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Sun A, Williams AO, Rojanasarot S, Moore G, McGovern AM, Hargens LM, Turner E, Babbar P. Downstream Revenue Realized by Facilities Placing Inflatable Penile Prosthesis in Medicare Beneficiaries to Treat Erectile Dysfunction. Urology 2024; 189:112-118. [PMID: 38677374 DOI: 10.1016/j.urology.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 04/01/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE To quantify the incremental downstream revenue generated from subsequent treatment of men who received an inflatable penile prosthesis (IPP) to treat erectile dysfunction (ED), compared to men without ED. METHODS The 100% Medicare Standard Analytic Files were used to conduct a retrospective claims analysis of the 5-year revenue generated by patients receiving IPP to treat their ED, compared to a propensity-matched cohort of men without ED. Men aged 65 years or older with ED who underwent IPP implantation (Current Procedural Terminology 54405) in a hospital outpatient setting between January 1, 2016 and December 31, 2021, and who had continuous Medicare Parts A and B enrollment for 12 months pre-index IPP and 5 years post-index IPP discharge date were included in the study. Men without ED but with comparable characteristics were identified and used as a comparator group. Revenue received by hospitals from Medicare was defined as the sum of payments for patient services, other payor-paid amounts, patient deductibles, copayments, and coinsurance. Revenue was inflated to 2022 US dollars. The mean values and their corresponding standard deviations (SD) are reported. RESULTS After matching, there were 2905 men with ED who received an IPP and 7462 men without ED. The IPP cohort showed a significantly higher 5-year cumulative revenue (mean=$34,571 [SD=$50,234]) compared to the men without ED (mean=$3189 [SD=$11,527]). When stratified by diagnosis type, the differences in revenue were $10,258 for circulatory disease, $2646 for diabetes, $2013 for urology, and $1043 for prostate cancer. Significantly more IPP patients had at least 1 health encounter for these conditions over the 5-year follow-up period than their matched controls (55.0% vs 7.8% for circulatory, 46.7% vs 16.8% for urology, 19.3% vs 3.6% for diabetes, and 19.0% vs 3.0% for prostate cancer). CONCLUSION Men with ED who received IPP generated substantially higher revenue for the healthcare system over a 5-year period, nearly 10 times as much, compared to men without ED, excluding the initial cost of the IPP procedure. The presence of ED, coupled with IPP usage, is associated with significantly increased healthcare revenue across a range of medical conditions compared to men without ED. These findings emphasize the financial implications for advanced ED programs to improve access to necessary care for these patients. Healthcare facilities may leverage these insights to effectively allocate resources to deliver critical healthcare to men with ED.
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Affiliation(s)
- Andrew Sun
- Urology Partners of North Texas, Arlington, TX.
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Sadeghi M, Askari A, Bostan F, Heidari A, Rafiee H, Alavi Tabatabaei G, Ghasemi G, Roohafza H. Impact of cardiac rehabilitation on erectile dysfunction in cardiovascular patients: a systematic review and meta-analysis. Sex Med 2024; 12:qfae043. [PMID: 38953013 PMCID: PMC11215551 DOI: 10.1093/sexmed/qfae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/07/2024] [Accepted: 06/08/2024] [Indexed: 07/03/2024] Open
Abstract
Background Cardiovascular diseases (CVDs) and erectile dysfunction (ED) frequently co-occur, significantly affecting the quality of life of individuals. Aim To assess the impact of cardiac rehabilitation (CR) on ED in patients with CVD through a systematic review and meta-analysis. Methods This study analyzed randomized controlled trials and other studies comparing CR with usual care for adult males (≥18 years) with any cardiac disease. Literature searches were extensive, and the risk of bias was evaluated by the Cochrane Collaboration tool. Data from 6 studies involving 668 participants were included in the meta-analysis. Outcomes The primary outcome was the improvement in ED, as measured with the International Index of Erectile Function. Results A statistically significant improvement in erectile function was observed across 6 studies, with a Morris dppc2 effect size of 0.38 (95% CI, 0.17-0.59). Despite initial high heterogeneity (I 2 = 95.7%), identification and correction for selective outcome reporting bias mitigated this issue. Clinical Translation CR has a modest but statistically significant impact on improving ED in patients with CVD, indicating its potential positive contribution to the quality of life of this group. Strengths and Limitations The study's strengths include a comprehensive literature search and a rigorous methodological approach. Limitations involve high heterogeneity among studies and a low level of evidence due to small sample sizes and study quality; however, the source of heterogeneity was identified and mitigated following risk-of-bias assessment. Conclusion The results suggest that CR has a statistically significant but modest impact on improving ED in patients with CVD. Clinicians should consider the integration of CR into the clinical management of these individuals. This study underscores the potential for CR to contribute positively to the quality of life for patients with CVD by addressing associated ED (PROSPERO: CRD42022374625).
