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Vigili de Kreutzenberg S. Silent coronary artery disease in type 2 diabetes: a narrative review on epidemiology, risk factors, and clinical studies. EXPLORATION OF MEDICINE 2021. [DOI: 10.37349/emed.2021.00029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Silent coronary artery disease (CAD) is one of the manifestations of heart disease that particularly affects subjects with type 2 diabetes mellitus (T2DM). From a clinical point of view, silent CAD represents a constant challenge for the diabetologist, who has to decide whether a patient could or could not be screened for this disease. In the present narrative review, several aspects of silent CAD are considered: the epidemiology of the disease, the associated risk factors, and main studies conducted, in the last 20 years, especially aimed to demonstrate the usefulness of the screening of silent CAD, to improve cardiovascular outcomes in type 2 diabetes.
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Bongongo T, Ndimande JV, Tumbo J. An assessment of erectile dysfunction among male diabetics attending Temba Community Health Centre, Pretoria. S Afr Fam Pract (2004) 2019. [DOI: 10.1080/20786190.2019.1658935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- T Bongongo
- Department of Family Medicine & PHC/Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - JV Ndimande
- Department of Family Medicine & PHC/Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - J Tumbo
- Department of Family Medicine & PHC/Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Coppola A, Gallotti P, Choussos D, Pujia A, Montalcini T, Gazzaruso C. Association between clitoral tissue perfusion and female sexual dysfunction in healthy women of reproductive age: a pilot study. Int J Impot Res 2019; 32:221-225. [DOI: 10.1038/s41443-019-0155-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/15/2019] [Accepted: 04/23/2019] [Indexed: 12/21/2022]
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Coppola A, Montalcini T, Gallotti P, Luzi L, Pujia A, Giustina A, Gazzaruso C. Transmucosal oxygen tension of the clitoris: a new parameter for future investigations of the sexual, metabolic, and cardiovascular health of women. Endocrine 2019; 63:177-181. [PMID: 30302662 DOI: 10.1007/s12020-018-1782-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/01/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Several studies suggested that abnormalities in tissue perfusion of external genitalia and vagina can lead to female sexual dysfunctions (FSDs) and can be associated to metabolic and cardiovascular risk factors. However, there are some technical difficulties in assessing these abnormalities. The measurement of oxygen partial pressure is a noninvasive method to measure oxygen partial pressure (pO2) at the skin surface to assess tissue perfusion. The aim of this study was to evaluate whether transmucosal oxygen tension (TmPO2) can be measured at the mucosal surface of clitoris and whether the measurements are reliable. METHODS TmPO2 was measured in six young healthy women by using a device to measure transcutaneous pO2 on the skin and by choosing a small sensor, usually used for newborns. The identical procedure for the detection of pO2 at the skin surface was used. RESULTS The mean value of TmPO2 was 42.3 mmHg (range: 24.1-53.4 mmHg). All the trend curves of the TmPO2 showed the same behavior: after a stabilization time, there was a stable pO2 (plateau phase) that corresponds to the TmPO2 of the clitoris. These curves had a similar trend to those recorded at the skin surface. CONCLUSIONS TmPO2 can be easily measured at the mucosal surface of clitoris. Large epidemiological studies in healthy and unhealthy women and in women with FSD are needed to establish both the normal range of TmPO2 and the meaning that different values of TmPO2 can have on sexual and general health of the women.
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Affiliation(s)
- A Coppola
- Diabetes and Endocrine and Metabolic Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.) Clinical Institute "Beato Matteo" (Hospital Group San Donato), 27029, Vigevano, Italy
| | - T Montalcini
- Nutrition Unit, Department of Clinical and Experimental Medicine, University Magna Grecia, Catanzaro, Italy
| | - P Gallotti
- Diabetes and Endocrine and Metabolic Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.) Clinical Institute "Beato Matteo" (Hospital Group San Donato), 27029, Vigevano, Italy
| | - L Luzi
- Department of Biomedical Sciences for Health, University of Milan, 20100, Milan, Italy
- Metabolism Research Center, IRCCS Policlinico San Donato, 20097, San Donato Milanese, Italy
| | - A Pujia
- Nutrition Unit, Department of Clinical and Experimental Medicine, University Magna Grecia, Catanzaro, Italy
| | - A Giustina
- Chair of Endocrinology, San Raffaele Vita-Salute University, Milan, Italy
| | - C Gazzaruso
- Diabetes and Endocrine and Metabolic Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.) Clinical Institute "Beato Matteo" (Hospital Group San Donato), 27029, Vigevano, Italy.
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The 2018 Revision to the Process of Care Model for Evaluation of Erectile Dysfunction. J Sex Med 2018; 15:1280-1292. [DOI: 10.1016/j.jsxm.2018.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 05/25/2018] [Accepted: 06/07/2018] [Indexed: 10/28/2022]
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Effects of Vitamin D Restricted Diet Administered during Perinatal and Postnatal Periods on the Penis of Wistar Rats. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6030646. [PMID: 29850540 PMCID: PMC5937572 DOI: 10.1155/2018/6030646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/19/2018] [Indexed: 01/08/2023]
Abstract
Vitamin D deficiency is common in pregnant women and infants. The present study aimed to investigate the effects of vitamin D restricted diet on the Wistar rats offspring penis morphology. Mother rats received either standard diet (SC) or vitamin D restricted (VitD) diet. At birth, offspring were divided into SC/SC (from SC mothers, fed with SC diet) and VitD/VitD (from VitD mothers, fed with VitD diet). After euthanasia the penises were processed for histomorphometric analysis. The VitD/VitD offspring displayed metabolic changes and reduction in the cross-sectional area of the penis, corpus cavernosum, tunica albuginea, and increased area of the corpus spongiosum. The connective tissue, smooth muscle, and cell proliferation percentages were greater in the corpus cavernosum and corpus spongiosum in the VitD/VitD offspring. The percentages of sinusoidal spaces and elastic fibers in the corpus cavernosum decreased. The elastic fibers in the tunica albuginea of the corpus spongiosum in the VitD/VitD offspring were reduced. Vitamin D restriction during perinatal and postnatal periods induced metabolic and structural changes and represented important risk factors for erectile dysfunction in the penis of the adult offspring. These findings suggest that vitamin D is an important micronutrient in maintaining the cytoarchitecture of the penis.
