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Wu SH, Chuang E, Chuang TY, Lin CL, Lin MC, Yen DJ, Kao CH. A Nationwide Population-Based Cohort Study of Migraine and Organic-Psychogenic Erectile Dysfunction. Medicine (Baltimore) 2016; 95:e3065. [PMID: 26962838 PMCID: PMC4998919 DOI: 10.1097/md.0000000000003065] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
As chronic illnesses and chronic pain are related to erectile dysfunction (ED), migraine as a prevalent chronic disorder affecting lots of people all over the world may negatively affect quality of life as well as sexual function. However, a large-scale population-based study of erectile dysfunction and other different comorbidities in patients with migraine is quite limited. This cohort longitudinal study aimed to estimate the association between migraine and ED using a nationwide population-based database in Taiwan.The data used for this cohort study were retrieved from the Longitudinal Health Insurance Database 2000 in Taiwan. We identified 5015 patients with migraine and frequency matched 20,060 controls without migraine from 2000 to 2011. The occurrence of ED was followed up until the end of 2011. We used Cox proportional hazard regression models to analyze the risks of ED.The overall incidence of ED was 1.78-fold greater in the migraine cohort than in the comparison cohort (23.3 vs 10.5 per 10,000 person-years; 95% confidence interval [CI] = 1.31-2.41). Furthermore, patients with migraine were 1.75-fold more likely to develop organic ED (95% CI = 1.27-2.41) than were the comparison cohort. The migraine patients with anxiety had a 3.6-fold higher HR of having been diagnosed with ED than the comparison cohort without anxiety (95% CI, 2.10-6.18).The results support that patients with migraine have a higher incidence of being diagnosed with ED, particularly in the patient with the comorbidity of anxiety.
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Affiliation(s)
- Szu-Hsien Wu
- From the Department of Physical Medicine and Rehabilitation (S-HW, T-YC), Taipei Veterans General Hospital and National Yang-Ming University; UC Berkeley Mishler Lab Undergraduate Researcher (EC), Intended B.S. Molecular and Cell Biology, University of California, Berkeley, CA; College of Medicine (C-LL); Management Office for Health Data (C-LL), China Medical University Hospital, Taichung; Department of Nuclear Medicine (M-GL), E-Da Hospital and I-Shou University, Kaohsiung; Department of Neurology, Neurological Institute (D-JY), Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Nuclear Medicine and PET Center (C-HK), China Medical University Hospital, Taichung; Graduate Institute of Clinical Medical Science (C-HK), China Medical University, Taichung, Taiwan
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102
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Raheem OA, Su JJ, Wilson JR, Hsieh TC. The Association of Erectile Dysfunction and Cardiovascular Disease: A Systematic Critical Review. Am J Mens Health 2016; 11:552-563. [PMID: 26846406 DOI: 10.1177/1557988316630305] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Despite strong association between erectile dysfunction (ED) and cardiovascular disease (CVD), there is a paucity of clear clinical guidelines detailing when and how to evaluate for ED in patients with known CVD, or vice versa. This systematic review discuss the role of cardiologists and urologists in the characterization of risk and management of CVD in the setting of ED, as well as contrasting the current evaluation of CVD and ED from the standpoint of published consensus statements. A comprehensive literature review utilizing MEDLINE®, the Cochrane Library® Central Search, and the Web of Science was performed to identify all published peer-reviewed articles in the English language describing ED and CVD across various disciplines. There is strong consensus that men with ED should be considered at high risk of CVD. Available risk assessment tools should be used to stratify the coronary risk score in each patient. The 2012 Princeton III Consensus Conference expanded on existing cardiovascular recommendations, proposing an approach to the evaluation and management of cardiovascular risk in men with ED and no known CVD. This systematic review highlights the similarities and differences of the existing clinical guidelines and recommendations regarding assessment and management of ED and CVD, as well as the pathophysiological linkage between ED and CVD, which may permit physicians, including urologists, to perform opportunistic screening and initiate secondary prophylaxis with regard to cardiovascular risk factors, particularly in young, nondiabetic men with ED.
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Affiliation(s)
- Omer A Raheem
- 1 University of California, San Diego, Department of Urology, San Diego, CA, USA
| | - Jeannie J Su
- 2 Yale School of Medicine, Department of Urology, New Haven, CT, USA
| | - Joel R Wilson
- 3 University of California, San Diego, Department of Medicine, Division of Cardiovascular Medicine, San Diego, CA, USA
| | - Tung-Chin Hsieh
- 1 University of California, San Diego, Department of Urology, San Diego, CA, USA
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103
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Musicki B, Bella AJ, Bivalacqua TJ, Davies KP, DiSanto ME, Gonzalez-Cadavid NF, Hannan JL, Kim NN, Podlasek CA, Wingard CJ, Burnett AL. Basic Science Evidence for the Link Between Erectile Dysfunction and Cardiometabolic Dysfunction. J Sex Med 2015; 12:2233-55. [PMID: 26646025 DOI: 10.1111/jsm.13069] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Although clinical evidence supports an association between cardiovascular/metabolic diseases (CVMD) and erectile dysfunction (ED), scientific evidence for this link is incompletely elucidated. AIM This study aims to provide scientific evidence for the link between CVMD and ED. METHODS In this White Paper, the Basic Science Committee of the Sexual Medicine Society of North America assessed the current literature on basic scientific support for a mechanistic link between ED and CVMD, and deficiencies in this regard with a critical assessment of current preclinical models of disease. RESULTS A link exists between ED and CVMD on several grounds: the endothelium (endothelium-derived nitric oxide and oxidative stress imbalance); smooth muscle (SM) (SM abundance and altered molecular regulation of SM contractility); autonomic innervation (autonomic neuropathy and decreased neuronal-derived nitric oxide); hormones (impaired testosterone release and actions); and metabolics (hyperlipidemia, advanced glycation end product formation). CONCLUSION Basic science evidence supports the link between ED and CVMD. The Committee also highlighted gaps in knowledge and provided recommendations for guiding further scientific study defining this risk relationship. This endeavor serves to develop novel strategic directions for therapeutic interventions.
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Affiliation(s)
- Biljana Musicki
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Anthony J Bella
- Division of Urology, Department of Surgery and Department of Neuroscience, Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, ON, Canada
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kelvin P Davies
- Department of Urology, Albert Einstein College of Medicine, New York, NY, USA
| | - Michael E DiSanto
- Department of Surgery/Division of Urology, Cooper University Hospital, Camden, NJ, USA
| | - Nestor F Gonzalez-Cadavid
- Division of Urology, Department of Surgery, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA.,Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Johanna L Hannan
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Noel N Kim
- Institute for Sexual Medicine, San Diego, CA, USA
| | - Carol A Podlasek
- Departments of Urology, Physiology, and Bioengineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Christopher J Wingard
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Arthur L Burnett
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
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104
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Artom N, Pinna G, Musso NR, Orlandini F, Malasoma P, Uccelli M, Artom A, Rabbia F, Pascale C, Lantieri F, Pende A. Prevalence of erectile dysfunction in a cohort of Italian hypertensive subjects. Clin Exp Hypertens 2015; 38:143-9. [PMID: 26418513 DOI: 10.3109/10641963.2015.1060994] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to evaluate the prevalence of erectile dysfunction (ED) in a cohort of Italian hypertensive men and the association with clinical and biochemical data. The study involved 270 consecutive hypertensive subjects aged 40-70 years evaluated in Italian Hypertension Centers of six hospitals from Liguria and Piedmont. ED was assessed through the self-administered questionnaire of the International Index of Erectile Function. Clinical history with ongoing drug treatment, various clinical parameters, biochemical data and evidence about the presence of subclinical target organ damage was collected. Twenty-seven subjects refused to answer the questionnaire (10%). Among the 243 remained subjects, 123 presented ED (50.6%). ED was highly related to age, systolic blood pressure, pulse pressure, smoking status, statin therapy and kidney function. The addition of a thiazide diuretic to an inhibitor of the renin-angiotensin system significantly increased the prevalence of ED. The prevalence of ED increased in relation with the number of hypotensive drug classes taken by the patients. ED was highly prevalent in this cohort of Italian hypertensive subjects and was associated with other cardiovascular risk factors, such as age, smoking status and kidney function. The role of ED as an early marker of cardiovascular disease is discussed.
