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Pregled Endocrine Society: le nizkokakovostni dokazi o tveganjih hormonov za srce, preučenih je bilo malo dogodkov

Spolni steroidi in srčno-žilni izidi pri transspolnih osebah: sistematični pregled in metaanaliza

Sistematični & evidenčni preglediKrižni spolni hormoni
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

  • Pregled je plačala Endocrine Society v podporo svojim smernicam iz leta 2017 za zdravljenje spolnega nelagodja (stiska zaradi lastnega spola) s hormoni.
  • Vključil je 29 študij, ki zajemajo 3.231 trans žensk in 1.500 trans moških; samo 1 je naključno razporedila zdravljenje, 17 jih je samo primerjalo ljudi pred in po, le 4 pa so imele primerjalno skupino.
  • Pri trans moških je bil testosteron po 2 ali več letih povezan z višjimi krvnimi maščobami (trigliceridi, višji za 21,4 mg/dL), višjim „slabim“ holesterolom (višji za 17,8 mg/dL) in nižjim „dobrim“ holesterolom (nižji do 8,5 mg/dL).
  • Pri trans ženskah so bile krvne maščobe po 2 ali več letih višje (višje za 31,9 mg/dL), brez jasne spremembe holesterola.
  • Pri trans ženskah so študije poročale o 56 krvnih strdkih pri 1.767 osebah, 14 srčnih infarktih pri 1.073, 8 možganskih kapeh pri 859 in 139 smrtih pri 1.486, vključno z 23 smrtmi zaradi srca in 26 samomori.
  • Pri trans moških so študije poročale le o 1 krvnem strdku pri 771, 1 srčnem infarktu pri 478, nobeni možganski kapi pri 340 in 13 smrtih pri 651.
  • Pregledovalci so celotne dokaze ocenili kot nizke kakovosti, verjetno pod vplivom selektivnega poročanja, z malo podatki o zdravstvenih dogodkih, ki so za bolnike najpomembnejši.

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.