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Basat S, Sivritepe R, Ortaboz D, Sevim Çalık E, Küçük EV, Şimşek B, Atay S, Çalışgan A. The relationship between vitamin D level and erectile dysfunction in patients with type 2 diabetes mellitus. Aging Male 2018; 21:111-115. [PMID: 28944704 DOI: 10.1080/13685538.2017.1379488] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Recent studies have suggested that a relationship could exist between 25-hydroxyvitamin D [25(OH)D] deficiency and erectile dysfunction (ED). The present study evaluated the relationship between 25(OH)D levels and ED in male patients with type 2 diabetes mellitus (DM). The study included 98 patients with type 2 DM aged between 18-80 years. The International Index of Erectile Function (IIEF-5) Questionnaire was administered. The patients were divided into three groups according to IIEF-5 scoring: IIEF-5 score between 5-10, severe ED; IIEF-5 score between 11-20, moderate ED; IIEF-5 score between 21-25, no ED. Biochemical parameters, 25(OH)D and hormonal analysis tests were obtained in all patients. All parameters were compared between these three groups. Of 98 patients included in the study, 32 had severe ED, 45 had moderate ED and 21 had no ED. The mean age was 55.12 ± 9.39 years and the mean 25(OH)D level was 13.69 ± 8.15 ng/ml. When the three groups were compared, 25(OH)D levels were significantly lower in patients with the IIEF-5 score between 5-10 (p = 0.020). There was a moderate positive relationship between IIEF-5 score and 25(OH)D level (r = 0.21, p = 0.038). The patients with severe ED have considerably lower 25(OH)D levels.
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Affiliation(s)
- Sema Basat
- a Department of Internal Medicine , University of Health Sciences Umraniye Education and Research Hospital , İstanbul , Turkey
| | - Rıdvan Sivritepe
- a Department of Internal Medicine , University of Health Sciences Umraniye Education and Research Hospital , İstanbul , Turkey
| | - Damla Ortaboz
- a Department of Internal Medicine , University of Health Sciences Umraniye Education and Research Hospital , İstanbul , Turkey
| | - Ecem Sevim Çalık
- a Department of Internal Medicine , University of Health Sciences Umraniye Education and Research Hospital , İstanbul , Turkey
| | - Eyüp Veli Küçük
- b Department of Urology , University of Health Sciences Umraniye Education and Research Hospital , İstanbul , Turkey
| | - Berkan Şimşek
- b Department of Urology , University of Health Sciences Umraniye Education and Research Hospital , İstanbul , Turkey
| | - Sabri Atay
- c Kartal Uğur Mumcu Family Healty Center , İstanbul , Turkey
| | - Arzu Çalışgan
- d Medstats Analysis and Consulting Company , İstanbul , Turkey
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Gazzaruso C, Coppola A, Montalcini T, Falcone C. Anti-diabetic agents and heart health: how to use new diabetes medications in a global strategy for the prevention of cardiovascular complications in type 2 diabetes. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:195. [PMID: 29951517 DOI: 10.21037/atm.2018.03.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Carmine Gazzaruso
- Diabetes and endocrine and metabolic diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.) Clinical Institute "Beato Matteo" (Hospital Group San Donato), Vigevano, Italy.,Interdepartmental Center for Research in Molecular Medicine (CIRMC), University of Pavia, Pavia, Italy
| | - Adriana Coppola
- Diabetes and endocrine and metabolic diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.) Clinical Institute "Beato Matteo" (Hospital Group San Donato), Vigevano, Italy
| | - Tiziana Montalcini
- Department of Clinical and Experimental Medicine, Nutrition Unit, University Magna Grecia, Catanzaro, Italy
| | - Colomba Falcone
- Interdepartmental Center for Research in Molecular Medicine (CIRMC), University of Pavia, Pavia, Italy.,Department of Cardiology, Istituti Clinici di Pavia e Vigevano, University Hospital, Pavia, Italy
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Coppola A, Luzi L, Montalcini T, Giustina A, Gazzaruso C. Role of structured individual patient education in the prevention of vascular complications in newly diagnosed type 2 diabetes: the INdividual Therapeutic Education in Newly Diagnosed type 2 diabetes (INTEND) randomized controlled trial. Endocrine 2018; 60:46-49. [PMID: 28936586 DOI: 10.1007/s12020-017-1427-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 09/11/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Recent studies showed that a structured patient therapeutic education (PTE) may decrease both mortality and the development of diabetes complications. Nevertheless, no data are available in the literature on the impact of individual PTE on the complications in newly diagnosed type 2 diabetic patients. Aim of the present randomized controlled trial is to evaluate the impact of individual PTE on the occurrence of macrovascular complications in newly diagnosed type 2 diabetic patients when compared to usual care (UC) and group PTE. DESIGN AND METHODS Six hundred newly diagnosed type 2 diabetic patients will be enrolled. The patients will be randomly assigned to one of these three groups: individual PTE, group PTE and UC. A comprehensive and complete PTE will be delivered to all the patients: PTE will include eleven themes. Primary composite endpoint of the study is occurrence of vascular complications, including cardiovascular death, non fatal coronary disease, non fatal stroke, peripheral artery disease. Secondary endpoints are: foot ulcers, amputations, sexual dysfunction, quality of life, microvascular complications, bone health, intensification of diabetes and hypertension therapy. RESULTS AND CONCLUSIONS The present trial can give precious information on the features for the most effective PTE.