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Affiliation(s)
- Nathan Artom
- a Clinic of Internal Medicine 1, University of Genoa , Genoa , Italy
| | - Giuliano Pinna
- b Division of Internal Medicine , Cottolengo Hospital , Turin , Italy .,c Division of Internal Medicine , Cardinal Massaia Hospital , Asti , Italy
| | - Natale R Musso
- a Clinic of Internal Medicine 1, University of Genoa , Genoa , Italy
| | | | - Paolo Malasoma
- d Division of Internal Medicine , Sant' Andrea Hospital , La Spezia , Italy
| | | | - Alberto Artom
- e Division of Internal Medicine , Santa Corona Hospital , Pietra Ligure , Italy
| | - Franco Rabbia
- f Division of Internal Medicine and Hypertension Unit , University of Turin , Turin , Italy , and
| | - Claudio Pascale
- b Division of Internal Medicine , Cottolengo Hospital , Turin , Italy
| | - Francesca Lantieri
- g Biostatistics Unit, Health Science Department, University of Genoa , Genoa , Italy
| | - Aldo Pende
- a Clinic of Internal Medicine 1, University of Genoa , Genoa , Italy
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105
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Atrial fibrillation is associated with increased risk of erectile dysfunction: A nationwide population-based cohort study. Int J Cardiol 2015; 190:106-10. [DOI: 10.1016/j.ijcard.2015.04.108] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 04/10/2015] [Accepted: 04/14/2015] [Indexed: 01/24/2023]
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106
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Yang CM, Shen YC, Weng SF, Wang JJ, Tien KJ. Increased Risk of Dementia in Patients With Erectile Dysfunction: A Population-Based, Propensity Score-Matched, Longitudinal Follow-Up Study. Medicine (Baltimore) 2015; 94:e990. [PMID: 26091478 PMCID: PMC4616558 DOI: 10.1097/md.0000000000000990] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Erectile dysfunction (ED) is a well-known predictor for future cardiovascular and cerebrovascular disease. However, the relationship between ED and dementia has rarely been examined. This study investigates the longitudinal risk for Alzheimer's disease and non-Alzheimer dementia in patients with ED. We collected a random sample of 1,000,000 individuals from Taiwan's National Health Insurance database. From this sample, we identified 4153 patients with newly diagnosed ED between 2000 and 2009 and compared them with a matched cohort of 20,765 patients without ED. All patients were tracked for 7 years from the index date to identify which of them subsequently developed dementia. During the 7-year follow-up period, the incidence rate of dementia in the ED cohort was 35.33 per 10,000 person-years. In the comparison groups, it was 21.67 per 10,000 person-years. After adjustment for patients characteristics and comorbidities, patients with ED were 1.68-times more likely to develop dementia than patients without ED (95% CI = 1.34-2.10, P < 0.0001). In addition, older patients and those with diabetes, hypertension, chronic kidney disease, stroke, depression, and anxiety were found to be at increased risk for dementia. Analyzing the data by dementia type, we found the hazard risk for Alzheimer's disease and non-Alzheimer dementia to be greater in patients with ED (adjusted HR 1.68, 95% CI = 1.31-2.16, P < 0.0001 and 1.63, 95% CI = 1.02-2.62, P = 0.0429, respectively). Log-rank test revealed that patients with ED had significantly higher cumulative incidence rates of dementia than those without (P < 0.0001). Patients with ED are at an increased risk for dementia later in life.
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Affiliation(s)
- Chun-Ming Yang
- From the Department of Neurology, Chi Mei Medical Center, Tainan (C-MY); Department of Urology, Kaohsiung Chang Gung Memorial Hospital (Y-CS); Cheng Shiu University, Kaohsiung (Y-CS); Department of Medical Research, Chi Mei Medical Center (S-FW, J-JW); Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science (S-FW); Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center (K-JT); and Department of Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan (K-JT)
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107
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Elhanbly SM, Elkholy AAM, Alghobary M, Abou Al-Ghar M. Clinical predictive factors of sildenafil response: a penile hemodynamic study. Andrology 2015; 3:241-6. [DOI: 10.1111/andr.271] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 07/09/2014] [Accepted: 08/05/2014] [Indexed: 11/29/2022]
Affiliation(s)
- S. M. Elhanbly
- Andrology Unit; Mansoura University Hospital; Mansoura Faculty of Medicine; Mansoura Egypt
| | - A. A.-M. Elkholy
- Andrology Unit; Mansoura University Hospital; Mansoura Faculty of Medicine; Mansoura Egypt
| | - M. Alghobary
- Andrology Unit; Mansoura University Hospital; Mansoura Faculty of Medicine; Mansoura Egypt
| | - M. Abou Al-Ghar
- Radiology Department; Urology Center; Mansoura Faculty of Medicine; Mansoura Egypt
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108
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Popp R, Kleemann Y, Burger M, Pfeifer M, Arzt M, Budweiser S. Impaired Vigilance Is Associated with Erectile Dysfunction in Patients with Sleep Apnea. J Sex Med 2015; 12:405-15. [DOI: 10.1111/jsm.12789] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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109
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110
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Fang SC, Rosen RC, Vita JA, Ganz P, Kupelian V. Changes in erectile dysfunction over time in relation to Framingham cardiovascular risk in the Boston Area Community Health (BACH) Survey. J Sex Med 2014; 12:100-8. [PMID: 25293632 DOI: 10.1111/jsm.12715] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Erectile dysfunction (ED) is associated with cardiovascular disease (CVD); however, the association between change in ED status over time and future underlying CVD risk is unclear. AIM The aim of this study was to investigate the association between change in ED status and Framingham CVD risk, as well change in Framingham risk. METHODS We studied 965 men free of CVD in the Boston Area Community Health (BACH) Survey, a longitudinal cohort study with three assessments. ED was assessed with the five-item International Index of Erectile Function at BACH I (2002-2005) and BACH II (2007-2010) and classified as no ED/transient ED/persistent ED. CVD risk was assessed with 10-year Framingham CVD risk algorithm at BACH I and BACH III (2010-2012). Linear regression models controlled for baseline age, socio-demographic and lifestyle factors, as well as baseline Framingham risk. Models were also stratified by age (≥/< 50 years). MAIN OUTCOME MEASURES Framingham CVD risk and change in Framingham CVD risk were the main outcome measures. RESULTS Transient and persistent ED was significantly associated with increased Framingham risk and change in risk over time in univariate and age-adjusted models. In younger men, persistent ED was associated with a Framingham risk that was 1.58 percentage points higher (95% confidence interval [CI]: 0.11, 3.06) and in older men, a Framingham risk that was 2.54 percentage points higher (95% CI: -1.5, 6.59), compared with those without ED. Change in Framingham risk over time was also associated with transient and persistent ED in men <50 years, but not in older men. CONCLUSIONS Data suggest that even after taking into account other CVD risk factors, transient and persistent ED is associated with Framingham CVD risk and a greater increase in Framingham risk over time, particularly in younger men. Findings further support clinical assessment of CVD risk in men presenting with ED, especially those under 50 years.
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Affiliation(s)
- Shona C Fang
- Division of Epidemiology, New England Research Institutes, Inc., Watertown, MA, USA; Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
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111
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Abstract
Erectile dysfunction and coronary artery disease are increasingly recognized as different clinical manifestations of the same process. Because the smaller vessels of the penis may be affected by plaque burden much earlier than the larger coronary, internal carotid, and femoral arteries, men may present with symptoms of erectile dysfunction long before signs of cardiovascular disease manifest. This presents an opportunity for the urologist to not only treat the sexual dysfunction and uncover occult coronary disease, but also to screen for cardiac risk, as even men with mild arteriogenic erectile dysfunction may be at risk for cardiovascular disease.
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Affiliation(s)
- Gerald Brock
- Professor of Surgery, Urology Program Director, Western University; Chair, Office of Education, Canadian Urologic Association, London, ON
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112
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Gerber RE, Vita JA, Ganz P, Wager CG, Araujo AB, Rosen RC, Kupelian V. Association of peripheral microvascular dysfunction and erectile dysfunction. J Urol 2014; 193:612-7. [PMID: 25196657 DOI: 10.1016/j.juro.2014.08.108] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Increasing evidence of a link between erectile dysfunction and cardiovascular disease suggests a shared vascular etiology with endothelial dysfunction as a plausible underlying biological mechanism. To our knowledge whether this association is different for large arterial endothelium compared to microvascular endothelium has not yet been established. We investigated the association of erectile dysfunction with macrovascular and microvascular endothelial function. MATERIALS AND METHODS A sample of 390 men with a mean age of 55.5 years was recruited from the BACH survey, a population based survey of urological symptoms. Erectile dysfunction was assessed using IIEF-5. The percent of brachial artery flow mediated dilatation, a measure of macrovascular function, and hyperemic flow velocity in cm per second, a measure of microvascular function, were assessed by ultrasound. Linear regression was used to assess the association of erectile dysfunction and endothelial function, and adjust for potential confounders. RESULTS Reactive hyperemia was lower in men with vs without erectile dysfunction (mean ± SE 97.1 ± 2.5 vs 106.0 ± 1.6 cm per second, p = 0.003). However, the difference in flow mediated dilatation between men with vs without erectile dysfunction was statistically nonsignificant (mean 6.6% ± 0.33% vs 7.2% ± 0.24%, p = 0.147). The association of erectile dysfunction with reactive hyperemia was attenuated but it remained statistically significant in men with moderate to severe erectile dysfunction (IIEF-5 less than 12) after adjusting for traditional cardiovascular risk factors (p = 0.038). CONCLUSIONS These results provide evidence of greater microvascular than macrovascular endothelial dysfunction as a potential contributor to erectile dysfunction and an underlying mechanism linking erectile dysfunction and cardiovascular disease.
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Affiliation(s)
| | - Joseph A Vita
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University, Boston, Massachusetts
| | - Peter Ganz
- Division of Cardiology, San Francisco General Hospital, University of California-San Francisco, San Francisco, California
| | - Carrie G Wager
- New England Research Institutes, Inc., Watertown, Massachusetts
| | - Andre B Araujo
- New England Research Institutes, Inc., Watertown, Massachusetts
| | - Raymond C Rosen
- New England Research Institutes, Inc., Watertown, Massachusetts
| | - Varant Kupelian
- New England Research Institutes, Inc., Watertown, Massachusetts.