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Affiliation(s)
- Masoumeh Sadeghi
- Chamran Cardiovascular Research and Education Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Askari
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Bostan
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Afshin Heidari
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Rafiee
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Golsa Ghasemi
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Roohafza
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Hyun CW, Hwang JY, Yun SW, Park TY, Yoon SG, Kim SB, Noh TI, Kang SG, Kang SH, Cho DH, Shim JS. The association between the severity of erectile dysfunction and left ventricular diastolic dysfunction in patients with and without cardiovascular disease. Investig Clin Urol 2024; 65:165-172. [PMID: 38454826 PMCID: PMC10925735 DOI: 10.4111/icu.20230272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 03/09/2024] Open
Abstract
PURPOSE Erectile dysfunction (ED) is considered a microvascular disorder and serves as an indicator for the potential development of cardiovascular disease (CVD). Although left ventricular diastolic dysfunction (LVDD) reflects early myocardial damage caused by microvascular disorders, the association between ED and LVDD remains poorly elucidated. MATERIALS AND METHODS A cross-sectional study was conducted on 123 patients with ED. They underwent RigiScan, and conventional echocardiography, and attempted International Index of Erectile Function (IIEF) questionnaire. ED severity was evaluated by measuring changes in the penile base circumference and duration of penile rigidity (≥70%) during erection. The early diastolic velocity of mitral inflow (E) and early diastolic velocity of the mitral annulus (e') were measured using echocardiography. The patients were grouped based on the presence of CVD. RESULTS Among 123 patients, 29 had CVD and 94 did not. Patients with CVD exhibited more pronounced ED and more severe LVDD. Associations between increased penile circumference with echocardiographic parameters were more prominent in patients with CVD than in those without CVD (ΔTtop and e' wave, r=0.508 and r=0.282, respectively, p for interaction=0.033; ΔTbase and E/e' ratio, r=-0.338 and r=-0.293, respectively, p for interaction <0.001). In the multivariate linear regression, the increase of penile base circumference was an independent risk factor for LVDD (e', B=0.503; E/e' ratio, B=-1.416, respectively, p<0.001). CONCLUSIONS ED severity correlated well with LV diastolic dysfunction, particularly in the presence of CVD. This study highlighted the potential role of ED assessment as early indicator of CVD development.
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Affiliation(s)
- Chang Wan Hyun
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jae Young Hwang
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seong Woo Yun
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae Young Park
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Goo Yoon
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung Bin Kim
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae Il Noh
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Gu Kang
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Dong-Hyuk Cho
- Division of Cardiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ji Sung Shim
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
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Park HJ. Letter to the editor: The association between the severity of erectile dysfunction and left ventricular diastolic dysfunction in patients with and without cardiovascular disease. Investig Clin Urol 2024; 65:196-197. [PMID: 38454830 PMCID: PMC10925730 DOI: 10.4111/icu.20240025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/16/2024] [Accepted: 02/22/2024] [Indexed: 03/09/2024] Open
Affiliation(s)
- Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute of Pusan National University Hospital, Busan, Korea.