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Affiliation(s)
- Adriana Coppola
- Diabetes and endocrine and metabolic diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.) Clinical Institute "Beato Matteo" (Hospital Group San Donato), Vigevano, Italy
| | - Livio Luzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Tiziana Montalcini
- Department of Clinical and Experimental Medicine, Nutrition Unit, University Magna Grecia, Catanzaro, Italy
| | - Andrea Giustina
- Chair of Endocrinology San Raffaele Vita-Salute University, Milan, Italy
| | - Carmine Gazzaruso
- Diabetes and endocrine and metabolic diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.) Clinical Institute "Beato Matteo" (Hospital Group San Donato), Vigevano, Italy.
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Erectile dysfunction as a predictor of asymptomatic coronary artery disease in elderly men with type 2 diabetes. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 13:552-6. [PMID: 27582774 PMCID: PMC4987428 DOI: 10.11909/j.issn.1671-5411.2016.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Abdelhamed A, Hisasue SI, Nada EA, Kassem AM, Abdel-Kareem M, Horie S. Relation Between Erectile Dysfunction and Silent Myocardial Ischemia in Diabetic Patients: A Multidetector Computed Tomographic Coronary Angiographic Study. Sex Med 2016; 4:e127-34. [PMID: 27375006 PMCID: PMC5005292 DOI: 10.1016/j.esxm.2016.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 04/05/2016] [Accepted: 04/21/2016] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Erectile dysfunction (ED) can precede coronary artery disease. In addition, silent myocardial ischemia (SMI) is more common in diabetic patients and is a strong predictor of cardiac events and death. AIM To evaluate the presence of SMI in patients with diabetes and ED using multidetector computed tomographic coronary angiography (MDCT-CA). METHODS This study evaluated patients with diabetes and ED without any history of cardiac symptoms or signs. Erectile function was evaluated with the Sexual Health Inventory for Men score, erection hardness score (EHS), and maximal penile circumferential change by an erectometer. MDCT-CA was used for the detection of coronary artery stenosis. MAIN OUTCOME MEASURES Sexual Health Inventory for Men score, EHS, maximal penile circumferential change, and coronary artery stenosis by MDCT-CA. RESULTS Of 20 patients (mean age = 61.45 ± 10.7 years), MDCT-CA showed coronary artery stenosis in 13 (65%) in the form of one-vessel disease (n = 6, 30%), two-vessel disease (n = 2, 10%), and three-vessel disease (n = 5, 25%). Fifty percent of patients showed at least 50% vessel lumen obstruction of the left anterior descending coronary artery, which was the most commonly affected vessel (55%). Fifteen percent (3 of 20) of patients had greater than 90% stenosis, and two of them underwent an immediate coronary angioplasty with stenting to prevent myocardial infarction. Maximum coronary artery stenosis was positively correlated with age (P = 0.016, r = 0.529) and negatively correlated with EHS (P = .046, r = -0.449). Multivariate regression analysis using age and EHS showed that age was the only independent predictor of SMI (P = .04). CONCLUSION MDCT-CA can be a useful tool to identify SMI in diabetic patients with ED, especially in those of advanced age and/or with severe ED.
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Affiliation(s)
- Amr Abdelhamed
- Department of Urology, Juntendo University, Tokyo, Japan; Department of Dermatology, Venereology, and Andrology, Sohag University, Nasr City, Sohag, Egypt
| | | | - Essam A Nada
- Department of Dermatology, Venereology, and Andrology, Sohag University, Nasr City, Sohag, Egypt
| | - Ali M Kassem
- Department of Internal Medicine, Sohag University, Nasr City, Sohag, Egypt
| | - Mohammed Abdel-Kareem
- Department of Dermatology, Venereology, and Andrology, Sohag University, Nasr City, Sohag, Egypt
| | - Shigeo Horie
- Department of Urology, Juntendo University, Tokyo, Japan.
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Caretta N, de Kreutzenberg SV, Valente U, Guarneri G, Ferlin A, Avogaro A, Foresta C. Hypovitaminosis D is associated with erectile dysfunction in type 2 diabetes. Endocrine 2016; 53:831-8. [PMID: 26758995 DOI: 10.1007/s12020-015-0851-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 12/25/2015] [Indexed: 12/29/2022]
Abstract
Diabetes is an established risk factor for erectile dysfunction (ED). The pathophysiology of ED in diabetic men is multifactorial, but it mainly involves a vascular disorder related to a reduction of endothelial function. Recently, several studies have correlated ED risk factors with vitamin D deficiency. In this study, we evaluate the relationship between 25-hydroxyvitamin D [25(OH)D] levels, erectile dysfunction, and vascular disease, in type 2 diabetes mellitus men (T2DM). In this observational study, 92 T2DM males (58.83 ± 9.73 years) underwent medical history collection, International Index of Erectile Function (IIEF-5) questionnaire, that allows the identification and grading of DE, physical examination, biochemical/hormonal blood tests, and penile echo-color Doppler ultrasonography. T2DM patients with lower 25(OH)D levels (<25 nmol/l) showed higher penile IMT (p < 0.05), waist circonference (p < 0.05), glucose concentrations (p < 0.05), and lower IIEF-5 score (p < 0.005), testosterone concentrations (p < 0.05), and cavernous peak systolic velocity (PSV) (p < 0.05), compared to patients with 25(OH)D >50 nmol/l. 25(OH)D levels were directly correlated with IIEF-5 (R = 0.39; p = 0.0001), testosterone (R = 0.24; p = 0.02), and PSV (R = 0.24; p = 0.04) and inversely with waist (R = -0.33; p = 0.002), HbA1c (R = -0.22; p = 0.03), triglyceride (R = -0.21; p = 0.06), and penile IMT (R = -0.30; p = 0.009). At multivariate analysis, 25(OH)D deficiency remained an independent predictor of DE. We demonstrate a significant association between 25(OH)D deficiency and erectile dysfunction in T2DM men. This association may be due to the influence of 25(OH)D deficiency on cardiovascular risk factor (glycaemia, HDL cholesterol, and triglycerides), testosterone plasma levels and endothelial dysfunction.