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113
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Toque HA, Caldwell RW. New approaches to the design and discovery of therapies to prevent erectile dysfunction. Expert Opin Drug Discov 2014; 9:1447-69. [DOI: 10.1517/17460441.2014.949234] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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114
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García-Cruz E, Gosálbez D, Sallent A, Piqueras M, Leibar-Tamayo A, Romero-Otero J, Castañeda-Argaiz R, Carrión A, Asiain I, Mateu L, Luque P, Alcaraz A. Erectile Dysfunction but Not Hormonal Levels Are Related to Higher Estimated Mortality Risk Using Charlson Comorbidity Index. JOURNAL OF MEN'S HEALTH 2014. [DOI: 10.1089/jomh.2014.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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115
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Vlachopoulos C, Ioakeimidis N, Aznaouridis K, Terentes-Printzios D, Rokkas K, Aggelis A, Panagiotakos D, Stefanadis C. Prediction of Cardiovascular Events With Aortic Stiffness in Patients With Erectile Dysfunction. Hypertension 2014; 64:672-8. [DOI: 10.1161/hypertensionaha.114.03369] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Erectile dysfunction confers an independent risk for cardiovascular events and total mortality. Aortic pulse wave velocity (PWV) is an important predictor of cardiovascular events and all-cause mortality. We investigated whether PWV predicts major adverse cardiovascular events (MACEs) in patients with erectile dysfunction beyond traditional risk factors. MACEs in relation to PWV were analyzed with proportional hazards models in 344 patients (mean age, 56 years) without established cardiovascular disease. During a mean follow-up of 4.7 years (range, 1–8.5 years), 24 of 344 participants (7.0%) experienced a MACE. Subjects in the highest PWV tertile (>8.8 m/s) had a 4-fold higher risk of MACEs compared with those in the lowest PWV tertile (<7.6 m/s; adjusted hazard ratio, 3.97;
P
=0.035). A PWV value of 7.81 m/s was associated with a negative predictive value (ability to rule out MACE) of 98.1%. Addition of PWV to standard risk factor model yielded correct patient reclassification to higher or lower risk category by 27.6% (
P
=0.0332) in the whole cohort. Our results show that higher aortic stiffness is associated with increased risk for a MACE in patients with erectile dysfunction without known cardiovascular disease. Aortic PWV improves risk prediction when added to standard risk factors and may represent a valuable biomarker of prediction of cardiovascular disease risk in these patients.
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Affiliation(s)
- Charalambos Vlachopoulos
- From the Cardiovascular Diseases and Sexual Health Unit, 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece (C.V., N.I., K.A., D.T.-P., K.R., A.A., C.S.); and Department of Nutrition Science and Dietetics, Harokopio University, Athens, Greece (D.P.)
| | - Nikolaos Ioakeimidis
- From the Cardiovascular Diseases and Sexual Health Unit, 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece (C.V., N.I., K.A., D.T.-P., K.R., A.A., C.S.); and Department of Nutrition Science and Dietetics, Harokopio University, Athens, Greece (D.P.)
| | - Konstantinos Aznaouridis
- From the Cardiovascular Diseases and Sexual Health Unit, 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece (C.V., N.I., K.A., D.T.-P., K.R., A.A., C.S.); and Department of Nutrition Science and Dietetics, Harokopio University, Athens, Greece (D.P.)
| | - Dimitrios Terentes-Printzios
- From the Cardiovascular Diseases and Sexual Health Unit, 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece (C.V., N.I., K.A., D.T.-P., K.R., A.A., C.S.); and Department of Nutrition Science and Dietetics, Harokopio University, Athens, Greece (D.P.)
| | - Konstantinos Rokkas
- From the Cardiovascular Diseases and Sexual Health Unit, 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece (C.V., N.I., K.A., D.T.-P., K.R., A.A., C.S.); and Department of Nutrition Science and Dietetics, Harokopio University, Athens, Greece (D.P.)
| | - Athanasios Aggelis
- From the Cardiovascular Diseases and Sexual Health Unit, 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece (C.V., N.I., K.A., D.T.-P., K.R., A.A., C.S.); and Department of Nutrition Science and Dietetics, Harokopio University, Athens, Greece (D.P.)
| | - Dimosthenis Panagiotakos
- From the Cardiovascular Diseases and Sexual Health Unit, 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece (C.V., N.I., K.A., D.T.-P., K.R., A.A., C.S.); and Department of Nutrition Science and Dietetics, Harokopio University, Athens, Greece (D.P.)
| | - Christodoulos Stefanadis
- From the Cardiovascular Diseases and Sexual Health Unit, 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece (C.V., N.I., K.A., D.T.-P., K.R., A.A., C.S.); and Department of Nutrition Science and Dietetics, Harokopio University, Athens, Greece (D.P.)
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116
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Zaman Huri H, Lian Choo T, Sulaiman CZ, Mark R, Abdul Razack AH. Oral drug treatments in patients with erectile dysfunction and multiple comorbidities: a retrospective observational study. BMJ Open 2014; 4:e005381. [PMID: 25001396 PMCID: PMC4091539 DOI: 10.1136/bmjopen-2014-005381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 05/27/2014] [Accepted: 06/16/2014] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate factors associated with demographic/clinical characteristics and drug selection in patients with erectile dysfunction (ED). The prevalence of ED is increasing worldwide. Studies have shown that ED is associated with age, lifestyle and comorbidities. However, the factors associated with patient characteristics as well as drug selection are incompletely understood. SETTING A tertiary medical centre in Kuala Lumpur, Malaysia. PARTICIPANTS A total of 219 patients (range 23-80 years) who had received phosphodiesterase type-5 (PDE-5) inhibitors as ED treatment were evaluated. INCLUSION CRITERIA Adult patients aged ≥18 years, diagnosed with ED, and prescribed with sildenafil, tadalafil or vardenafil. EXCLUSION CRITERIA Patients diagnosed with ED but who did not receive any PDE-5 inhibitor, or those with missing data. PRIMARY AND SECONDARY OUTCOME MEASURES Factors associated with demographic and clinical characteristics as well as drug selection were assessed. RESULTS Ischaemic heart disease (p=0.025), benign prostatic hyperplasia (p<0.001), obesity (p=0.005), lower urinary tract symptoms (LUTS) (p=0.006) and α-blockers (p<0.001) were significantly associated with elderly patients with ED. Additionally, LUTS (p=0.038) and α-blockers (p=0.008) were significantly associated with the selection of PDE-5 inhibitor. CONCLUSIONS These data showed that elderly patients with ED were significantly associated with comorbidities and α-blockers, whereas LUTS and α blockers were associated with drug selection.
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Affiliation(s)
- Hasniza Zaman Huri
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Clinical Investigation Centre, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Tee Lian Choo
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Che Zuraini Sulaiman
- Department of Pharmacy, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Raymond Mark
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Moore CS, Grant MD, Zink TA, Panizzon MS, Franz CE, Logue MW, Hauger RL, Kremen WS, Lyons MJ. Erectile dysfunction, vascular risk, and cognitive performance in late middle age. Psychol Aging 2014; 29:163-72. [PMID: 24660805 DOI: 10.1037/a0035463] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Vascular disease is the most common etiology of erectile dysfunction (ED). Men with ED are at a 65% increased relative risk of developing coronary heart disease and a 43% increased risk of stroke within 10 years. Vascular disease is associated with cognitive impairment; ED-an overt manifestation of vascular dysfunction-could also signal early compromised cognition. We sought to determine whether cognitive differences existed between men with ED and healthy peers. Our sample consisted of 651 men (ages 51-60 years) from the Vietnam Era Twin Study of Aging. ED was associated with poorer cognitive performance, particularly on attention-executive-psychomotor speed tasks. ED remained significantly associated with cognition after inclusion of other cardiovascular risk factors (including hypertension, high cholesterol, body mass index, and smoking). These findings underscore the importance of further study of ED as a predictor of cognitive and cardiovascular health. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | - Mark W Logue
- Biomedical Genetics, Boston University School of Medicine
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118
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Khajehei M. Why is there a need for an interdisciplinary approach to assess erectile dysfunction? World J Clin Urol 2014; 3:1-8. [DOI: 10.5410/wjcu.v3.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 12/16/2013] [Indexed: 02/06/2023] Open
Abstract
Erectile dysfunction is a prevalent complaint among men. The majority of patients suffering erectile dysfunction exhibit various risk factors of vascular diseases. Erectile dysfunction used to be recognised as one of the consequences of vascular diseases in patients suffering heart attack or myocardial infarction. During the last decade, however, the role of endothelial dysfunction in the occurrence of erectile dysfunction has been signified, and it has been suggested that erectile dysfunction may not be simply a consequence of vascular diseases but an indicator of future vascular problems. Erectile dysfunction has been known as “the tip of iceberg” of a generalised vascular dysfunction, which typically happens before serious vascular problems. Considerable evidence shows a link between erectile dysfunction and vascular disorders. Several theories have been considered for the association between erectile dysfunction and vascular diseases. One of them is the “artery size” theory focusing on the differences between the diameter of the penile artery and other arteries. Another theory is based on “endothelial dysfunction”, which highlights inappropriate vasoconstriction as a cause of erectile dysfunction and vascular diseases. “Age” has also been reported to have pivotal role in the development of vascular dysfunction resulting in erectile dysfunction and ultimately vascular diseases. Another theory explaining the pathophysiology of erectile dysfunction and its relationship with vascular diseases focuses on the formation of atherosclerosis plaques. This article endeavours to review the current literature and discuss why a multidisciplinary approach is needed while assessing erectile dysfunction.