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Kloner RA, Burnett AL, Miner M, Blaha MJ, Ganz P, Goldstein I, Kim NN, Kohler T, Lue T, McVary KT, Mulhall JP, Parish SJ, Sadeghi-Nejad H, Sadovsky R, Sharlip ID, Rosen RC. Princeton IV consensus guidelines: PDE5 inhibitors and cardiac health. J Sex Med 2024; 21:90-116. [PMID: 38148297 DOI: 10.1093/jsxmed/qdad163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND In 1999, 1 year after the approval of the first oral phosphodiesterase type 5 (PDE5) inhibitor for the treatment of erectile dysfunction (ED), the first Princeton Consensus Conference was held to address the clinical management of men with ED who also had cardiovascular disease. These issues were readdressed in the second and third conferences. In the 13 years since the last Princeton Consensus Conference, the experience with PDE5 inhibitors is more robust, and recent new data have emerged regarding not only safety and drug-drug interactions, but also a potential cardioprotective effect of these drugs. AIM In March 2023, an interdisciplinary group of scientists and practitioners met for the fourth Princeton Consensus Guidelines at the Huntington Medical Research Institutes in Pasadena, California, to readdress the cardiovascular workup of men presenting with ED as well as the approach to treatment of ED in men with known cardiovascular disease. METHOD A series of lectures from experts in the field followed by Delphi-type discussions were developed to reach consensus. OUTCOMES Consensus was reached regarding a number of issues related to erectile dysfunction and the interaction with cardiovascular health and phosphodiesterase-5 inhibitors. RESULTS An algorithm based on recent recommendations of the American College of Cardiology and American Heart Association, including the use of computed tomography coronary artery calcium scoring, was integrated into the evaluation of men presenting with ED. Additionally, the issue of nitrate use was further considered in an algorithm regarding the treatment of ED patients with coronary artery disease. Other topics included the psychological effect of ED and the benefits of treating it; the mechanism of action of the PDE5 inhibitors; drug-drug interactions; optimizing use of a PDE5 inhibitors; rare adverse events; potential cardiovascular benefits observed in recent retrospective studies; adulteration of dietary supplements with PDE5 inhibitors; the pros and cons of over-the-counter PDE5 inhibitors; non-PDE5 inhibitor therapy for ED including restorative therapies such as stem cells, platelet-rich plasma, and shock therapy; other non-PDE5 inhibitor therapies, including injection therapy and penile prostheses; the issue of safety and effectiveness of PDE5 inhibitors in women; and recommendations for future studies in the field of sexual dysfunction and PDE5 inhibitor use were discussed. CLINICAL IMPLICATIONS Algorithms and tables were developed to help guide the clinician in dealing with the interaction of ED and cardiovascular risk and disease. STRENGTHS AND LIMITATIONS Strengths include the expertise of the participants and consensus recommendations. Limitations included that participants were from the United States only for this particular meeting. CONCLUSION The issue of the intersection between cardiovascular health and sexual health remains an important topic with new studies suggesting the cardiovascular safety of PDE5 inhibitors.
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Affiliation(s)
- Robert A Kloner
- Department of Cardiovascular Research Pasadena, Huntington Medical Research Institutes, CA 91105, United States
- Department of Medicine, Keck School of Medicine at University of Southern California, Los Angeles, CA, United States
| | - Arthur L Burnett
- Department of Urology, Johns Hopkins University, Baltimore, MD, United States
| | - Martin Miner
- Men's Health Center, Miriam Hospital, Providence, RI, United States
| | - Michael J Blaha
- Cardiology and Epidemiology, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States
| | - Peter Ganz
- Department of Medicine (PG); Department of Urology (TL, IDS); Department of Psychiatry and Behavioral Sciences, (RCR), University of California, San Francisco, San Francisco, CA, United States
| | - Irwin Goldstein
- Department of Sexual Medicine, Institute for Sexual Medicine, Alvarado Hospital, San Diego, CA, United States
| | - Noel N Kim
- Department of Sexual Medicine, Institute for Sexual Medicine, Alvarado Hospital, San Diego, CA, United States
| | | | - Tom Lue
- Department of Medicine (PG); Department of Urology (TL, IDS); Department of Psychiatry and Behavioral Sciences, (RCR), University of California, San Francisco, San Francisco, CA, United States
| | - Kevin T McVary
- Center for Male Health, Stritch School of Medicine at Loyola University Medical Center, Maywood, IL, United States
| | - John P Mulhall
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Sharon J Parish
- Weill Cornell Medicine, New York, NY, United States
- Department of Medicine and Psychiatry White Plains, Westchester Behavioral Health Center, NewYork-Presbyterian Hospital, NY, United States
| | - Hossein Sadeghi-Nejad
- Department of Urology NY, NYU Langone Grossman School of Medicine, NY, United States
| | - Richard Sadovsky
- Department of Family and Community Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, United States