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Affiliation(s)
- Nicola Caretta
- Department of Medicine, Section of Endocrinology and Centre for Human Reproduction Pathology, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy.
| | | | - Umberto Valente
- Department of Medicine, Section of Endocrinology and Centre for Human Reproduction Pathology, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Gabriella Guarneri
- Section of Diabetes and Metabolic Diseases, Department of Medicine, University of Padova, Padua, Italy
| | - Alberto Ferlin
- Department of Medicine, Section of Endocrinology and Centre for Human Reproduction Pathology, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Angelo Avogaro
- Section of Diabetes and Metabolic Diseases, Department of Medicine, University of Padova, Padua, Italy
| | - Carlo Foresta
- Department of Medicine, Section of Endocrinology and Centre for Human Reproduction Pathology, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
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Gazzaruso C, Fodaro M, Coppola A. Structured therapeutic education in diabetes: is it time to re-write the chapter on the prevention of diabetic complications? Endocrine 2016; 53:347-9. [PMID: 27048357 DOI: 10.1007/s12020-016-0947-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 03/29/2016] [Indexed: 01/21/2023]
Affiliation(s)
- Carmine Gazzaruso
- Diabetes and Endocrine-metabolic Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute "Beato Matteo" (Hospital Group San Donato), Corso Pavia, 84, 27029, Vigevano, Italy.
| | - Mariangela Fodaro
- Diabetes and Endocrine-metabolic Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute "Beato Matteo" (Hospital Group San Donato), Corso Pavia, 84, 27029, Vigevano, Italy
| | - Adriana Coppola
- Diabetes and Endocrine-metabolic Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute "Beato Matteo" (Hospital Group San Donato), Corso Pavia, 84, 27029, Vigevano, Italy
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Coppola A, Sasso L, Bagnasco A, Giustina A, Gazzaruso C. The role of patient education in the prevention and management of type 2 diabetes: an overview. Endocrine 2016; 53:18-27. [PMID: 26494579 DOI: 10.1007/s12020-015-0775-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 10/10/2015] [Indexed: 12/25/2022]
Abstract
The management of type 2 diabetes mellitus includes ability and empowerment of the patient to change lifestyle, maintain an adequate diet and physical activity, manage the disease, and follow a specific program of periodic medical checks and education sessions. In addition, the patient should be able to correctly identify and adequately solve problems related to the disease and actively collaborate with the healthcare system. To obtain these goals, therapeutic patient education (TPE) is now considered a crucial element not only in the treatment but also in the prevention of type 2 diabetes. Several trials showed that TPE is able to improve clinical, lifestyle, and psycho-social outcomes. Nevertheless, studies have not clarified the ideal characteristics of a comprehensive patient education program in clinical practice. Other work is needed to answer open questions regarding the type of PTE (individual or group education), themes, frequency and number of education sessions, contact time between educator and patient, background of educators, use of new technologies, and barriers to self-management. The present review discusses these points on the basis of the most recent data of the literature.
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Affiliation(s)
- Adriana Coppola
- Diabetes and Endocrine-Metabolic Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute "Beato Matteo" Vigevano, Corso Pavia, 84, 27029, Vigevano, Italy.
- Department of Health Sciences, University of Genoa, Genoa, Italy.
| | - Loredana Sasso
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Andrea Giustina
- Chair of Endocrinology, A.O. Spedali Civili, University of Brescia, Brescia, Italy
| | - Carmine Gazzaruso
- Diabetes and Endocrine-Metabolic Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute "Beato Matteo" Vigevano, Corso Pavia, 84, 27029, Vigevano, Italy
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Abstract
PURPOSE OF REVIEW This narrative review discusses the associations of erectile dysfunction with coronary heart disease (CHD) morbidity and mortality, all-cause death and CHD risk factors. Treatment strategies for erectile dysfunction are also mentioned. RECENT FINDINGS Erectile dysfunction shares common pathways and risk factors with vascular diseases. Erectile dysfunction has been reported to independently predict CHD events, thus highlighting its role as a marker of early atherosclerosis. Erectile dysfunction prevalence may be followed by the presentation of CHD symptoms in 2-3 years, and a CHD event may occur in 3-5 years. Furthermore, erectile dysfunction has been associated with stroke, peripheral artery disease, diabetes and chronic kidney disease as well as with several CHD risk factors including hypertension, dyslipidaemia, smoking, obesity, metabolic syndrome, hyperuricaemia, arterial stiffness and obstructive sleep apnea syndrome. On the basis of these data, erectile dysfunction may be regarded as a part of polyvascular disease. SUMMARY Patients with erectile dysfunction are at an increased risk for CHD morbidity and/or mortality as well as for all-cause death. Clinicians should monitor patients with erectile dysfunction by assessing their vascular risk and preventing or adequately treating CHD risk factors. In this context, lifestyle interventions should be recommended in addition to drug treatment to attain better outcomes.