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Abstract
We aimed to summarize the etiology, clinical characteristics, diagnosis, and possible treatment options of sexual dysfunction in diabetic patients of both sexes. Details of dysfunction in diabetic women are less conclusive than in men due to the lack of standardized evaluation of sexual function in women. Male sexual dysfunction is a common complication of diabetes, including abnormalities of orgasmic/ejaculatory function and desire/libido in addition to penile erection. The prevalence of erectile dysfunction (ED) among diabetic men varies from 35% to 75%. Diabetes-induced ED has a multifactorial etiology including metabolic, neurologic, vascular, hormonal, and psychological components. ED should be regarded as the first sign of cardiovascular disease because it can be present before development of symptomatic coronary artery disease, as larger coronary vessels better tolerate the same amount of plaque compared to smaller penile arteries. The diagnosis of ED is based on validated questionnaires and determination of functional and organic abnormalities. First-, second- and third-line therapy may be applied. Phosphodiesterase-5 (PDE-5) inhibitor treatment from the first-line options leads to smooth muscle relaxation in the corpus cavernosum and enhancement in blood flow, resulting in erection during sexual stimulus. The use of PDE-5 inhibitors in the presence of oral nitrates is strictly contraindicated in diabetic men, as in nondiabetic subjects. All PDE-5 inhibitors have been evaluated for ED in diabetic patients with convincing efficacy data. Second-line therapy includes intracavernosal, trans- or intraurethral administration of vasoactive drugs or application of a vacuum device. Third-line therapies are the implantation of penile prosthesis and penile revascularization.
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Affiliation(s)
- Várkonyi Tamás
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary.
| | - Peter Kempler
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
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Chen S, Wu R, Huang Y, Zheng F, Ou Y, Tu X, Zhang Y, Gao Y, Chen X, Zheng T, Yang Q, Wan Z, Zhang Y, Sun X, Liu G, Deng C. Insulin resistance is an independent determinate of ED in young adult men. PLoS One 2013; 8:e83951. [PMID: 24391852 PMCID: PMC3877124 DOI: 10.1371/journal.pone.0083951] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 11/11/2013] [Indexed: 01/25/2023] Open
Abstract
Background Insulin resistance (IR) triggers endothelial dysfunction, which contributes to erectile dysfunction (ED) and cardiovascular disease. Aim To evaluate whether IR was related to ED in young adult patients. Methods A total of 283 consecutive men complaining of ED at least six months were enrolled, with a full medical history, physical examination, and laboratory tests collected. Quantitative Insulin Sensitivity Check Index (QUICKI) was used to determine IR. The severity of ED was assessed by IIEF-5 questionnaire. Endothelial function was assessed by ultrasonographic examination of brachial artery flow mediated dilation (FMD). Results IR was detected in 52% patients. Subjects with IR had significant higher total cholesterol, triglycerides, low density lipoprotein-cholesterol (LDL-c), glycated haemoglobin (HBA1c), high sensitivity C-reactive protein (hs-CRP) and body mass index (BMI), but showed significant lower IIEF-5 score, FMD%, high density lipoprotein -cholesterol (HDL-c), testosterone, sex hormone binding globulin (SHBG) levels than patients without IR. Multiple regression analysis showed QUICKI and testosterone were independent predictors of IIEF-5 score. Furthermore, the incidence of IR was correlated with the severity of ED. Conclusions Compared with other CVFs, IR was found as the most prevalent in our subjects. Besides, IR was independently associated with ED and its severity, suggesting an adverse effect of insulin resistance on erectile function.
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Affiliation(s)
- Shengfu Chen
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Rongpei Wu
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Yanping Huang
- Department of Urology, Shanghai Institute of Andrology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Fufu Zheng
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Yangbin Ou
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Xiangan Tu
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Yadong Zhang
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Yong Gao
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Xin Chen
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Tao Zheng
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Qiyun Yang
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Zi Wan
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Yuanyuan Zhang
- Wake Forest University, Institute for Regenerative Medicine, Winston-Salem, North Carolina, United States of America
| | - Xiangzhou Sun
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
- * E-mail: (XS); (GL); (CD)
| | - Guihua Liu
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
- Wake Forest University, Institute for Regenerative Medicine, Winston-Salem, North Carolina, United States of America
- * E-mail: (XS); (GL); (CD)
| | - Chunhua Deng
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
- * E-mail: (XS); (GL); (CD)
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Kobat MA, Fırdolas F, Balin M, Çelik A, Bentli R, Baydas A. Circulating Soluble Lectin-Like Oxidized Low-Density Lipoprotein Receptor-1 Levels Are Associated With Erectile Dysfunction in Patients Without Known Coronary Artery Disease. J Sex Med 2013; 10:2782-9. [DOI: 10.1111/j.1743-6109.2012.02964.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Jackson G, Nehra A, Miner M, Billups KL, Burnett AL, Buvat J, Carson CC, Cunningham G, Goldstein I, Guay AT, Hackett G, Kloner RA, Kostis JB, Montorsi P, Ramsey M, Rosen R, Sadovsky R, Seftel AD, Shabsigh R, Vlachopoulos C, Wu FCW. The assessment of vascular risk in men with erectile dysfunction: the role of the cardiologist and general physician. Int J Clin Pract 2013; 67:1163-72. [PMID: 23714173 DOI: 10.1111/ijcp.12200] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 04/23/2013] [Indexed: 12/26/2022] Open
Abstract
Erectile dysfunction (ED) and cardiovascular disease (CVD) share risk factors and frequently coexist, with endothelial dysfunction believed to be the pathophysiologic link. ED is common, affecting more than 70% of men with known CVD. In addition, clinical studies have demonstrated that ED in men with no known CVD often precedes a CVD event by 2-5 years. ED severity has been correlated with increasing plaque burden in patients with coronary artery disease. ED is an independent marker of increased CVD risk including all-cause and especially CVD mortality, particularly in men aged 30-60 years. Thus, ED identifies a window of opportunity for CVD risk mitigation. We recommend that a thorough history, physical exam (including visceral adiposity), assessment of ED severity and duration and evaluation including fasting plasma glucose, lipids, resting electrocardiogram, family history, lifestyle factors, serum creatinine (estimated glomerular filtration rate) and albumin:creatinine ratio, and determination of the presence or absence of the metabolic syndrome be performed to characterise cardiovascular risk in all men with ED. Assessment of testosterone levels should also be considered and biomarkers may help to further quantify risk, even though their roles in development of CVD have not been firmly established. Finally, we recommend that a question about ED be included in assessment of CVD risk in all men and be added to CVD risk assessment guidelines.
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Affiliation(s)
- G Jackson
- Department of Cardiology, Guy's and St Thomas' Hospitals London, London, UK
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Gandaglia G, Briganti A, Jackson G, Kloner RA, Montorsi F, Montorsi P, Vlachopoulos C. A systematic review of the association between erectile dysfunction and cardiovascular disease. Eur Urol 2013; 65:968-78. [PMID: 24011423 DOI: 10.1016/j.eururo.2013.08.023] [Citation(s) in RCA: 282] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 08/12/2013] [Indexed: 02/07/2023]
Abstract
CONTEXT Erectile dysfunction (ED) is considered a vascular impairment that shares many risk factors with cardiovascular disease (CVD). A correlation between ED and CVD has been hypothesized, and ED has been proposed as an early marker of symptomatic CVD. OBJECTIVE To analyze the relationship between ED and CVD, evaluating the pathophysiologic links between these conditions, and to identify which patients would benefit from cardiologic assessment when presenting with ED. EVIDENCE ACQUISITION A systematic literature review searching Medline, Embase, and Web of Science databases was performed. The search strategy included the terms erectile dysfunction, cardiovascular disease, coronary artery disease, risk factors, pathophysiology, atherosclerosis, low androgen levels, inflammation, screening, and phosphodiesterase type 5 inhibitors alone or in combination. We limited our search to studies published between January 2005 and May 2013. EVIDENCE SYNTHESIS Several studies reported an association between ED and CVD. The link between these conditions might reside in the interaction between androgens, chronic inflammation, and cardiovascular risk factors that determines endothelial dysfunction and atherosclerosis, resulting in disorders of penile and coronary circulation. Because penile artery size is smaller compared with coronary arteries, the same level of endothelial dysfunction causes a more significant reduction of blood flow in erectile tissues compared with that in coronary circulation. Thus ED could be an indicator of systemic endothelial dysfunction. From a clinical standpoint, because ED may precede CVD, it can be used as an early marker to identify men at higher risk of CVD events. ED patients at high risk of CVD should undergo detailed cardiologic assessment and receive intensive treatment of risk factors. CONCLUSIONS ED and CVD should be regarded as two different manifestations of the same systemic disorder. ED usually precedes CVD onset, and it might be considered an early marker of symptomatic CVD.