| | - Ira D Sharlip
- Department of Medicine (PG); Department of Urology (TL, IDS); Department of Psychiatry and Behavioral Sciences, (RCR), University of California, San Francisco, San Francisco, CA, United States
| | - Raymond C Rosen
- Department of Medicine (PG); Department of Urology (TL, IDS); Department of Psychiatry and Behavioral Sciences, (RCR), University of California, San Francisco, San Francisco, CA, United States
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Kalka C, Keo HH, Ingwersen M, Knoechel J, Hoppe H, Do DD, Schumacher M, Diehm N. Men with erectile dysfunction (ED) should be screened for cardiovascular risk factors - Cost-benefit considerations in Swiss men. VASA 2024; 53:68-76. [PMID: 38047756 DOI: 10.1024/0301-1526/a001105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Background: Current evidence indicates that erectile dysfunction (ED) is an independent risk factor for future cardiovascular events. This study aimed to estimate the cost-effectiveness of screening and subsequent preventive treatment for cardiovascular risk factors among men newly diagnosed with ED from the Swiss healthcare system perspective. Methods: Based on known data on ED and cardiovascular disease (CVD) prevalence and incidence costs and effects of a screening intervention for cardiovascular risk including corresponding cardiovascular prevention in men with ED were calculated for the Swiss population over a period of 10 years. Results: Screening and cardiovascular prevention over a period of 10 years in Swiss men with ED of all seriousness degrees, moderate and severe ED only, or severe ED only can probably avoid 41,564, 35,627, or 21,206 acute CVD events, respectively. Number needed to screen (NNS) to prevent one acute CVD event is 30, 23, and 10, respectively. Costs for the screening intervention are expected to be covered at the seventh, the fifth, and the first year, respectively. Conclusion: Screening and intervention for cardiovascular risk factors in men suffering from ED is a cost-effective tool not only to strengthen prevention and early detection of cardiovascular diseases but also to avoid future cardiovascular events.
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Affiliation(s)
- Christoph Kalka
- Vascular Institute Central Switzerland, Aarau, Switzerland
- University of Cologne, Germany
| | - Hak-Hong Keo
- Vascular Institute Central Switzerland, Aarau, Switzerland
- Department of Angiology, University Hospital of Basel, Switzerland
| | - Maja Ingwersen
- Department of Radiology, Friedrich-Schiller-University, Jena University Hospital, Jena, Germany
| | - Jonas Knoechel
- Vascular Institute Central Switzerland, Aarau, Switzerland
| | - Hanno Hoppe
- University of Lucerne, Switzerland
- University of Bern, Switzerland
| | - Dai-Do Do
- Vascular Institute Central Switzerland, Aarau, Switzerland
- University of Bern, Switzerland
| | | | - Nicolas Diehm
- Vascular Institute Central Switzerland, Aarau, Switzerland
- University of Bern, Switzerland
- University of Applied Sciences Furtwangen, Villingen-Schwenningen, Germany
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Pang K, Pan D, Xu H, Ma Y, Wang J, Xu P, Wang H, Zang G. Advances in physical diagnosis and treatment of male erectile dysfunction. Front Physiol 2023; 13:1096741. [PMID: 36699684 PMCID: PMC9868413 DOI: 10.3389/fphys.2022.1096741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/28/2022] [Indexed: 01/10/2023] Open
Abstract
Erectile dysfunction (ED) is the most common male sexual dysfunction by far and the prevalence is increasing year after year. As technology advances, a wide range of physical diagnosis tools and therapeutic approaches have been developed for ED. At present, typical diagnostic devices include erection basic parameter measuring instrument, erection hardness quantitative analysis system, hemodynamic testing equipment, nocturnal erection measuring instrument, nerve conduction testing equipment, etc. At present, the most commonly used treatment for ED is pharmacological therapy represented by phosphodiesterase five inhibitors (PDE5i). As a first-line drug in clinical, PDE5i has outstanding clinical effects, but there are still some problems that deserve the attention of researchers, such as cost issues and some side effects, like visual disturbances, indigestion, myalgia, and back pain, as well as some non-response rates. Some patients have to consider alternative treatments. Moreover, the efficacy in some angiogenic EDs (diabetes and cardiovascular disease) has not met expectations, so there is still a need to continuously develop new methods that can improve hemodynamics. While drug have now been shown to be effective in treating ED, they only control symptoms and do not restore function in most cases. The increasing prevalence of ED also makes us more motivated to find safer, more effective, and simpler treatments. The exploration of relevant mechanisms can also serve as a springboard for the development of more clinically meaningful physiotherapy approaches. Therefore, people are currently devoted to studying the effects of physical therapy and physical therapy combined with drug therapy on ED. We reviewed the diagnosis of ED and related physical therapy methods, and explored the pathogenesis of ED. In our opinion, these treatment methods could help many ED patients recover fully or partially from ED within the next few decades.
