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Ruplin A, Segal E, McFarlane T. Review of drug-drug interactions in patients with prostate cancer. J Oncol Pharm Pract 2024:10781552241238198. [PMID: 38720547 DOI: 10.1177/10781552241238198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
OBJECTIVE The objective of this review is to provide an overview of common drug-drug interactions (DDIs) associated with prostate cancer treatments and outline recommendations for managing polypharmacy. DATA SOURCES A literature search of PubMed, Embase, and CINAHL was carried out to identify pharmacokinetic and pharmacodynamic changes caused by DDIs that are relevant for prostate cancer patients, DDIs between prostate cancer therapies and co-administered medications (both prescription and over-the-counter), and measures to prevent DDIs. Medication package inserts were used to identify the impact of DDI on the prostate cancer therapy and suggested interventions. DATA SUMMARY No DDIs are expected for the LHRH agonists leuprolide acetate, histrelin, goserelin, or leuprolide mesylate. However, DDIs have been reported for GnRH antagonists, anti-androgens, PARP inhibitors, and taxanes. Although there are no confirmed DDIs for sipuleucel-T to date, it is not generally recommended to use sipuleucel-T concurrently with immunosuppressive medications. Interventions to prevent DDIs include the use of software that can detect clinically significant DDIs, up-to-date medication reconciliation, the inclusion of dedicated clinical pharmacists in cancer treatment teams, and patient/caregiver education. CONCLUSIONS Prostate cancer patients have a high risk of potential DDIs due to numerous new anti-cancer therapies, the increased use of treatment combinations, and the likelihood of comorbid conditions also requiring drug therapy. Drug-drug interaction screening software, up-to-date medication reconciliation, inclusion of oncology pharmacists on healthcare teams, and patient/caregiver education will aid the development of treatment plans that focus on achieving an optimal risk-benefit profile whilst reducing the risk of DDIs.
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Affiliation(s)
- Andrew Ruplin
- Department of Pharmacy, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Eve Segal
- Department of Pharmacy, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Tom McFarlane
- School of Pharmacy, University of Waterloo, Kitchener, Canada
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2
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Lin Y, Zhou F, Wang X, Guo Y, Chen W. Effect of the index of cardiac electrophysiological balance on major adverse cardiovascular events in patients with diabetes complicated with coronary heart disease. PeerJ 2023; 11:e15969. [PMID: 37818331 PMCID: PMC10561639 DOI: 10.7717/peerj.15969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/06/2023] [Indexed: 10/12/2023] Open
Abstract
Purpose To investigate the prognostic value of the index of cardio-electrophysiological balance (ICEB) and its association with major adverse cardiac events (MACE) and cardiovascular death in diabetic patients complicated with coronary heart disease. Methods A total of 920 diabetic patients were enrolled in this longitudinal study. Participants were categorized into three groups based on their ICEB levels: normal ICEB, low ICEB, and high ICEB. The primary outcome was the occurrence of MACE, and secondary outcomes included cardiovascular death, coronary heart disease (CHD), heart failure (HF), and sudden cardiac arrest (SCA). Patients were followed for a median period of 3.26 years, and the associations between ICEB levels and various outcomes were evaluated. Results Over the follow-up period, 46 (5.0%) MACE were observed in the normal ICEB group, 57 (6.2%) in the low ICEB group, and 62 (6.8%) in the high ICEB group. Elevated ICEB levels were found to be associated with a higher risk of MACE and cardiovascular death. A significant relationship between ICEB levels and the risk of MACE was observed for both genders. The risk of MACE increased with each unit increment in the ICEB index. However, the two-stage linear regression model did not outperform the single-line linear regression models in determining the threshold effect. Conclusion This study demonstrates the potential utility of ICEB, derived from a standard non-invasive ECG, as a prognostic tool for predicting MACE and cardiovascular death in diabetic patients complicated with CVD. The associations between ICEB levels and the risk of MACE highlight the importance of understanding cardiac electrophysiological imbalances and their implications in CVD.