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Affiliation(s)
- Giorgio Gandaglia
- Urological Research Institute, University Vita-Salute San Raffaele, Department of Urology, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Urological Research Institute, University Vita-Salute San Raffaele, Department of Urology, San Raffaele Scientific Institute, Milan, Italy
| | | | - Robert A Kloner
- Good Samaritan Hospital, Los Angeles, Department of Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Francesco Montorsi
- Urological Research Institute, University Vita-Salute San Raffaele, Department of Urology, San Raffaele Scientific Institute, Milan, Italy
| | - Piero Montorsi
- Centro Cardiologico Monzino, Institute of Cardiology, University of Milan, Milan, Italy
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Çevik Ö, Çadırcı S, Şener TE, Tinay I, Akbal C, Tavukçu HH, Çetinel S, Kıran D, Şener G. Quercetin treatment against ischemia/reperfusion injury in rat corpus cavernosum tissue: a role on apoptosis and oxidative stress. Free Radic Res 2013; 47:683-91. [DOI: 10.3109/10715762.2013.814912] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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125
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Pauker-Sharon Y, Arbel Y, Finkelstein A, Halkin A, Herz I, Banai S, Justo D. Cardiovascular risk factors in men with ischemic heart disease and erectile dysfunction. Urology 2013; 82:377-80. [PMID: 23769116 DOI: 10.1016/j.urology.2013.03.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 03/02/2013] [Accepted: 03/07/2013] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To study the prevalence of cardiovascular risk factors in men with ischemic heart disease (IHD) and erectile dysfunction (ED). METHODS We studied cardiovascular risk factors in men with IHD and ED, who undergo coronary angiography. All men filled the Sexual Health Inventory for Males questionnaire (SHIM). SHIM questionnaire scores between 17 and 21 represented mild ED. SHIM questionnaire scores of 16 or lower represented significant ED. Cardiovascular risk factors included the following: age, diabetes mellitus, hypertension, smoking, hyperlipidemia, left ventricular ejection fraction ≤30%, and 3-vessel disease. Binary regression analysis was used to study which cardiovascular risk factors were independently associated with ED. RESULTS The study included 171 men. Mean age was 64.2 ± 12.6 years. Overall, 61 men (35.7%) had mild ED and 80 men (46.8%) had significant ED. More than half of men (n = 101; 59.1%) had 3 or more cardiovascular risk factors. Age was the only cardiovascular risk factor independently associated with significant ED (odds ratio 1.154; 95% confidence interval 1.081-1.232; P <.0001). No cardiovascular risk factors were independently associated with mild ED. CONCLUSION ED and its cardiovascular risk factors are highly prevalent in men with IHD. However, only age is independently associated with significant ED in this population.
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126
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Impaired flow-mediated vasodilatation in Asian Indians with erectile dysfunction. Asian J Androl 2013; 15:652-7. [PMID: 23708464 DOI: 10.1038/aja.2013.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 01/17/2013] [Accepted: 01/25/2013] [Indexed: 01/22/2023] Open
Abstract
Endothelial dysfunction is the postulated link between coronary artery disease (CAD) and erectile dysfunction (ED). Brachial artery flow-mediated vasodilatation (FMD) is a non-invasive surrogate marker for endothelial function assessment. Despite Asian Indians representing a considerable global CAD burden, data on FMD and ED in these patients are lacking. Of the 225 patients undergoing coronary angiography, 72% had ED (assessed using the International Index of Erectile Function (IIEF-5) questionnaire); ED was moderate to severe in 61% of the patients. ED patients had a higher incidence of severe and diffuse angiographic CAD, a greater number of coronary vessels involved and a lower mean brachial artery FMD (6.40%±4.60% vs. 9.10%±4.87%, P<0.001) compared to non-ED patients. A progressive reduction in FMD was noted with increasing severity of ED. Impaired FMD (≤5.5%) was twice as common in ED patients (52% vs. 24% without ED). Patients with impaired FMD had higher ED prevalence (85% vs. 62%) and lower mean IIEF-5 scores compared to those with normal FMD. Impaired FMD was a significant ED predictor independent of other risk factors (odds ratio, 2.33; 95% confidence interval: 0.59-9.23; P=0.03). An inverse correlation between FMD and ED severity was observed (r=-0.22; P=0.004). ED is common among Asian Indians with angiographically documented CAD. Patients with ED have impaired FMD independent of other risk factors, suggesting that endothelial dysfunction is the underlying pathophysiology. Urologists and cardiologists need to be aware of the association between ED, CAD and endothelial dysfunction.
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127
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Jackson G. Erectile dysfunction and cardiovascular disease. Arab J Urol 2013; 11:212-6. [PMID: 26558084 PMCID: PMC4442980 DOI: 10.1016/j.aju.2013.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 03/24/2013] [Accepted: 03/27/2013] [Indexed: 01/01/2023] Open
Abstract
The link between erectile dysfunction (ED) and cardiovascular disease (CVD) is reviewed by assessing original papers, current consensus, previous reviews and meta-analyses. The link between these conditions is confirmed, and the evaluation and assessment summarised with a new evidence-based algorithm. ED, especially in younger men, is a marker of an increased risk of CVD, and ED needs to be incorporated into all risk-screening programmes.
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128
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Chew SKH, Taouk Y, Xie J, Nicolaou TE, Wang JJ, Wong TY, Lamoureux EL. Relationship between diabetic retinopathy, diabetic macular oedema and erectile dysfunction in type 2 diabetics. Clin Exp Ophthalmol 2013; 41:683-9. [DOI: 10.1111/ceo.12099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 02/05/2013] [Indexed: 01/27/2023]
Affiliation(s)
- Sky KH Chew
- Centre for Eye Research Australia; the Royal Victorian Eye and Ear Hospital; University of Melbourne; Melbourne; Victoria; Australia
| | - Yamna Taouk
- Centre for Eye Research Australia; the Royal Victorian Eye and Ear Hospital; University of Melbourne; Melbourne; Victoria; Australia
| | - Jing Xie
- Centre for Eye Research Australia; the Royal Victorian Eye and Ear Hospital; University of Melbourne; Melbourne; Victoria; Australia
| | - Theona E Nicolaou
- Centre for Eye Research Australia; the Royal Victorian Eye and Ear Hospital; University of Melbourne; Melbourne; Victoria; Australia
| | - Jie Jin Wang
- Centre for Eye Research Australia; the Royal Victorian Eye and Ear Hospital; University of Melbourne; Melbourne; Victoria; Australia
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Gandaglia G, Salonia A, Passoni N, Montorsi P, Briganti A, Montorsi F. Erectile dysfunction as a cardiovascular risk factor in patients with diabetes. Endocrine 2013; 43:285-92. [PMID: 22948773 DOI: 10.1007/s12020-012-9780-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 08/22/2012] [Indexed: 01/23/2023]
Abstract
Erectile dysfunction (ED) is a highly prevalent disorder among patients with diabetes mellitus (DM). In most cases, ED is considered a vascular disease and its development is significantly related to the exposure to CVD risk factors. In this context, ED and coronary artery disease (CAD) have been proposed as different manifestations of the same systemic disease; in nondiabetic patients, ED has progressively emerged as an important sentinel marker of the subsequent onset of CVD events. The aim of this review was to evaluate the association between ED and CAD in diabetic patients and to evaluate the role of ED as an independent CVD risk factor in these patients. Three large prospective studies confirmed that ED is a powerful predictor of CAD and cardiac mortality in patients with DM. Overall, diabetic patients with ED had roughly 1.4-fold higher risk of CAD as compared with those without ED. Interestingly, in diabetic patients, CAD is often silent and CAD screening according to the current guidelines can miss up to 40 % patients with occult myocardial perfusion abnormalities. Indeed, patients with ED have higher risk of silent myocardial ischemia compared to those without ED, and when ED is added to the risk factors, it can even improve the sensitivity of screening for asymptomatic CAD. Therefore, ED should be considered an independent CVD risk factor, and it could improve the identification of diabetic patients suitable for screening, leading to an early detection of CAD, and thus potentially enhancing the therapeutic effectiveness.
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Affiliation(s)
- Giorgio Gandaglia
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
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130
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Ryu JK, Jin HR, Yin GN, Kwon MH, Song KM, Choi MJ, Park JM, Das ND, Kwon KD, Batbold D, Lee T, Gao ZL, Kim KW, Kim WJ, Suh JK. Erectile dysfunction precedes other systemic vascular diseases due to incompetent cavernous endothelial cell-cell junctions. J Urol 2013; 190:779-89. [PMID: 23454152 DOI: 10.1016/j.juro.2013.02.100] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2013] [Indexed: 02/06/2023]
Abstract
PURPOSE Erectile dysfunction is often a harbinger of cardiovascular disease. We sought to gain mechanistic insight at the cellular and molecular levels into why erectile dysfunction precedes the clinical consequences of cardiovascular disease. MATERIALS AND METHODS Diabetes was induced by intraperitoneal streptozotocin injection in 8-week-old C57BL/6J mice. At 8 weeks after diabetes induction, we determined the expression of endothelial cell-cell junction proteins and vascular endothelial permeability in the penis, heart and hind limb by systemic injection of various vascular space markers (350 Da to 2,000 kDa) or by immunohistochemical staining with antibody to oxidized low density lipoprotein. We also investigated the effect of recombinant Ang1 protein on cavernous endothelial permeability. RESULTS Alterations in the integrity of the endothelial cell-cell junction, including a decrease in endothelial cell-cell junction proteins and an increase in vascular permeability to fluorescent tracers or oxidized low density lipoprotein, were prominent in the cavernous tissue of diabetic mice. In contrast, no significant changes in endothelial cell-cell junction proteins or vascular permeability were noted in heart or hind limb tissue according to the diabetic condition. Intracavernous injection of Ang1 protein, an anti-permeability factor, significantly decreased cavernous endothelial permeability to oxidized low density lipoprotein by restoring endothelial cell-cell junction proteins in diabetic mice. CONCLUSIONS The incompetent cavernous endothelial cell-cell junction in the diabetic condition provides an important clue to why erectile dysfunction is highly prevalent and often precedes other systemic vascular diseases.