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Colson MH. Dysfonctions sexuelles de la maladie chronique, l’état des lieux. Première partie : fréquence, impact et gravité. SEXOLOGIES 2016. [DOI: 10.1016/j.sexol.2016.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Colson MH. Sexual dysfunction and chronic illness. Part 1. Epidemiology, impact and significance. SEXOLOGIES 2016. [DOI: 10.1016/j.sexol.2016.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Kim ES, Lee SW, Mo EY, Moon SD, Han JH. Inverse association between serum total bilirubin levels and diabetic peripheral neuropathy in patients with type 2 diabetes. Endocrine 2015; 50:405-12. [PMID: 25846483 DOI: 10.1007/s12020-015-0583-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/17/2015] [Indexed: 12/18/2022]
Abstract
Several studies have suggested that bilirubin, a potent innate antioxidant, plays a protective role against cardiovascular and microvascular disease. This study investigated the association between serum concentrations of total bilirubin (TB) and the presence of diabetic peripheral neuropathy (DPN) in Korean diabetic patients. This cross-sectional study involved 1207 patients aged more than 30 years with type 2 diabetes. DPN was assessed according to clinical symptoms and physical examinations using Michigan Neuropathy Screening Instrument examination score, 10-g monofilament sensation, and current perception threshold. The subjects were stratified into gender-specific tertiles based on TB values, and the relationship between the TB values and DPN was analyzed. Compared with patients within the lowest TB tertile, those with higher TB levels consisted of patients with shorter duration of diabetes, lower HbA1c, better renal function, and less autonomic neuropathy, retinopathy, and albuminuria. Serum TB levels were inversely associated with DPN. In multivariate analysis for the development of DPN after adjusting for potential confounding factors including retinopathy, albuminuria, and autonomic neuropathy, the TB levels were inversely associated with the presence of DPN, both as a continuous variable [odds ratio (OR) per log standard deviation (SD) 0.79; 95% confidence interval (CI) 0.65-0.97; P = 0.022] and when categorized in tertiles (the highest vs. the lowest tertile; OR 0.63; 95% CI 0.40-0.99; P = 0.046). Low serum bilirubin levels are significantly associated with DPN, independently of classic risk factors and other microvascular complications. Further investigation is necessary to determine whether serum bilirubin has a prognostic significance on DPN.
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Affiliation(s)
- Eun Sook Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- The Catholic University of Korea Incheon St. Mary's Hospital, Incheon, Korea
| | - Sung Won Lee
- Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- The Catholic University of Korea Incheon St. Mary's Hospital, Incheon, Korea
| | - Eun Young Mo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- The Catholic University of Korea Incheon St. Mary's Hospital, Incheon, Korea
| | - Sung Dae Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
- The Catholic University of Korea Incheon St. Mary's Hospital, Incheon, Korea.
| | - Je Ho Han
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
- The Catholic University of Korea Incheon St. Mary's Hospital, Incheon, Korea.
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Sansone A, Romanelli F, Gianfrilli D, Lenzi A. Endocrine evaluation of erectile dysfunction. Endocrine 2014; 46:423-30. [PMID: 24705931 DOI: 10.1007/s12020-014-0254-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
Abstract
Erectile dysfunction is highly prevalent, affecting up to half of men in their 50-70s, and has been variably associated to a variety of causes including unhealthy lifestyles, such as smoking or overweight, or comorbidities such as hypertension, diabetes mellitus, and neurological disorders. General interest toward ED has exploded since the introduction of phosphodiesterase type 5 inhibitors-oral drugs that are widely accepted as the first line treatment in patients suffering from this conditions. In the last decade, the time lapse between first symptoms of sexual disorders and seeking of medical advice has greatly reduced. Unfortunately, none of the PDE5i has been proven curative, but rather acts as a symptomatic treatment. The availability of very active and safe drugs, however, diminished the space for diagnosis and search of etiological treatments. This is particularly true for the several endocrinopathies associated with ED. A number of epidemiological data support an inverse relationship between sexual health and testosterone levels, and it is well accepted that testosterone deficiency is a good marker of sexual and physical frailty. However, several other hormones, including LH, prolactin, TSH, and FT4 are involved in sexual functioning and should be investigated in a proper work-out of ED. Existing guidelines provide information almost entirely focusing on late-onset hypogonadism and therapeutic strategies; this mini-review aims to provide a wider spectrum of the diagnostic endocrine work-out of ED patients unrevealing the complexity of conditions, overt or subclinical, which can affect ED.
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Affiliation(s)
- Andrea Sansone
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy,
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20
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Chen RH, Zhao XH, Gu Z, Gu PL, Zhou B, Zhu ZH, Xu LY, Zou YF, Jiang XZ. Serum levels of 25-hydroxyvitamin D are associated with cognitive impairment in type 2 diabetic adults. Endocrine 2014; 45:319-24. [PMID: 23982512 DOI: 10.1007/s12020-013-0041-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 08/14/2013] [Indexed: 12/27/2022]
Abstract
Hypovitaminosis D is highly prevalent in type 2 diabetes. The aim of this study is to determine the serum levels of 25-hydroxyvitamin D [25(OH)D] in type 2 diabetic patients with and without mild cognitive impairment (MCI), and examine the relationship of 25(OH)D and MCI with other clinical factors. One hundred and sixty-five diabetic patients were enrolled in this study. Among whom, 95 patients were considered as MCI [Montreal Cognitive Assessment score (MoCA) < 26] and the other 70 as no MCI (MoCA ≥ 26). Subjects were assessed clinically. Diabetic patients with MCI had a longer duration of DM, fewer years of education, elevated fasting blood glucose (FBG), resistant index (RI) of carotid, and lower levels of 25(OH)D {[17.35 (13.02-25.92) vs 28.00 (19.67-34.30)] ng/ml, P < 0.001}. The MoCA score was positively correlated with log10[25(OH)D], education year, and inversely correlated with duration of DM, history of hypertension, intima-media thickness (IMT), FBG, max-RI, and min-RI. Log10[25(OH)D] was positively correlated with MoCA score, and inversely correlated with IMT, in multivariate regression analysis adjusted for age, sex, and education year, 25(OH)D (β = 0.210, P = 0.003), history of hypertension (β = -0.191, P = 0.007), IMT (β = -0.194, P = 0.007), and FBG (β = -0.157, P = 0.026) independently predicted MoCA score. In conclusion, our results suggest that levels of serum 25(OH)D are inversely associated with the cognitive impairment in diabetic patients. Vitamin D may be a potential protective factor for cognitive impairment in patients with type 2 diabetes.