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Affiliation(s)
- Kun Pang
- Department of Urology, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, The Affiliated Xuzhou Hospital of Medical College of Southeast University, The Affiliated Xuzhou Center Hospital of Nanjing University of Chinese Medicine, Xuzhou, Jiangsu, China
| | - Deng Pan
- Graduate School, Bengbu Medical College, Bengbu, Anhui, China
| | - Hao Xu
- Graduate School, Bengbu Medical College, Bengbu, Anhui, China
| | - Yuyang Ma
- Graduate School, Bengbu Medical College, Bengbu, Anhui, China
| | - Jingkai Wang
- Graduate School, Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Peng Xu
- Graduate School, Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Hailuo Wang
- Department of Urology, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, The Affiliated Xuzhou Hospital of Medical College of Southeast University, The Affiliated Xuzhou Center Hospital of Nanjing University of Chinese Medicine, Xuzhou, Jiangsu, China
| | - Guanghui Zang
- Department of Urology, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, The Affiliated Xuzhou Hospital of Medical College of Southeast University, The Affiliated Xuzhou Center Hospital of Nanjing University of Chinese Medicine, Xuzhou, Jiangsu, China,*Correspondence: Guanghui Zang,
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Yang H, Breyer BN, Rimm EB, Giovannucci E, Loeb S, Kenfield SA, Bauer SR. Plant-based diet index and erectile dysfunction in the Health Professionals Follow-Up Study. BJU Int 2022; 130:514-521. [PMID: 35484829 PMCID: PMC9474604 DOI: 10.1111/bju.15765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the longitudinal association between plant-based diet index (PDI) score and incident erectile dysfunction (ED). MATERIALS AND METHODS We conducted a prospective analysis of 21 942 men aged 40 to 75 years who were enrolled in the Health Professionals Follow-Up Study. ED was assessed with questionnaires every 4 years starting in 2000. Dietary data were collected via validated food frequency questionnaires completed every 4 years and were used to calculate total PDI scores, as well as healthy (hPDI) and unhealthy (uPDI) subscores. Multivariable Cox proportional hazards models were used to compute hazard ratios (HRs) for incident ED. All models were stratified by age (<60, 60 to <70, ≥70 years). RESULTS Among men aged 60 to <70 years, hPDI was inversely associated with incident ED. Those in the highest quintile of hPDI in that age group had an 18% lower risk of ED (HR 0.82, 95% confidence interval (CI) 0.73-0.91; P-trend <0.001) compared to those in the lowest quintile. Conversely, uPDI was positively associated with ED in men aged <60 years (HR 1.27, 95% CI 1.01-1.60; P-trend = 0.02). CONCLUSIONS Encouraging a healthy plant-based diet may be an environmentally sustainable intervention for men interested in maintaining erectile function.