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Affiliation(s)
- Ji-Kan Ryu
- National Research Center for Sexual Medicine and Department of Urology, Inha University School of Medicine, Incheon, Republic of Korea
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Kumar J, Bhatia T, Kapoor A, Ranjan P, Srivastava A, Sinha A, Kumar S, Garg N, Tewari S, Kapoor R, Goel PK. Erectile dysfunction precedes and is associated with severity of coronary artery disease among Asian Indians. J Sex Med 2013; 10:1372-9. [PMID: 23347017 DOI: 10.1111/jsm.12041] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) and coronary artery disease (CAD) often share common risk factors, and there is growing evidence that ED might serve as a clinical marker for cardiovascular disease. Despite rising trends of CAD in Asian Indians, limited data are available on the prevalence of ED and its correlation with CAD severity in such patients. AIM To study the prevalence of ED in Asian Indian patients undergoing coronary angiography and to assess if the severity of ED correlates with angiographic severity of CAD. METHODS In all patients undergoing coronary angiography, ED was assessed using the International Index of Erectile Function-5 questionnaire. MAIN OUTCOME MEASURES AND RESULTS Among 175 male patients, ED was present in 70%; patients with ED had a higher incidence of multivessel CAD (80% vs. 36%, P 0.001), diffuse CAD (81% vs. 34%, P 0.001), and higher number of mean coronary vessels involved compared with those without ED. Those with severe ED had higher prevalence of multivessel CAD and higher number of mean coronary vessels involved compared with those with milder grades of ED. Onset of symptoms of ED preceded symptoms of CAD by a mean of 24.6 months in 84% of patients. The presence of severe ED was associated with a 21-fold higher risk of having triple-vessel disease (odds ratio [OR] 21.94, 95% confidence interval [CI] 3.41-141.09, P = 0.001) and an 18-fold higher risk of having diffuse angiographic CAD (OR 17.91, 95% CI 3.11-111.09, P = 0.001). CONCLUSION Asian Indians with angiographic CAD frequently have ED; symptoms of ED precede that of CAD in most patients. Incidence of multivessel and diffuse CAD is significantly more common in patients with ED. It is important for physicians to be aware of the close relationship between the two conditions so that patients with ED can have optimal risk stratification for concomitant CAD whenever required.
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Affiliation(s)
- Jatinder Kumar
- Department of Urology and Renal Transplantation, Sanjay Gandhi PGIMS, Lucknow, India
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Salonia A, Ferrari M, Saccà A, Pellucchi F, Castagna G, Clementi MC, Matloob R, Briganti A, Rigatti P, Montorsi F. Delay in Seeking Medical Help in Patients with New‐Onset Erectile Dysfunction Remained High Over and Despite the PDE5 Era—An Ecological Study. J Sex Med 2012; 9:3239-46. [DOI: 10.1111/j.1743-6109.2012.02953.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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133
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Yamada T, Hara K, Umematsu H, Suzuki R, Kadowaki T. Erectile dysfunction and cardiovascular events in diabetic men: a meta-analysis of observational studies. PLoS One 2012; 7:e43673. [PMID: 22962586 PMCID: PMC3433443 DOI: 10.1371/journal.pone.0043673] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 07/23/2012] [Indexed: 12/17/2022] Open
Abstract
Background Several studies have shown that erectile dysfunction (ED) influences the risk of cardiovascular events (CV events). However, a meta-analysis of the overall risk of CV events associated with ED in patients with diabetes has not been performed. Methodology/Principal Findings We searched MEDLINE and the Cochrane Library for pertinent articles (including references) published between 1951 and April 22, 2012. English language reports of original observational cohort studies and cross-sectional studies were included. Pooled effect estimates were obtained by random effects meta-analysis. A total of 3,791 CV events were reported in 3 cohort studies and 9 cross-sectional studies (covering 22,586 subjects). Across the cohort studies, the overall odds ratio (OR) of diabetic men with ED versus those without ED was 1.74 (95% confidence interval [CI]: 1.34–2.27; P<0.001) for CV events and 1.72 (95% CI: 1.5–1.98; P<0.001) for coronary heart disease (CHD). The funnel plot, Begg's test, and Egger's test did not show evidence of publication bias (all P>0.05). Moreover, meta-regression analysis found no relationship between the method used to assess ED (questionnaire or interview), mean age, mean hemoglobin A1c, mean body mass index, or mean duration of diabetes and the risk of CV events or CHD. In the cross-sectional studies, the OR of diabetic men with ED versus those without ED was 3.39 (95% CI: 2.58–4.44; P<0.001) for CV events (N = 9), 3.43 (95% CI: 2.46–4.77; P<0.001) for CHD (N = 7), and 2.63 (95% CI: 1.41–4.91; P = 0.002) for peripheral vascular disease (N = 5). Conclusion/Significance ED was associated with an increased risk of CV events in diabetic patients. Prevention and early detection of cardiovascular disease are important in the management of diabetes, especially in view of the rapid increase in its prevalence.
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Affiliation(s)
- Tomohide Yamada
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kazuo Hara
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- * E-mail:
| | - Hitomi Umematsu
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Ryo Suzuki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Takashi Kadowaki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Miner M, Seftel AD, Nehra A, Ganz P, Kloner RA, Montorsi P, Vlachopoulos C, Ramsey M, Sigman M, Tilkemeier P, Jackson G. Prognostic utility of erectile dysfunction for cardiovascular disease in younger men and those with diabetes. Am Heart J 2012; 164:21-8. [PMID: 22795278 DOI: 10.1016/j.ahj.2012.04.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 04/12/2012] [Indexed: 01/02/2023]
Abstract
Multiple published studies have established erectile dysfunction (ED) as an independent risk marker for cardiovascular disease (CVD). In fact, incident ED has a similar or greater predictive value for cardiovascular events than traditional risk factors including smoking, hyperlipidemia, and family history of myocardial infarction. Here, we review evidence that supports ED as a particularly significant harbinger of CVD in 2 populations: men <60 years of age and those with diabetes. Although addition of ED to the Framingham Risk Score only modestly improved the 10-year predictive capacity of the Framingham Risk Score for myocardial infarction or coronary death data in men enrolled in the Massachusetts Male Aging Study, other epidemiologic studies suggest that the predictive value of ED is quite strong in younger men. Indeed, in the Olmstead County Study, men 40 to 49 years of age with ED had a 50-fold higher incidence of new-incident coronary artery disease than those without ED. However, ED had less predictive value (5-fold increased risk) for coronary artery disease in men 70 years and older. Several studies, including a large analysis of more than 6300 men enrolled in the ADVANCE study, suggest that ED is a particularly powerful predictor of CVD in diabetic men as well. Based on the literature reviewed here, we encourage physicians to inquire about ED symptoms in all men more than 30 years of age with cardiovascular risk factors. Identification of ED, particularly in men <60 years old and those with diabetes, represents an important first step toward CVD risk detection and reduction.
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Affiliation(s)
- Martin Miner
- Department of Family Medicine, Warren Alpert School of Medicine, Brown University, Providence, RI, USA.
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135
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Ribarič S. The pharmacological properties and therapeutic use of apomorphine. Molecules 2012; 17:5289-309. [PMID: 22565480 PMCID: PMC6268166 DOI: 10.3390/molecules17055289] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 04/22/2012] [Accepted: 04/25/2012] [Indexed: 12/12/2022] Open
Abstract
Apomorphine (APO) is an aporphine derivative used in human and veterinary medicine. APO activates D1, D2S, D2L, D3, D4, and D5 receptors (and is thus classified as a non-selective dopamine agonist), serotonin receptors (5HT1A, 5HT2A, 5HT2B, and 5HT2C), and α-adrenergic receptors (α1B, α1D, α2A, α2B, and α2C). In veterinary medicine, APO is used to induce vomiting in dogs, an important early treatment for some common orally ingested poisons (e.g., anti-freeze or insecticides). In human medicine, it has been used in a variety of treatments ranging from the treatment of addiction (i.e., to heroin, alcohol or cigarettes), for treatment of erectile dysfunction in males and hypoactive sexual desire disorder in females to the treatment of patients with Parkinson's disease (PD). Currently, APO is used in patients with advanced PD, for the treatment of persistent and disabling motor fluctuations which do not respond to levodopa or other dopamine agonists, either on its own or in combination with deep brain stimulation. Recently, a new and potentially important therapeutic role for APO in the treatment of Alzheimer’s disease has been suggested; APO seems to stimulate Aβ catabolism in an animal model and cell culture, thus reducing the rate of Aβ oligomerisation and consequent neural cell death.