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Affiliation(s)
- Yuan Lin
- Department of Endocrinology, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Fang Zhou
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Xihui Wang
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Yaju Guo
- Department of Endocrinology, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Weiguo Chen
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, China
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3
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Moey MYY, Wilkin M, Gandjbakhch E, Bachelot A, Abbar B, Pinna B, Simon JM, Funck-Brentano C, Salem JE. Androgens, QT, sex and ventricular repolarization-a double-edged sword: A case series. Therapie 2021; 77:265-271. [PMID: 34895755 DOI: 10.1016/j.therap.2021.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/26/2021] [Accepted: 10/14/2021] [Indexed: 01/08/2023]
Abstract
The prevalence and incidence of cardiac pro-arrhythmic disorders are often influenced by sex due to specific effects on the QT interval. Androgens shorten QT, which may be protective against acquired long QT syndromes and their related arrhythmias in men such as torsade de pointes (TdP). On the other hand, androgens can potentiate Brugada and early repolarization syndromes, which are most prevalent in men. In this case series, we highlight four male patients with aborted SCD in the setting of abnormal testosterone status; two patients with TdP in a setting of testosterone deprivation (of which one drug-induced) and 2 patients with ventricular fibrillation associated with exogenous androgenic booster (Tribulus terrestris) intake. From this case series, we review the current available literature of the effects of androgen as a double-edged sword on the QTc interval and emphasize the importance of QTc monitoring in this subset of patients.
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Affiliation(s)
- Melissa Y Y Moey
- Department of Cardiovascular Disease, Vidant Medical Center/East Carolina University, Greenville, NC, USA
| | - Marie Wilkin
- Department of Cardiology, Arrhythmia unit, Sorbonne Université, INSERM, AP-HP, Pitié-Salpêtrière Hospital, 75013 Paris, France
| | - Estelle Gandjbakhch
- Department of Cardiology, Arrhythmia unit, Sorbonne Université, INSERM, AP-HP, Pitié-Salpêtrière Hospital, 75013 Paris, France
| | - Anne Bachelot
- AP-HP, Pitié-Salpêtrière Hospital, IE3M, Department of Endocrinology and Reproductive Medicine, and Centre de Référence des Maladies Endocriniennes Rares de la croissance et Centre des Pathologies gynécologiques Rares; Sorbonne Universités, 75013 Paris, France
| | - Baptiste Abbar
- Sorbonne Université, Inserm CIC Paris-Est (CIC-1901), AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Department of Pharmacology, UNICO-GRECO Cardio-Oncology Program, 75013 Paris, France
| | - Bruno Pinna
- Sorbonne Université, Inserm CIC Paris-Est (CIC-1901), AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Department of Pharmacology, UNICO-GRECO Cardio-Oncology Program, 75013 Paris, France
| | - Jean-Marc Simon
- Sorbonne Université, GRC n°5, Oncotype-Uro, Department of Oncology Radiotherapy, Assistance Publique-Hôpitaux de Paris (APHP), Pitié-Salpêtrière Hospital, 75013 Paris, France
| | - Christian Funck-Brentano
- Sorbonne Université, Inserm CIC Paris-Est (CIC-1901), AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Department of Pharmacology, UNICO-GRECO Cardio-Oncology Program, 75013 Paris, France
| | - Joe-Elie Salem
- Sorbonne Université, Inserm CIC Paris-Est (CIC-1901), AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Department of Pharmacology, UNICO-GRECO Cardio-Oncology Program, 75013 Paris, France.
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4
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Gheorghe GS, Hodorogea AS, Ciobanu A, Nanea IT, Gheorghe ACD. Androgen Deprivation Therapy, Hypogonadism and Cardiovascular Toxicity in Men with Advanced Prostate Cancer. ACTA ACUST UNITED AC 2021; 28:3331-3346. [PMID: 34590590 PMCID: PMC8482210 DOI: 10.3390/curroncol28050289] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 01/04/2023]
Abstract
Androgen deprivation therapy (ADT) is successfully used in patients with advanced prostatic cancer, but there are many concerns about its systemic side effects, especially due to advanced age and frequent comorbidities in most patients. In patients treated with ADT there are metabolic changes involving the glycaemic control and lipid metabolism, increased thrombotic risk, an increased risk of myocardial infarction, severe arrhythmia and sudden cardiac death. Still, these adverse effects can be also due to the subsequent hypogonadism. Men with heart failure or coronary artery disease have a lower level of serum testosterone than normal men of the same age, and hypogonadism is related to higher cardiovascular mortality. Many clinical studies compared the cardiovascular effects of hypogonadism post orchiectomy or radiotherapy with those of ADT but their results are controversial. However, current data suggest that more intensive treatment of cardiovascular risk factors and closer cardiological follow-up of older patients under ADT might be beneficial. Our paper is a narrative review of the literature data in this field.
