Steroid sex hormones for lower limb atherosclerosis.
BACKGROUND
There is accumulating evidence that steroid sex hormones have a beneficial effect on a number of risk factors for peripheral arterial disease.


OBJECTIVE
The objective of this review was to determine whether exogenous steroid sex hormones are an effective treatment for patients with lower limb atherosclerosis.


METHODS
The Cochrane Peripheral Vascular Diseases Group trials register was searched, together with reference lists from relevant articles and reviews obtained through searches of Embase and Medline (up to May 2001).


METHODS
Randomised or quasi-randomised controlled trials of steroid sex hormones in patients with lower limb atherosclerosis were selected.


METHODS
Both reviewers extracted data and assessed trial quality independently. Whenever possible investigators were contacted to obtain information needed for the review that could not be found in published reports.


RESULTS
Four trials appeared to meet the inclusion criteria, but one was excluded because of poor methodology. The three remaining trials compared testosterone treatment with placebo in a total of 109 subjects with intermittent claudication or critical leg ischaemia. The most recent trial to meet the inclusion criteria dated from 1971. No trials were available which investigated the potentially beneficial effects of oestrogenic hormones in women with lower limb atherosclerosis. Testosterone therapy produced no significant improvement in tests of walking distance or in a variety of other objective tests for peripheral arterial disease, including venous filling time, muscle blood flow and plethysmography. The relative risk for subjective improvement in symptoms using the combined trial results was also non-significant (relative risk 1.10, 95% confidence interval 0.81 to 1.48).


CONCLUSIONS
There is no evidence to date that short-term testosterone treatment is beneficial in subjects with lower limb atherosclerosis. However, this might reflect limited data rather than the lack of a real effect.
Price
J F
JF
Wolfson Unit for the Prevention of Peripheral Vascular Disesases, University of Edinburgh, Medical School, Teviot Place, Edinburgh, Scotland, UK, EH8 9AG.
Leng
G C
GC
D001161:Arteriosclerosis / Q000188:drug therapy*; D005260:Female; D012739:Gonadal Steroid Hormones / Q000627:therapeutic use*; D006801:Humans; D007383:Intermittent Claudication / Q000188:drug therapy; D007866:Leg / Q000098:blood supply*; D008297:Male; D016491:Peripheral Vascular Diseases / Q000188:drug therapy*; D013739:Testosterone / Q000627:therapeutic use*
D012739:Gonadal Steroid Hormones; D013739:Testosterone