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Affiliation(s)
- Samo Ribarič
- Institute of Pathophysiology, Medical Faculty, University of Ljubljana, Zaloška 4, SI-1000 Ljubljana, Slovenia.
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136
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García-Cruz E, Piqueras M, Gosálbez D, Pérez-Márquez M, Peri L, Izquierdo L, Franco A, Luque P, Corral J, Alvarez-Vijande R, Alcaraz A. [Erectile dysfunction and its severity are related to the number of cardiovascular risk factors]. Actas Urol Esp 2012; 36:291-5. [PMID: 22266257 DOI: 10.1016/j.acuro.2011.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 11/28/2011] [Accepted: 11/29/2011] [Indexed: 10/28/2022]
Abstract
AIM Erectile dysfunction (ED) is a very common condition in the general population. ED is closely related to Hypertension (HT), Diabetes Mellitus (DM), Dyslipidemia (DLP) and Metabolic Syndrome (MS). This study has aimed to clarify whether the presence and severity of ED are related to the presence and number of cardiovascular risk factors (CVRF). MATERIAL AND METHODS We retrospectively analyzed the characteristics of 242 males referred to our center for a prostate biopsy from September 2007 to December 2009. The following variables were collected prospectively: age, height, weight, body mass index (BMI), AHT, DM, DLP and obesity (BMI<30 kg/m(2)). The Erection Hardness Score Questionnaire was used to assess erectile function. We analyzed the relation between the presence and severity of ED and the presence of HT, DM, DLP and obesity. We analyzed the clinical variables based on the presence or absence of ED and in relationship to its severity. RESULTS The presence of ED was related to HT (OR: 1.805 [1.128-2.887]; p=0.013), DM (OR 3.585 [1.613-7.966]; p=0.001) and Dyslipidemia (OR: 1.928 [1.062-3.500]; p=0.029). Erectile function was not related to Obesity (OR: 0.929 [0.522-1.632]; p=0.795). Patients with ED were more likely to have more CVRF (p=0.009) and the severity of ED was related to the presence of HT (p<0.001), DM (p<0.001), DLP (p=0.001) and the number of CVRF (p<0.001). CONCLUSIONS The presence and severity of ED correlate with the presence of HT, DM, Dyslipidemia and the number of DVRF.
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137
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García-Cruz E, Piqueras M, Gosálbez D, Pérez-Márquez M, Peri L, Izquierdo L, Franco A, Luque P, Corral J, Alvarez-Vijande R, Alcaraz A. Erectile dysfunction and its severity are related to the number of cardiovascular risk factors. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.acuroe.2012.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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138
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Wagle KC, Carrejo MH, Tan RS. The implications of increasing age on erectile dysfunction. Am J Mens Health 2012; 6:273-9. [PMID: 22398995 DOI: 10.1177/1557988311431629] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Erectile dysfunction (ED) has long been correlated with psychological well-being. More recently, an understanding has developed of ED being, in some cases, a vascular condition of the penile artery. Given the narrowness of the penile artery, a small amount of atherosclerosis may result in ED before any other manifestations are evident, making ED a useful marker for other vascular conditions with potentially greater clinical implications. In light of this, possible underreporting of ED takes on added significance. A questionnaire regarding ED prevalence and management was distributed for self-administration to men in the waiting room of primary care clinics; the data were analyzed with a focus on the relationship between ED and age. The study had a remarkable response rate of >95%. The prevalence of ED in the ≥70-year age-group was 77%, compared with 61% in the 40- to 69-year age-group (p = .0001). ED correlated linearly with age (R(2) = .80, p < .0001). Among those who had ED, more than half had not discussed it with any provider; the likelihood of discussing ED did increase with the reported severity of symptoms (p < .0001). Older men had more severe ED than younger men (p < .0001). Furthermore, 72% of men with a history of ED were never treated. Younger men were more likely to be treated than older men (p = .004). Given the potential implications of underreporting ED, and the willingness of the men in this study to complete the questionnaire, further work may be merited on new models for ED assessment and follow-up.
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139
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Ryan JG, Gajraj J. Erectile dysfunction and its association with metabolic syndrome and endothelial function among patients with type 2 diabetes mellitus. J Diabetes Complications 2012; 26:141-7. [PMID: 22437118 DOI: 10.1016/j.jdiacomp.2011.12.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 12/14/2011] [Accepted: 12/15/2011] [Indexed: 12/16/2022]
Abstract
CONTEXT Evidence suggests that numerous comorbid conditions contribute to erectile dysfunction (ED) among patients with type 2 diabetes mellitus (T2DM). OBJECTIVE To review the relationship and mechanism between diabetes, metabolic syndrome, cardiovascular disease (CVD), and ED. METHODS A manual review of authoritative literature from peer-reviewed publications from January 2001 through July 2010 was performed. These publications were further mined to consider the impact of metabolic syndrome as a comorbid condition. Publications from key references were also consulted. RESULTS The associations between obesity, dyslipidemia, metabolic syndrome, T2DM, CVD, and depression with sexual dysfunction suggest that sexual dysfunction, particularly ED, is a precursor to CVD. Because these conditions share important risk factors with CVD, identifying them and their relationships with the pathogenesis of ED is likely to be critical to the manner in which primary care physicians screen for and manage this condition. CONCLUSIONS Primary care physicians ought to establish trusting relationships with their patients, providing opportunities for them to probe such sensitive issues as sexual activities, as a means of addressing the possibility of ED. When making the new diagnosis of sexual dysfunction in the absence of metabolic disease or CVD, physicians ought to consider the risk for T2DM and CVD. Associations between metabolic disease, heart disease, and sexual dysfunction further suggest that all patients who are obese and have dyslipidemia, T2DM, and/or depression should be further screened for ED.
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Affiliation(s)
- John G Ryan
- Division of Primary Care/Health Services Research and Development, Department of Family Medicine and Community Health, University of Miami Miller School of Medicine, Miami, FL, USA.
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140
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Tan HM, Tong SF, Ho CCK. Men's health: sexual dysfunction, physical, and psychological health--is there a link? J Sex Med 2011; 9:663-71. [PMID: 22188573 DOI: 10.1111/j.1743-6109.2011.02582.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Sexual dysfunction in men, such as erectile dysfunction, hypogonadism, and premature ejaculation, generates considerable attention. Its association with physical and psychological health is an issue which should be addressed seriously. AIM A review of the literature pertaining to the correlation between sexual dysfunction and physical and psychological health. METHODS PubMed search for relevant publications on the association between sexual dysfunction in men and physical and psychological health. MAIN OUTCOME MEASURE Clinical and epidemiological evidence that demonstrates the association between sexual dysfunction in men and physical and psychological health. RESULTS Sexual dysfunction, i.e., erectile dysfunction, hypogonadism, and premature ejaculation, has been shown to be associated with physical and psychological health. There is a strong correlation between sexual dysfunction and cardiovascular disease, metabolic syndrome, quality of life, and depression. CONCLUSION The association between men's sexual dysfunction and physical and psychological health is real and proven. Therefore, it should not be taken lightly but instead treated as a life-threatening medical problem.
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141
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Chung E, De Young L, Brock GB. Investigative Models in Erectile Dysfunction: A State‐of‐the‐Art Review of Current Animal Models. J Sex Med 2011; 8:3291-305. [DOI: 10.1111/j.1743-6109.2011.02505.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Phé V, Rouprêt M. Erectile dysfunction and diabetes: a review of the current evidence-based medicine and a synthesis of the main available therapies. DIABETES & METABOLISM 2011; 38:1-13. [PMID: 22056307 DOI: 10.1016/j.diabet.2011.09.003] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 09/25/2011] [Indexed: 12/20/2022]
Abstract
AIM This review aimed to provide an update of the epidemiology, pathophysiology and management of erectile dysfunction (ED) in diabetes patients. METHODS Data on the management of ED in diabetes patients in the literature were analyzed using Medline, and by matching the following keywords: diabetes; erectile dysfunction; endothelial dysfunction; cardiovascular disease; phosphodiesterase inhibitors; intracavernous injection; and penile prosthesis. RESULTS ED has a higher incidence in diabetic patients. The pathophysiology is multifactorial, involving endothelial dysfunction, specific complications of diabetes and psychological factors. Recent studies have shown that ED is able to predict future cardiovascular events not only in non-diabetics, but also in patients with diabetes. ED could also be a potential marker to screen for silent coronary artery disease. The management of ED has been revolutionized by the discovery of phosphodiesterase type-5 (PDE5) inhibitors, the first-line therapeutic options for diabetic men with ED that are efficient and safe. As a second line, intracavernous injections remain a gold-standard treatment, although a vacuum device can be used as well. In cases of failure, penile prosthesis may be considered. Hypogonadism, commonly found in diabetics, may require identification and treatment. Optimalized glycaemic control, management of associated co-morbidities and lifestyle modifications are essential in all patients. As ED and diabetes negatively impact male self-esteem, and generate depression and anxiety, the psychological treatment of patients is also likely to be beneficial. CONCLUSION The aetiology of diabetic ED is multifactorial. Endothelial dysfunction is the link between diabetes-induced ED and coronary artery disease. A global approach is needed for the successful management of diabetic ED.