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Affiliation(s)
| | | | - Eric B. Rimm
- Departments of Nutrition & Epidemiology, Harvard T.H. Chan School of Public Health
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital
| | - Edward Giovannucci
- Departments of Nutrition & Epidemiology, Harvard T.H. Chan School of Public Health
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital
| | - Stacy Loeb
- Department of Urology and Population Health, New York University and Manhattan Veterans Affairs
| | - Stacey A. Kenfield
- Department of Urology, UCSF
- Department of Epidemiology & Biostatistics, UCSF
| | - Scott R. Bauer
- Department of Urology, UCSF
- Division of General Internal Medicine, Department of Medicine, UCSF
- San Francisco Veterans Affairs Healthcare System
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Clephane K, O'Loughlin JI, Bodnar TS, Wilson MC, Stariha JT, Craig AN, Weinberg J, Brotto LA, Lorenz TK. Lack of Evidence for a Relationship Between Salivary CRP and Women's Sexual Desire: An Investigation Across Clinical and Healthy Samples. J Sex Med 2022; 19:745-760. [PMID: 35296386 PMCID: PMC9064911 DOI: 10.1016/j.jsxm.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/29/2022] [Accepted: 02/04/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Inflammation has been linked to a variety of mental and physical health outcomes that disproportionately impact women, and which can impair sexual function; thus, there is reason to expect a link between inflammation and women's sexual functioning. AIM To test the hypothesis that higher concentrations of C-reactive protein (CRP), a general biomarker of inflammation, would predict women's lower sexual desire. METHOD As 2 independent research teams, we conducted 3 separate studies (total n = 405) that assessed salivary CRP and various measurements of sexual desire in different women populations. OUTCOMES Female Sexual Function Index, Sexual Desire Inventory-2, Decreased Sexual Desire Screener, and Sexual Interest and Desire Inventory. RESULTS Regardless of the way sexual desire was measured (e.g., state vs trait; general desire vs. desire functioning) and the population sampled (i.e., healthy vs. clinically diagnosed with sexual dysfunction), all the studies revealed null results. CLINICAL IMPLICATIONS While exploratory, the convergence of these null results across studies and researchers suggests that if there is an association between inflammation and women's sexual desire, it is likely very subtle. STRENGTHS & LIMITATIONS Across 2 independent research teams, 3 unrelated studies, and various measurements of sexual desire, results were consistent. These points lend to the generalizability of the results. However, study designs were cross-sectional. CONCLUSIONS Future research may reveal (i) a non-linear threshold effect, such that inflammation does not begin to impact women's sexual desire until it is at a high level, (ii) inflammatory biomarkers other than CRP might be more sensitive in detecting associations between inflammation and desire, should they exist, or (iii) the mechanisms underlying sexual dysfunction may differ between sexes. Clephane K, et al. Lack of Evidence for a Relationship Between Salivary CRP and Women's Sexual Desire: An Investigation Across Clinical and Healthy Samples. J Sex Med 2022;19:745-760.
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Affiliation(s)
- Kirstin Clephane
- University of Nebraska - Lincoln, Center for Brain, Biology and Behavior, Lincoln, NE, USA; University of Nebraska - Lincoln, Psychology Department, Lincoln, NE, USA
| | - Julia I O'Loughlin
- University of British Columbia, Department of Educational and Counselling Psychology, and Special Education, Vancouver, British Columbia, CA, USA
| | - Tamara S Bodnar
- University of British Columbia, Department of Cellular and Physiological Sciences, Vancouver, British Columbia, CA, USA
| | - M Claire Wilson
- Indiana University, Department of Psychological and Brain Sciences, Bloomington, IN, USA
| | - Jordan Tb Stariha
- University of British Columbia, Department of Obstetrics and Gynecology, Vancouver, British Columbia, CA, USA
| | - Amber N Craig
- Medical College of Wisconsin, Department of Psychiatry and Behavioral Medicine, Milwaukee, WI, USA
| | - Joanne Weinberg
- University of British Columbia, Department of Cellular and Physiological Sciences, Vancouver, British Columbia, CA, USA
| | - Lori A Brotto
- University of British Columbia, Department of Obstetrics and Gynecology, Vancouver, British Columbia, CA, USA; University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, CA, USA
| | - Tierney K Lorenz
- University of Nebraska - Lincoln, Center for Brain, Biology and Behavior, Lincoln, NE, USA; University of Nebraska - Lincoln, Psychology Department, Lincoln, NE, USA.
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Dauti Isiklar A, Ocak Serin S. FASTING BLOOD GLUCOSE LEVEL IN PATIENTS PRESENTING WITH ERECTILE DYSFUNCTION. SANAMED 2021. [DOI: 10.24125/sanamed.v16i2.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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11
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Diaconu CC, Manea M, Marcu DR, Socea B, Spinu AD, Bratu OG. The erectile dysfunction as a marker of cardiovascular disease: a review. Acta Cardiol 2020; 75:286-292. [PMID: 30955454 DOI: 10.1080/00015385.2019.1590498] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Cardiovascular disease (CVD) and erectile dysfunction (ED) are two conditions that often coexist. Both diseases are consequences of the systemic vascular disease, sharing common risk factors, like diabetes mellitus, arterial hypertension, smoking, obesity, dyslipidaemia. Furthermore, they share the same pathological basis, endothelial dysfunction. Symptoms of ED precede with three to five years the clinical manifestations of CVD. This period may be a window of opportunity for the early initiation of a prompt therapeutic action for cardiovascular risk factors. This article reviews the incidence and prevalence of CVD and ED, the common risk factors, the pathophysiological link between the two diseases, and the current diagnosis and management strategies of patients with CVD and ED, in order to prevent myocardial infarction, stroke or heart failure.