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Affiliation(s)
- Gabriela Silvia Gheorghe
- Faculty of Medicine, Department 4, Cardio-Thoracic Pathology, Carol Davila University of Medicine and Pharmacy, 050471 Bucharest, Romania; (G.S.G.); (A.C.); (I.T.N.); (A.C.D.G.)
- Department of Internal Medicine and Cardiology, Theodor Burghele Clinical Hospital, 050653 Bucharest, Romania
| | - Andreea Simona Hodorogea
- Faculty of Medicine, Department 4, Cardio-Thoracic Pathology, Carol Davila University of Medicine and Pharmacy, 050471 Bucharest, Romania; (G.S.G.); (A.C.); (I.T.N.); (A.C.D.G.)
- Department of Internal Medicine and Cardiology, Theodor Burghele Clinical Hospital, 050653 Bucharest, Romania
- Correspondence: ; Tel.: +40-726-315872
| | - Ana Ciobanu
- Faculty of Medicine, Department 4, Cardio-Thoracic Pathology, Carol Davila University of Medicine and Pharmacy, 050471 Bucharest, Romania; (G.S.G.); (A.C.); (I.T.N.); (A.C.D.G.)
- Department of Internal Medicine and Cardiology, Theodor Burghele Clinical Hospital, 050653 Bucharest, Romania
| | - Ioan Tiberiu Nanea
- Faculty of Medicine, Department 4, Cardio-Thoracic Pathology, Carol Davila University of Medicine and Pharmacy, 050471 Bucharest, Romania; (G.S.G.); (A.C.); (I.T.N.); (A.C.D.G.)
- Department of Internal Medicine and Cardiology, Theodor Burghele Clinical Hospital, 050653 Bucharest, Romania
| | - Andrei Cristian Dan Gheorghe
- Faculty of Medicine, Department 4, Cardio-Thoracic Pathology, Carol Davila University of Medicine and Pharmacy, 050471 Bucharest, Romania; (G.S.G.); (A.C.); (I.T.N.); (A.C.D.G.)
- Department of Internal Medicine and Cardiology, Theodor Burghele Clinical Hospital, 050653 Bucharest, Romania
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5
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Gutierrez G, Wamboldt R, Baranchuk A. The Impact of Testosterone on the QT Interval: A Systematic Review. Curr Probl Cardiol 2021; 47:100882. [PMID: 34103195 DOI: 10.1016/j.cpcardiol.2021.100882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/02/2021] [Indexed: 11/03/2022]
Abstract
Humans and mammals have sex-specific differences in cardiac electrophysiology, linked to the action of sex hormones in the cardiac muscle. These hormones can upregulate or downregulate the expression of ionic channels modulating the cardiac cycle through genomic and non-genomic interactions. Systematic search in PubMed, Medline and EMBASE including keywords pertaining to testosterone and QT interval. Included experimental studies and observation studies and case reports presenting the results of testosterone administration, excess or deficiency in humans and animals. Testosterone has been shown to shorten the action potential duration, by enhancing the expression of K+ channels and downregulating ICaL increasing the repolarization reserve of the cardiac muscle. This effect has been observed in both genders and animals. Testosterone deficient states can promote arrhythmogenesis. The evidence in this paper may be used to guide clinical considerations, such as increased clinical surveillance of patients in testosterone deficient states using ECG.
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Affiliation(s)
- Gilmar Gutierrez
- Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Rachel Wamboldt
- Division of Internal Medicine, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada.
