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Analiza Endocrine Society: doar dovezi de calitate scăzută privind riscurile cardiace ale hormonilor, puține evenimente

Steroizii sexuali și rezultatele cardiovasculare la persoanele transgender: o analiză sistematică și metaanaliză

Recenzii sistematice și ale dovezilorHormoni de sex opus
Authors
Spyridoula Maraka, Naykky Singh Ospina, Rene Rodriguez-Gutierrez, Caroline J. Davidge-Pitts, Todd B. Nippoldt, Larry J. Prokop, M. Hassan Murad
Journal
The Journal of Clinical Endocrinology & Metabolism
Year
2017
Source
https://doi.org/10.1210/jc.2017-01643

Summary

To prepare its 2017 guideline on hormone treatment for trans people, the Endocrine Society (a body of hormone doctors) paid Mayo Clinic reviewers to gather all studies on cross-sex hormones and heart health. They found 29 studies. Almost all simply observed patients, and many had no comparison group. Testosterone in trans men worsened cholesterol, raising 'bad' cholesterol and blood fats and lowering 'good' cholesterol. Estrogen in trans women raised blood fats. Heart attacks, strokes, blood clots and deaths were too rarely reported to measure risk, though they were more common in trans women. The reviewers judged the evidence low quality. The review mainly shows how little was known about heart safety when the guideline was written. Larger studies published since (for example Getahun 2018 and Nota 2019) are not included.

Key findings

  • Analiza a fost plătită de Endocrine Society pentru a susține ghidul său din 2017 privind tratarea disforiei de gen (suferința legată de sexul cuiva) cu hormoni.
  • A inclus 29 de studii cuprinzând 3.231 de femei trans și 1.500 de bărbați trans; doar 1 a repartizat aleatoriu tratamentul, 17 au comparat doar oamenii înainte și după, iar doar 4 aveau un grup de comparație.
  • La bărbații trans, după 2 sau mai mulți ani, testosteronul a fost legat de grăsimi mai mari în sânge (trigliceride, în creștere cu 21,4 mg/dL), colesterol „rău” mai mare (în creștere cu 17,8 mg/dL) și colesterol „bun” mai mic (în scădere cu până la 8,5 mg/dL).
  • La femeile trans, grăsimile din sânge au fost mai mari după 2 sau mai mulți ani (în creștere cu 31,9 mg/dL), fără nicio schimbare clară a colesterolului.
  • Printre femeile trans, studiile au raportat 56 de cheaguri de sânge la 1.767 de persoane, 14 infarcte la 1.073, 8 accidente vasculare cerebrale la 859 și 139 de decese la 1.486, inclusiv 23 de decese legate de inimă și 26 de sinucideri.
  • Printre bărbații trans, studiile au raportat doar 1 cheag de sânge la 771, 1 infarct la 478, niciun accident vascular cerebral la 340 și 13 decese la 651.
  • Evaluatorii au considerat dovezile în ansamblu ca fiind de calitate scăzută, probabil afectate de raportarea selectivă, cu puține date despre evenimentele de sănătate care contează cel mai mult pentru pacienți.

Abstract

BACKGROUND: Transgender individuals receive cross-sex hormonal therapy to induce desired secondary sexual characteristics despite limited data regarding its effects on cardiovascular health. METHODS: A comprehensive search of several databases up to 7 April 2015 was conducted for studies evaluating the effect of sex steroid use on lipids, myocardial infarction, stroke, venous thromboembolism (VTE), and mortality in transgender individuals. Pairs of reviewers selected and appraised the studies. A random-effects model was used to pool weighted mean differences and 95% confidence intervals (CIs). RESULTS: We found 29 eligible studies with moderate risk of bias. In female-to-male (FTM) individuals, sex steroid therapy was associated with statistically significant increases in serum triglyceride (TG) levels at 3 to 6 months and at ≥24 months (21.4 mg/dL; 95% CI: 0.14 to 42.6) and in low-density lipoprotein cholesterol (LDL-C) levels at 12 months and ≥24 months (17.8 mg/dL; 95% CI: 3.5 to 32.1). High-density lipoprotein cholesterol (HDL-C) levels decreased significantly across all follow-up periods (highest at ≥24 months, -8.5 mg/dL; 95% CI: -13.0 to -3.9). In male-to-female (MTF) individuals, serum TG levels were significantly higher at ≥24 months (31.9 mg/dL; 95% CI: 3.9 to 59.9) without any changes in other parameters. Few myocardial infarction, stroke, VTE, and death events were reported (more frequently in MTF individuals). CONCLUSIONS: Low-quality evidence suggests that sex steroid therapy may increase LDL-C and TG levels and decrease HDL-C level in FTM individuals, whereas oral estrogens may increase TG levels in MTF individuals. Data about important patient outcomes remain sparse.

Conclusion

Low-quality evidence suggests that sex steroid therapy may increase LDL-C and TG levels and decrease HDL-C level in FTM individuals, whereas oral estrogens may increase TG levels in MTF individuals. Data about important patient outcomes remain sparse.