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Affiliation(s)
- Camelia Cristina Diaconu
- Internal Medicine Clinic, University of Medicine and Pharmacy “Carol Davila”, Clinical Emergency Hospital of Bucharest, Bucharest, Romania
| | - Maria Manea
- Cardiology Clinic, Emergency University Central Military Hospital, Bucharest, Romania
| | - Dragos Radu Marcu
- Department of Urology, University of Medicine and Pharmacy “Carol Davila”, Emergency University Central Military Hospital, Bucharest, Romania
| | - Bogdan Socea
- General Surgery Clinic, University of Medicine and Pharmacy “Carol Davila”, Emergency Clinical Hospital “Sfântul Pantelimon”, Bucharest, Romania
| | - Arsenie Dan Spinu
- Department of Urology, University of Medicine and Pharmacy “Carol Davila”, Emergency University Central Military Hospital, Bucharest, Romania
| | - Ovidiu Gabriel Bratu
- Department of Urology, University of Medicine and Pharmacy “Carol Davila”, Emergency University Central Military Hospital, Bucharest, Romania
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Gonzaga NA, do Vale GT, da Silva CB, Pinheiro LC, Leite LN, Carneiro FS, Tanus-Santos JE, Tirapelli CR. Treatment with nitrite prevents reactive oxygen species generation in the corpora cavernosa and restores intracavernosal pressure in hypertensive rats. Nitric Oxide 2020; 94:19-26. [DOI: 10.1016/j.niox.2019.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/23/2019] [Accepted: 10/08/2019] [Indexed: 12/29/2022]
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13
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Assaly R, Gorny D, Compagnie S, Mayoux E, Bernabe J, Alexandre L, Giuliano F, Behr-Roussel D. The Favorable Effect of Empagliflozin on Erectile Function in an Experimental Model of Type 2 Diabetes. J Sex Med 2018; 15:1224-1234. [DOI: 10.1016/j.jsxm.2018.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/03/2018] [Accepted: 07/06/2018] [Indexed: 12/19/2022]
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Wang XY, Huang W, Zhang Y. Relation between hypertension and erectile dysfunction: a meta-analysisof cross-section studies. Int J Impot Res 2018; 30:141-146. [DOI: 10.1038/s41443-018-0020-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/27/2017] [Accepted: 07/14/2017] [Indexed: 02/02/2023]
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Nordin RB, Soni T, Kaur A, Loh KP, Miranda S. Prevalence and predictors of erectile dysfunction in adult male outpatient clinic attendees in Johor, Malaysia. Singapore Med J 2018; 60:40-47. [PMID: 29774359 DOI: 10.11622/smedj.2018049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) is a serious global burden that affects men as well as their partners. This study aimed to determine the prevalence and predictors of ED among male outpatient clinic attendees in Johor, Malaysia. METHODS We conducted a cross-sectional study of Malaysian men aged ≥ 18 years attending two major outpatient clinics in Johor Bahru and Segamat in Johor, Malaysia, between 1 January 2016 and 31 March 2016. Subjects were chosen via simple random sampling and 400 patients were recruited. The study instrument was a survey form that consisted of three sections: sociodemographic and comorbid profile, validated English and Malay versions of the 15-item International Index of Erectile Function, and the 21-item Depression Anxiety Stress Scale. RESULTS The overall prevalence of self-reported ED was 81.5%. The prevalence of ED according to severity was as follows: mild (17.0%), mild to moderate (23.8%), moderate (11.3%) and severe (29.5%). Multivariate analysis showed that ED was associated with increasing age (odds ratio [OR] 4.023, 95% confidence interval [CI] 1.633-9.913), Indian as compared to Malay ethnicity (OR 3.252, 95% CI 1.280-8.262), secondary as compared to tertiary education (OR 2.171, 95% CI 1.203-3.919), single as compared to married status (OR 6.119, 95% CI 2.542-14.734) and stress (OR 4.259, 95% CI 1.793-10.114). CONCLUSION ED has significant prevalence and severity among adult male outpatient clinic attendees in Johor. Increasing age, Indian ethnicity, lower educational level, singlehood and stress were significant predictors of ED.