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6
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Grouthier V, Moey MYY, Gandjbakhch E, Waintraub X, Funck-Brentano C, Bachelot A, Salem JE. Sexual Dimorphisms, Anti-Hormonal Therapy and Cardiac Arrhythmias. Int J Mol Sci 2021; 22:ijms22031464. [PMID: 33540539 PMCID: PMC7867204 DOI: 10.3390/ijms22031464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/21/2021] [Accepted: 01/27/2021] [Indexed: 02/07/2023] Open
Abstract
Significant variations from the normal QT interval range of 350 to 450 milliseconds (ms) in men and 360 to 460 ms in women increase the risk for ventricular arrhythmias. This difference in the QT interval between men and women has led to the understanding of the influence of sex hormones on the role of gender-specific channelopathies and development of ventricular arrhythmias. The QT interval, which represents the duration of ventricular repolarization of the heart, can be affected by androgen levels, resulting in a sex-specific predilection for acquired and inherited channelopathies such as acquired long QT syndrome in women and Brugada syndrome and early repolarization syndrome in men. Manipulation of the homeostasis of these sex hormones as either hormonal therapy for certain cancers, recreational therapy or family planning and in transgender treatment has also been shown to affect QT interval duration and increase the risk for ventricular arrhythmias. In this review, we highlight the effects of endogenous and exogenous sex hormones in the physiological and pathological states on QTc variation and predisposition to gender-specific pro-arrhythmias.
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Affiliation(s)
- Virginie Grouthier
- Department of Endocrinology, Diabetes and Nutrition, Centre Hospitalier Universitaire de Bordeaux, Haut Leveque Hospital, F-33000 Bordeaux, France;
| | - Melissa Y. Y. Moey
- Department of Cardiovascular Disease, Vidant Medical Center/East Carolina University, Greenville, NC 27834, USA;
| | - Estelle Gandjbakhch
- APHP, Pitié-Salpêtrière Hospital, Institute of Cardiology, Centre de Référence des Maladies Cardiaques Héréditaires, Institute of Cardiometabolism and Nutrition (ICAN), UPMC Univ Paris 06, INSERM 1166, Sorbonne Universités, F-75013 Paris, France; (E.G.); (X.W.)
| | - Xavier Waintraub
- APHP, Pitié-Salpêtrière Hospital, Institute of Cardiology, Centre de Référence des Maladies Cardiaques Héréditaires, Institute of Cardiometabolism and Nutrition (ICAN), UPMC Univ Paris 06, INSERM 1166, Sorbonne Universités, F-75013 Paris, France; (E.G.); (X.W.)
| | - Christian Funck-Brentano
- INSERM, CIC-1901, AP-HP, Pitié-Salpêtrière Hospital, Regional Pharmacovigilance Center, UNICO-GRECO Cardio-Oncology Program, Department of Pharmacology and Clinical Investigation Center, CLIP2 Galilée, Sorbonne Université, F-75013 Paris, France;
| | - Anne Bachelot
- AP-HP, Pitié-Salpêtrière Hospital, IE3M, and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, and Centre de Référence des Pathologies Gynécologiques Rares, Department of Endocrinology and Reproductive Medicine, Sorbonne Université, F-75013 Paris, France;
| | - Joe-Elie Salem
- INSERM, CIC-1901, AP-HP, Pitié-Salpêtrière Hospital, Regional Pharmacovigilance Center, UNICO-GRECO Cardio-Oncology Program, Department of Pharmacology and Clinical Investigation Center, CLIP2 Galilée, Sorbonne Université, F-75013 Paris, France;
- Cardio-Oncology Program, Department of Medicine and Pharmacology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Correspondence: ; Tel.: +33-1-42-17-85-31 or +1-(615)-322-0067
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7
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Strauss DG, Wu WW, Li Z, Koerner J, Garnett C. Translational Models and Tools to Reduce Clinical Trials and Improve Regulatory Decision Making for QTc and Proarrhythmia Risk (ICH E14/S7B Updates). Clin Pharmacol Ther 2021; 109:319-333. [PMID: 33332579 PMCID: PMC7898549 DOI: 10.1002/cpt.2137] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 01/06/2023]
Abstract
