone replacement, a significant improvement over the mean 0.3 pg/mL gain while patients were on placebo.

IL-10, an anti-inflammatory cytokine, increased by 0.32 pg/mL during testosterone therapy and decreased by 0.87 pg/mL during the placebo phase, a difference that bordered on statistical significance.

Total serum cholesterol declined by 0.26 mmol/L in the testosterone phase, compared with a 0.005 mmol/L reduction while on placebo, a nonsignificant trend.

This pilot study is the first ever to evaluate the effect of testosterone replacement on inflammatory and anti-inflammatory cytokines in men with CHD, according to Dr. Malkin. The hormonal therapy has previously been shown to inhibit atherosclerosis in castrated male animals fed a high-cholesterol diet.