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Affiliation(s)
- Rui-hua Chen
- Department of Endocrinology, Shanghai Pudong New Area People's Hospital, No.490, South Chuanhuan Road, Shanghai, China
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21
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Canat L, Cicek G, Atis G, Gurbuz C, Caskurlu T. Is there a relationship between severity of coronary artery disease and severity of erectile dysfunction? Int Braz J Urol 2014; 39:465-73. [PMID: 24054376 DOI: 10.1590/s1677-5538.ibju.2013.04.03] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 05/25/2013] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The correlation between erectile dysfunction (ED) and coronary artery disease has been emphasized and ED has been recognized as a potential independent risk factor and/or predictor of coronary artery disease (CAD). We evaluated the association between the number of occluded coronary arteries in myocardial infarction (MI) patients with the severity of ED, and investigated the influence of related risk factors in our study group. MATERIALS AND METHODS 183 male patients who underwent coronary angiography because of acute MI from November 2009 to May 2011 were included. Following the stabilization of patients after the treatment, each patient was evaluated for erectile functionality. Risk factors such as age, diabetes, smoking, waist circumference, hypertension, and hematologic parameters were recorded. RESULTS Among 183 patients with a mean age of 55.2 years who underwent coronary angiography due to acute MI, 100 (54.64 %) had ED, while the ED rate was 45.36 % (44/97) in cases of single-vessel disease, 64.5 % (31/48) in cases of two-vessel disease, and 65.7 % (25/38) in cases of three-vessel disease. The mean IIEF score was 24.2 ± 4.3, 20.4 ± 4.9 and 20.5 ± 4.2 for single or two or three-vessel disease, respectively. The presence of hypertension aggravated ED only in patients with three-vessel disease and increased total and LDL cholesterol levels in patients with single-vessel or two-vessel disease were accompanied by significantly decreasing IIEF scores. CONCLUSION The severity of ED correlated with the number of occluded vessels documented by coronary angiography, in male patients with acute myocardial infarction. In addition, the presence of hypertension had a significant influence over erectile function only in patients with three-vessel occlusion.
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Affiliation(s)
- Lutfi Canat
- Urology Department, Kastamonu State Hospital, Turkey
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22
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Gili M, Orsello A, Gallo S, Brizzi MF. Diabetes-associated macrovascular complications: cell-based therapy a new tool? Endocrine 2013; 44:557-75. [PMID: 23543434 DOI: 10.1007/s12020-013-9936-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 03/20/2013] [Indexed: 01/01/2023]
Abstract
Diabetes mellitus and its ongoing macrovascular complications represent one of the major health problems around the world. Rise in obesity and population ages correlate with the increased incidence of diabetes. This highlights the need for novel approaches to prevent and treat this pandemic. The discovery of a reservoir of stem/progenitors in bone marrow and in mesenchymal tissue has attracted interest of both biologists and clinicians. A number of preclinical and clinical trials were developed to explore their potential clinical impact, as target or vehicle, in different clinical settings, including diabetes complications. Currently, bone marrow, peripheral blood, mesenchymal, and adipose tissues have been used as stem/progenitor cell sources. However, evidences have been provided that both bone marrow and circulating progenitor cells are dysfunctional in diabetes. These observations along with the growing advantages in genetic manipulation have spurred researchers to exploit ex vivo manipulated cells to overcome these hurdles. In this article, we provide an overview of data relevant to stem-progenitors potential clinical application in revascularization and/or vascular repair. Moreover, the hurdles at using progenitor cells in diabetic patients will be also discussed.
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Affiliation(s)
- Maddalena Gili
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
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23
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Youssef AA, Kader SSA, Mahran AM, Hussein MA. Erectile dysfunction as a predictive factor for coronary artery disease. Egypt Heart J 2013. [DOI: 10.1016/j.ehj.2012.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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24
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Gazzaruso C, Coppola A, Falcone C, Luppi C, Montalcini T, Baffero E, Gallotti P, Pujia A, Solerte SB, Pelissero G, Giustina A. Transcutaneous oxygen tension as a potential predictor of cardiovascular events in type 2 diabetes: comparison with ankle-brachial index. Diabetes Care 2013; 36:1720-5. [PMID: 23404303 PMCID: PMC3661826 DOI: 10.2337/dc12-1401] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Transcutaneous oxygen tension (TcPO2) measures tissue perfusion and is important in the management of peripheral artery disease (PAD). Ankle brachial index (ABI) is used for the diagnosis of PAD and represents a predictor of major adverse cardiovascular events (MACE), even if in diabetes its diagnostic and predictive value seems to be reduced. No study has evaluated TcPO2 as a predictor of cardiovascular events. Aim of this longitudinal study was to assess whether TcPO2 is better than ABI at predicting MACE in type 2 diabetic patients. RESEARCH DESIGN AND METHODS Among 361 consecutive patients with apparently uncomplicated diabetes, 67 MACE occurred during a follow-up period of 45.8 ± 23.2 months. RESULTS The percentage of both subjects with low ABI (≤ 0.9) and subjects with low TcPO2 (≤ 46 mmHg as measured by a receiver operating characteristic curve) was significantly (<0.001) greater among patients with than among those without MACEs (ABI 64.2 vs. 40.8; TcPO2 58.2 vs. 34%). The Kaplan-Meier method showed that both low ABI (Mantel log-rank test, 4.087; P = 0.043) and low TcPO2 (Mantel log-rank test, 33.748; P > 0.0001) were associated with a higher rate of MACEs. Cox regression analysis showed that low TcPO2 (hazard ratio 1.78 [95% CI 1.44-2.23]; P < 0.001) was a significant predictor of MACE, while ABI did not enter the model. CONCLUSIONS This longitudinal study showed that TcPO2 may be a potential predictor of MACE among patients with uncomplicated type 2 diabetes and that its predictive value seems to be greater than that of ABI.