After multiple drugs were removed from the market secondary to drug-induced torsade de pointes (TdP) risk, the International Council for Harmonisation (ICH) released guidelines in 2005 that focused on the nonclinical (S7B) and clinical (E14) assessment of surrogate biomarkers for TdP. Recently, Vargas et al. published a pharmaceutical-industry perspective making the case that "double-negative" nonclinical data (negative in vitro hERG and in vivo heart-rate corrected QT (QTc) assays) are associated with such low probability of clinical QTc prolongation and TdP that potentially all double-negative drugs would not need detailed clinical QTc evaluation. Subsequently, the ICH released a new E14/S7B Draft Guideline containing Questions and Answers (Q&As) that defined ways that double-negative nonclinical data could be used to reduce the number of "Thorough QT" (TQT) studies and reach a low-risk determination when a TQT or equivalent could not be performed. We review the Vargas et al. proposal in the context of what was contained in the ICH E14/S7B Draft Guideline and what was proposed by the ICH E14/S7B working group for a "stage 2" of updates (potential expanded roles for nonclinical data and details for assessing TdP risk of QTc-prolonging drugs). Although we do not agree with the exact probability statistics in the Vargas et al. paper because of limitations in the underlying datasets, we show how more modest predictive value of individual assays could still result in low probability for TdP with double-negative findings. Furthermore, we expect that the predictive value of the nonclinical assays will improve with implementation of the new ICH E14/S7B Draft Guideline.
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Affiliation(s)
- David G. Strauss
- Division of Applied Regulatory ScienceOffice of Clinical PharmacologyOffice of Translational SciencesCenter for Drug Evaluation and ResearchUS Food and Drug AdministrationSilver SpringMarylandUSA
| | - Wendy W. Wu
- Division of Applied Regulatory ScienceOffice of Clinical PharmacologyOffice of Translational SciencesCenter for Drug Evaluation and ResearchUS Food and Drug AdministrationSilver SpringMarylandUSA
| | - Zhihua Li
- Division of Applied Regulatory ScienceOffice of Clinical PharmacologyOffice of Translational SciencesCenter for Drug Evaluation and ResearchUS Food and Drug AdministrationSilver SpringMarylandUSA
| | - John Koerner
- Division of Pharm/Tox for Cardiology, Hematology, Endocrinology and NephrologyOffice of Cardiology, Hematology, Endocrinology and NephrologyOffice of New DrugsCenter for Drug Evaluation and ResearchUS Food and Drug AdministrationSilver SpringMarylandUSA
| | - Christine Garnett
- Division of Cardiology and NephrologyOffice of Cardiology, Hematology, Endocrinology and NephrologyOffice of New DrugsCenter for Drug Evaluation and ResearchUS Food and Drug AdministrationSilver SpringMarylandUSA
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8
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Hiremath PG, Bhondoekhan F, Haberlen SA, Ashikaga H, Palella FJ, D'Souza G, Budoff MJ, Kingsley LA, Dobs AS, Post WS, Soliman EZ, Brown TT, Wu KC. Testosterone use and shorter electrocardiographic QT interval duration in men living with and without HIV. HIV Med 2020; 22:418-421. [PMID: 33270338 DOI: 10.1111/hiv.13029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/22/2020] [Accepted: 10/21/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Testosterone usage (T-use) may alter risk factors for sudden cardiac death in men living with HIV (MLWH). Electrocardiographic QT interval prolongation, which could potentiate ventricular arrhythmias, has previously been associated with HIV infection and, separately, with low testosterone levels. We investigated whether T-use shortens the QT interval duration in MLWH and HIV-uninfected men. METHODS We utilized data from the Multicenter AIDS Cohort Study, a prospective, longitudinal study of HIV infection among men who have sex with men. Multivariable linear regression analyses were used to evaluate associations between T-use and corrected QT interval (QTc) duration. RESULTS Testosterone usage was more common in MLWH compared with HIV-uninfected men (19% vs. 9%). In a multivariable regression analysis, T-use was associated with a 5.7 ms shorter QT interval [95% confidence interval (CI): -9.5 to -1.9; P = 0.003). Furthermore, stronger associations were observed for prolonged duration of T-use and recent timing of T-use. CONCLUSIONS This study is the first known analysis of T-use and QTc interval in MLWH. Overall, our data demonstrate that recent T-use is associated with a shorter QTc interval. Increased T-use duration above a threshold of ≥ 50% of visits in the preceding 5 years was associated with a shorter QTc interval while lesser T-use duration was not.