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Affiliation(s)
- V Phé
- Urology and Andrology Academic Department of Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre-et-Marie-Curie, University Paris-VI, Paris, France
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143
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Gokkaya CS, Aktas BK, Toprak U, Yahsi S, Bulut S, Ozden C, Memis A. Is there a concordance between carotid and penile cavernosal artery intima-media thickness in patients with erectile dysfunction? Int J Impot Res 2011; 24:44-8. [DOI: 10.1038/ijir.2011.46] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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144
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Dong JY, Zhang YH, Qin LQ. Erectile dysfunction and risk of cardiovascular disease: meta-analysis of prospective cohort studies. J Am Coll Cardiol 2011; 58:1378-85. [PMID: 21920268 DOI: 10.1016/j.jacc.2011.06.024] [Citation(s) in RCA: 290] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 06/02/2011] [Accepted: 06/07/2011] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Our goal was to evaluate the association between erectile dysfunction (ED) and risk of cardiovascular disease (CVD) and all-cause mortality by conducting a meta-analysis of prospective cohort studies. BACKGROUND Observational studies suggest an association between ED and the incidence of CVD. However, whether ED is an independent risk factor of CVD remains controversial. METHODS The PubMed database was searched through January 2011 to identify studies that met pre-stated inclusion criteria. Reference lists of retrieved articles were also reviewed. Two authors independently extracted information on the designs of the studies, the characteristics of the study participants, exposure and outcome assessments, and control for potential confounding factors. Either a fixed- or a random-effects model was used to calculate the overall combined risk estimates. RESULTS Twelve prospective cohort studies involving 36,744 participants were included in the meta-analysis. The overall combined relative risks for men with ED compared with the reference group were 1.48 (95% confidence interval [CI]: 1.25 to 1.74) for CVD, 1.46 (95% CI: 1.31 to 1.63) for coronary heart disease, 1.35 (95% CI: 1.19 to 1.54) for stroke, and 1.19 (95% CI: 1.05 to 1.34) for all-cause mortality. Sensitivity analysis restricted to studies with control for conventional cardiovascular risk factors yielded similar results. No evidence of publication bias was observed. CONCLUSIONS This meta-analysis of prospective cohort studies suggests that ED significantly increases the risk of CVD, coronary heart disease, stroke, and all-cause mortality, and the increase is probably independent of conventional cardiovascular risk factors.
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Affiliation(s)
- Jia-Yi Dong
- Department of Nutrition and Food Hygiene, School of Radiation Medicine and Public Health, Soochow University, Suzhou, China.
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145
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Adamowicz J, Drewa T. Is there a link between soft drinks and erectile dysfunction? Cent European J Urol 2011; 64:140-3. [PMID: 24578881 PMCID: PMC3921721 DOI: 10.5173/ceju.2011.03.art8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 04/30/2011] [Accepted: 05/09/2011] [Indexed: 01/02/2023] Open
Abstract
This review focuses on the potential role of soft drinks, particularly the sugar component, in the pathogenesis of erectile dysfunction (ED). We analyzed the hypothetical link between metabolic disorders, induced by sweetened soft drinks overconsumption, and ED. High caloric intake, high refined-carbohydrates, and high fructose corn syrup (HFCS) content and less satiety are main factors responsible for metabolic disorders contributing to ED development. Regular diet mistakes among human males, such as soft drink consumption, may lead to slow and asymptomatic progression of ED, finally resulting in full claimed manifestation of ED.
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Affiliation(s)
- Jan Adamowicz
- Department of Tissue Engineering, Nicolaus Copernicus University, Bydgoszcz, Poland ; Department of Urology, Oncology Centre, prof. Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, Poland
| | - Tomasz Drewa
- Department of Tissue Engineering, Nicolaus Copernicus University, Bydgoszcz, Poland ; Department of Urology, Oncology Centre, prof. Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, Poland
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146
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Kirby MG, Schnetzler G, Zou KH, Symonds T. Prevalence and detection rate of underlying disease in men with erectile dysfunction receiving phosphodiesterase type 5 inhibitors in the United Kingdom: a retrospective database study. Int J Clin Pract 2011; 65:797-806. [PMID: 21676121 DOI: 10.1111/j.1742-1241.2011.02693.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AIM To determine the rate of newly detected underlying disease in men receiving their first (index) phosphodiesterase type 5 inhibitor (PDE5i) prescription. METHODS This non-interventional, retrospective study used anonymised patient records from UK general practices identified from the THIN database. Records of men aged ≥ 18 years, who received an index PDE5i prescription between January 1999 and June 2008 and with a continuous medical history (≥ 60 months) before the index prescription were included. Primary end-points were the prevalence of underlying disease prior to the index prescription and to establish the detection rate, defined as cumulative incidence of such a diagnosis in the 3 months following the index prescription. Assessments included comparison with age-matched controls, comparison with identical time periods immediately before and 1 year after, index prescription, and changes over time during the study period. Descriptive statistics, analysis of proportions and multivariate logistic regression analysis were used. RESULTS Among the 24,708 patients receiving a PDE5i, the prevalence of any underlying diagnosis before the index prescription was 70.23%; prevalence of vasculogenic disease was highest (48.20%). The detection rate of any underlying disease was 11.53%, and again highest for vasculogenic disease (4.07%). Compared with an age-matched control population, the additional detection rate of an unknown underlying disease at PDE5i prescription was 45 for hypertension, 61 for hypercholesterolaemia, 38 for diabetes and 5 for hypogonadism per 10,000 men. CONCLUSION Only a minority of men with erectile dysfunction have a previously undiagnosed important underlying disease that is uncovered at the time of an initial PDE5i prescription by a GP.
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Affiliation(s)
- M G Kirby
- Faculty of Health and Human Sciences, Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK.
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Pohjantähti-Maaroos H, Palomäki A, Hartikainen J. Erectile dysfunction, physical activity and metabolic syndrome: differences in markers of atherosclerosis. BMC Cardiovasc Disord 2011; 11:36. [PMID: 21707993 PMCID: PMC3157429 DOI: 10.1186/1471-2261-11-36] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 06/27/2011] [Indexed: 11/10/2022] Open
Abstract
Background Erectile dysfunction (ED), impaired arterial elasticity, elevated resting heart rate as well as increased levels of oxidized LDL and fibrinogen associate with future cardiovascular events. Physical activity is crucial in the prevention of cardiovascular diseases (CVD), while metabolic syndrome (MetS) comprises an increased risk for CVD events. The aim of this study was to assess whether markers of subclinical atherosclerosis are associated with the presence of ED and MetS, and whether physical activity is protective of ED. Methods 57 MetS (51.3 ± 8.0 years) and 48 physically active (PhA) (51.1 ± 8.1 years) subjects participated in the study. ED was assessed by the International Index of Erectile Function (IIEF) questionnaire, arterial elasticity by a radial artery tonometer (HDI/PulseWave™ CR-2000) and circulating oxLDL by a capture ELISA immunoassay. Fibrinogen and lipids were assessed by validated methods. The calculation of mean daily energy expenditure of physical exercise was based on a structured questionnaire. Results ED was more often present among MetS compared to PhA subjects, 63.2% and 27.1%, respectively (p < 0.001). Regular physical exercise at the level of > 400 kcal/day was protective of ED (OR 0.12, 95% CI 0.017-0.778, p = 0.027), whereas increased fibrinogen (OR 4.67, 95% CI 1.171-18.627, p = 0.029) and elevated resting heart rate (OR 1.07, 95% CI 1.003-1.138, p = 0.04) were independently associated with the presence of ED. In addition, large arterial elasticity (ml/mmHgx10) was lower among MetS compared to PhA subjects (16.6 ± 4.0 vs. 19.6 ± 4.2, p < 0.001), as well as among ED compared to non-ED subjects (16.7 ± 4.6 vs. 19.0 ± 3.9, p = 0.008). Fibrinogen and resting heart rate were highest and large arterial elasticity lowest among subjects with both MetS and ED. Conclusions Markers of subclinical atherosclerosis associated with the presence of ED and were most evident among subjects with both MetS and ED. Thus, especially MetS patients presenting with ED should be considered at high risk for CVD events. Physical activity, on its part, seems to be protective of ED. Trial registration ClinicalTrials.gov NCT01119404
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Chew KK, Gibson N, Sanfilippo F, Stuckey B, Bremner A. Cardiovascular Mortality in Men with Erectile Dysfunction: Increased Risk But Not Inevitable. J Sex Med 2011; 8:1761-71. [DOI: 10.1111/j.1743-6109.2011.02239.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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149
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150
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Henis O, Shahar Y, Steinvil A, Finn T, Heruti R, Loewenstein A, Justo D. Erectile Dysfunction is Associated With Severe Retinopathy in Diabetic Men. Urology 2011; 77:1133-6. [DOI: 10.1016/j.urology.2011.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 12/23/2010] [Accepted: 01/04/2011] [Indexed: 11/25/2022]
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