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Affiliation(s)
- Carmine Gazzaruso
- Internal Medicine, Diabetes, Vascular and Endocrine-Metabolic Diseases Unit and the Centre for Applied Clinical Research, Clinical Institute Beato Matteo, Vigevano, Italy.
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25
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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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26
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Di Luigi L, Romanelli F, Sgrò P, Lenzi A. Andrological aspects of physical exercise and sport medicine. Endocrine 2012; 42:278-84. [PMID: 22430368 DOI: 10.1007/s12020-012-9655-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 03/06/2012] [Indexed: 12/21/2022]
Abstract
Appropriate physical activity is one of the bases of healthy lifestyle. In fact, physical exercise and playing sport may be associated with both improvements and injury to both general and reproductive health. A biologically normal testosterone secretion appears fundamental in males to guarantee both a physiological exercise adaptation and safe sport participation. The reproductive system is highly sensitive to the effects of exercise-related stress and the reproductive hormones may both increase and decrease after different acute or chronic exercises. Exercise and sport participation may positively or negatively influence andrological health status depending on the type, intensity and duration of performed physical activity and on individual health status. In addition, prohibited substances administration (e.g. androgenic-anabolic steroids, and so forth) in competitive and non-competitive athletes represents the main cause of iatrogenic andrological diseases. Preventing and treating andrological problems in active healthy and unhealthy individuals is as important as promoting a correct lifestyle. Physicians need to be educated on the relationships between the male reproductive system and sport participation and on the great role of the pre-participation physical examination in the prevention of andrological diseases.
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Affiliation(s)
- Luigi Di Luigi
- Unit of Endocrinology, Department of Health Sciences, University of Rome Foro Italico, Piazza Lauro de Bosis, 15, 00135 Rome, Italy.
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27
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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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28
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Salonia A, Castagna G, Saccà A, Ferrari M, Capitanio U, Castiglione F, Rocchini L, Briganti A, Rigatti P, Montorsi F. Is erectile dysfunction a reliable proxy of general male health status? The case for the International Index of Erectile Function-Erectile Function domain. J Sex Med 2012; 9:2708-15. [PMID: 22897643 DOI: 10.1111/j.1743-6109.2012.02869.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) has emerged progressively as a sentinel marker of cardiovascular disease (CVD). The correlation between ED and the burden arising from multiple comorbid conditions has been incompletely analyzed. AIM Assess whether erectile function, defined with the International Index of Erectile Function-Erectile Function (IIEF-EF) domain score, is associated with health-significant comorbidities scored with the Charlson comorbidity index (CCI). METHODS Clinical and hemodynamic variables of the last 140 consecutive patients who underwent penile color Doppler ultrasonography for new-onset ED were considered. Patients were assessed with a thorough medical and sexual history. Health-significant comorbidities were scored with the CCI. MAIN OUTCOME MEASURE Descriptive statistics and either linear or logistic regression models tested the association among IIEF-EF, hemodynamic parameters, and CCI, which was included in the model both as continuous and categorized variable (0 vs. ≥1). RESULTS Complete data were available for 138 patients (98.6%) (mean age 46.6 years [standard deviation 13.0]; range 21-75 years). CCI was 0, 1, and ≥2 in 94 (68.1%), 23 (16.7%), and 21 (15.25%) patients, respectively. Of all, 35 patients (79.5%) did not have a CVD comorbidity. Mean IIEF-EF was 13.7 (9.3). ED severity was no ED, mild, mild to moderate, moderate, and severe in 12 (9.1%), 28 (20.2%), 12 (9.1%), 23 (16.2%), and 63 (45.5%) patients, respectively. At multivariable linear regression analysis, CCI significantly worsened with increased age (β=0.33; P=0.001) and decreased IIEF-EF values (β=-0.25; P=0.01). At logistic regression analysis, age (odds ratio [OR]: 1.05; P=0.004) and IIEF-EF (OR: 0.95; P=0.04) emerged as significant predictors of categorized CCI. CONCLUSIONS Severity of ED, as objectively interpreted with IIEF-EF, accounts for a higher CCI, which may be considered a reliable proxy of a lower general male health status regardless of the etiology of ED.
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Affiliation(s)
- Andrea Salonia
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy.
