To the Editor Dr Budoff and colleagues demonstrated that testosterone therapy compared with placebo in elderly men for 1 year increased noncalcified plaque volume in coronary arteries as measured by computed tomographic angiography.1 An analysis of the individual components revealed that the increase was confined to the fibrous component of the plaque, which provides for plaque stability.2 Fatty and necrotic portions, characterized by low attenuation and indicative of a vulnerable plaque,2 as well as calcified plaque volume did not alter. Thus, testosterone therapy may have resulted in stabilization of coronary plaques. This finding is consistent with retrospective reports of decreased major adverse cardiovascular events after testosterone therapy.3 The placebo group had greater calcified and noncalcified plaque volume at baseline. The adjusted mean change in fibrous plaque volume in the testosterone group was numerically higher than the change in median volumes between the 2 groups. Were the results driven by large changes in a few men who drove the mean but not the median? It would be informative if the authors could provide the number of participants who had an increase or a decrease in plaque volume.
Dhindsa S, Wilson MF, Dandona P. Changes in Coronary Artery Plaque With Testosterone Therapy. JAMA. 2017;317(23):2450. doi:10.1001/jama.2017.6016