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Affiliation(s)
- P G Hiremath
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - F Bhondoekhan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - S A Haberlen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - H Ashikaga
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - F J Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - G D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M J Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - L A Kingsley
- Departments of Infectious Diseases and Microbiology and Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - A S Dobs
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - W S Post
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - E Z Soliman
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center (EPICARE), Winston-Salem, NC, USA
| | - T T Brown
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - K C Wu
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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9
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Tomaselli Muensterman E, Jaynes HA, Sowinski KM, Overholser BR, Shen C, Kovacs RJ, Tisdale JE. Transdermal Testosterone Attenuates Drug-Induced Lengthening of Both Early and Late Ventricular Repolarization in Older Men. Clin Pharmacol Ther 2020; 109:1499-1504. [PMID: 33020898 PMCID: PMC10150401 DOI: 10.1002/cpt.2072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/27/2020] [Indexed: 01/16/2023]
Abstract
We have previously reported that transdermal testosterone attenuates drug-induced QT interval lengthening in older men. However, it is unknown whether this is due to modulation of early ventricular repolarization, late repolarization, or both. In a secondary analysis of a prospective, randomized, double-blind, placebo-controlled three-way crossover study, we determined if transdermal testosterone and oral progesterone attenuate drug-induced lengthening of early and late ventricular repolarization, represented by the electrocardiographic measurements J-Tpeak c and Tpeak -Tend , respectively, as well as Tpeak -Tend /QT, a measure of transmural dispersion of repolarization. Male volunteers ≥ 65 years of age (n = 14) were randomized to receive transdermal testosterone 100 mg, oral progesterone 400 mg, or matching transdermal/oral placebo daily for 7 days. On the morning following the seventh day, subjects received intravenous ibutilide 0.003 mg/kg, after which electrocardiograms were performed serially. One subject was excluded due to difficulty in T-wave interpretation. Pre-ibutilide J-Tpeak c was lower during the testosterone phase than during progesterone and placebo (216 ± 23 vs. 227 ± 28 vs. 227 ± 21 ms, P = 0.002). Maximum post-ibutilide J-Tpeak c was also lower during the testosterone phase (233 ± 22 vs. 246 ± 29 vs. 248 ± 23 ms, P < 0.0001). Pre-ibutilide Tpeak -Tend was not significantly different during the three phases, but maximum post-ibutilide Tpeak -Tend was lower during the testosterone phase (80 ± 12 vs. 89 ± 18 vs. 86 ± 15 ms, P = 0.002). Maximum Tpeak -Tend /QT was also lower during the testosterone phase (0.199 ± 0.023 vs. 0.216 ± 0.035 vs. 0.209 ± 0.031, P = 0.005). Progesterone exerted minimal effect on drug-induced lengthening of J-Tpeak c, and no effect on Tpeak -Tend or Tpeak -Tend /QT. Transdermal testosterone attenuates drug-induced lengthening of both early and late ventricular repolarization in older men.
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Affiliation(s)
| | - Heather A Jaynes
- College of Pharmacy, Purdue University, Indianapolis, Indiana, USA
| | - Kevin M Sowinski
- College of Pharmacy, Purdue University, Indianapolis, Indiana, USA.,Division of Clinical Pharmacology, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Brian R Overholser
- College of Pharmacy, Purdue University, Indianapolis, Indiana, USA.,Division of Clinical Pharmacology, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Changyu Shen
- The Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard J Kovacs
- Krannert Institute of Cardiology, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - James E Tisdale
- College of Pharmacy, Purdue University, Indianapolis, Indiana, USA.,Division of Clinical Pharmacology, School of Medicine, Indiana University, Indianapolis, Indiana, USA
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