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29
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Corona G, Rastrelli G, Balercia G, Lotti F, Sforza A, Monami M, Forti G, Mannucci E, Maggi M. Hormonal Association and Sexual Dysfunction in Patients with Impaired Fasting Glucose: A Cross-Sectional and Longitudinal Study. J Sex Med 2012; 9:1669-80. [DOI: 10.1111/j.1743-6109.2012.02717.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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30
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Sorenson M, Grant WB. Does vitamin D deficiency contribute to erectile dysfunction? DERMATO-ENDOCRINOLOGY 2012; 4:128-36. [PMID: 22928068 PMCID: PMC3427191 DOI: 10.4161/derm.20361] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Erectile dysfunction (ED) is a multifactorial disease, and its causes can be neurogenic, psychogenic, hormonal and vascular. ED is often an important indicator of cardiovascular disease (CVD) and a powerful early marker for asymptomatic CVD. Erection is a vascular event, and ED is often a vascular disease caused by endothelial damage and subsequent inhibition of vasodilation. We show here that risk factors associated with a higher CVD risk also associate with a higher ED risk. Such factors include diabetes mellitus, hypertension, arterial calcification and Inflammation in the vascular endothelium. Vitamin D deficiency is one of several dynamics that associates with increased CVD risk, but to our knowledge, it has not been studied as a possible contributor to ED. Here we examine research linking ED and CVD and discuss how vitamin D influences CVD and its classic risk factors-factors that also associate to increased ED risk. We also summarize research indicating that vitamin D associates with reduced risk of several nonvascular contributing factors for ED. We conclude that VDD contributes to ED. This hypothesis should be tested through observational and intervention studies.
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Affiliation(s)
| | - William B. Grant
- Sunlight, Nutrition, and Health Research Center; San Francisco, CA USA
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31
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Yan Q, Zhang Y, Hong J, Gu W, Dai M, Shi J, Zhai Y, Wang W, Li X, Ning G. The association of serum chemerin level with risk of coronary artery disease in Chinese adults. Endocrine 2012; 41:281-8. [PMID: 22042485 DOI: 10.1007/s12020-011-9550-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 09/29/2011] [Indexed: 10/16/2022]
Abstract
Chemerin is a newly discovered adipokine which has been found closely associated with obesity, metabolic syndrome (MetS), and inflammatory status. This study will investigate whether serum chemerin levels are associated with coronary artery disease (CAD) independently of other cardiovascular risk factors. This study included a total of 430 subjects (239 with CAD and 191 with non-CAD) who underwent coronary angiography. Anthropometric measurements were performed and chemerin, glucose, lipid profiles, and other biochemical characteristics were measured. The severity of coronary atherosclerosis was estimated by the total number of diseased vessels and Gensini score. Serum chemerin levels were significantly higher in the CAD group than in the non-CAD group (P = 0.011). The odds ratios (95% CI) of CAD across increasing quartiles of serum chemerin were 1.04 (0.61-1.78), 1.08 (0.63-1.83), and 1.87 (1.07-3.24), (P = 0.386, 0.508, and 0.012, respectively). Adjusting for age, sex, and other conventional risk factors for CAD did not appreciably alter the results. Serum chemerin levels were significantly increased with an increasing of number of diseased vessels (P = 0.024). In conditional linear regression models, chemerin levels were positively related to Gensini score even after established cardiovascular risk factors (β = 0.13, P = 0.019). Correlation analysis showed serum chemerin levels were significantly associated with TG levels, TC levels, fasting serum insulin, HOMA-IR and MetS (all P < 0.05). Higher serum chemerin levels were associated with increased risk of CAD and metabolic parameters in Chinese adults. Chemerin may represent a novel link between metabolic signals and atherosclerosis.
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Affiliation(s)
- Qun Yan
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrinology and Metabolism, Key Laboratory for Endocrinology and Metabolism of Chinese Health Ministry, Rui-jin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Er Road, Shanghai 200025, China
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32
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Gazzaruso C, Coppola A, Montalcini T, Baffero E, Garzaniti A, Pelissero G, Collaviti S, Grugnetti A, Gallotti P, Pujia A, Solerte SB, Giustina A. Lipoprotein(a) and homocysteine as genetic risk factors for vascular and neuropathic diabetic foot in type 2 diabetes mellitus. Endocrine 2012; 41:89-95. [PMID: 21986921 DOI: 10.1007/s12020-011-9544-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 09/25/2011] [Indexed: 12/12/2022]
Abstract
Neuropathy and peripheral artery disease represent the main pathophysiological conditions underlying diabetic foot. Several studies showed that Lipoprotein(a)-Lp(a)-and homocysteine (Hcy) can be associated with diabetic complications, but their relationship with diabetic foot is unclear. Aim of this study was to investigate whether Lp(a) and Hcy were associated with diabetic foot ulcerations, classified according to the presence of peripheral artery disease (PAD) or neuropathy. From among consecutive type 2 diabetic attending at the Diabetic Foot Clinic 27 subjects with vascular diabetic foot (VDF), 43 with neuropathic diabetic foot (NDF) and 52 controls without foot ulceration, neuropathy, and PAD were enrolled. Both Lp(a) (26.1 ± 22.7 vs. 14.9 ± 19.5 mg/dl; P = 0.003) and Hcy levels (15.4 ± 5.7 vs. 12.2 ± 5.1 μmol/l; P = 0.022) were significantly greater in the VDF group than in controls. Lp(a) levels were significantly lower in the NDF group than in controls (6.9 ± 8.1 versus 14.9 ± 19.5 mg/dl; P = 0.009), while no difference in Hcy levels was found. Multiple logistic regression analysis showed that Hcy was associated with VDF (OR: 1.11; 95% CI: 1.07-14.1; P = 0.048). Lp(a) did not enter the model, but its P-value was very near to the significant level (OR: 1.09; 95% CI: 0.99-12.05; P = 0.059). Moreover, low Lp(a) levels were associated with NDF (OR: 0.84; 95% CI: 0.21-0.96; P = 0.039). Our study has shown for the first time that high Lp(a) and Hcy levels are associated with the development of VDF, while low Lp(a) levels appear to be associated with delayed wound healing in patients with neuropathic foot ulcerations.
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Affiliation(s)
- Carmine Gazzaruso
- Internal Medicine, Diabetes, Endocrine-Metabolic Diseases and Cardiovascular Prevention Unit and The Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute "Beato Matteo", Corso Pavia 84, 27029, Vigevano, Italy.
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