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Affiliation(s)
- Rusli Bin Nordin
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
| | - Trived Soni
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
| | - Amrina Kaur
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
| | - Kean Por Loh
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
| | - Shashi Miranda
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
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Gao L, Zhao Z, Guo F, Liu Y, Guo J, Zhao Y, Wang Z. Association of endothelial nitric oxide synthase polymorphisms with an increased risk of erectile dysfunction. Asian J Androl 2018; 19:330-337. [PMID: 26908069 PMCID: PMC5427790 DOI: 10.4103/1008-682x.163300] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The purpose of our meta-analysis is to examine the associations between three single nucleotide polymorphisms of endothelial nitric oxide synthase (eNOS) gene, G894T, intron 4 and T-786C, and the risk of erectile dysfunction. An electronic database search was performed to identify case-control studies reporting the association between single nucleotide polymorphisms of eNOS gene and erectile dysfunction. Stringent inclusion and exclusion criteria were employed to select high-quality studies for this meta-analysis. Comprehensive Meta-analysis 2.0 software (Biostat Inc., Englewood, New Jersey, USA) was used for statistical analysis of the data extracted from the selected studies. From the initial 203 articles retrieved from database search, this meta-analysis finally selected 12 high-quality case-control studies that conformed to our inclusion criteria. The 12 studies contained a total of 1962 patients with erectile dysfunction and 1752 healthy controls. The results of our meta-analysis showed that G894T correlated with an increased risk erectile dysfunction under both the allele and dominant models (allele: OR = 1.556, 95% CI = 1.064–2.275, P = 0.023; dominant: OR = 1.613, 95% CI = 1.050–2.476, P = 0.029). A similar association was found between T-786C and erectile dysfunction under the allele model (OR = 1.679, 95% CI = 1.341–2.102, P < 0.001), but not under the dominant model (all P > 0.05). Our meta-analysis showed that the two single nucleotide polymorphisms in eNOS gene, G894T and T-786C, are strongly associated with the risk of erectile dysfunction.
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Affiliation(s)
- Lei Gao
- Department of Urinary Surgery, Linyi People's Hospital, Linyi 276000, China
| | - Zhifeng Zhao
- Department of Urinary Surgery, Linyi People's Hospital, Linyi 276000, China
| | - Fengfu Guo
- Department of Urinary Surgery, Linyi People's Hospital, Linyi 276000, China
| | - Yan Liu
- Department of Urinary Surgery, Linyi Cancer Hospital, Linyi 276000, China
| | - Jianhua Guo
- Department of Urology and Andrology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China.,Department of Urology, Shanghai Pudong Hospital, Fudan University Pudong Medical Centre, Shanghai 200011, China
| | - Yang Zhao
- Department of Urology and Andrology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Zhong Wang
- Department of Urology and Andrology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China
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17
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Hackett G, Kirby M. Erectile dysfunction and testosterone deficiency as cardiovascular risk factors? Int J Clin Pract 2018; 72. [PMID: 29381240 DOI: 10.1111/ijcp.13054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/14/2017] [Indexed: 12/18/2022] Open
Abstract
Graham Jackson introduced the concept that erectile dysfunction was a marker for undiagnosed cardiovascular disease and future events. Unfortunately this had had modest impact on CVD management as ED is not incorporated into current risk calculators. In this paper, we examine recent evidence as to whether ED should be upgraded to a risk factor, especially with the high predictive value in younger men. In the Princeton 3 guidelines, he recognised the important impact of testosterone deficiency (TD) on all-cause and cardiovascular mortality. Recent evidence suggests that testosterone therapy to target levels and for sufficient duration, reduces cardiovascular events. In this paper, we also produce a case for testosterone deficiency to be considered as an independent risk factor. The evidence for inclusion of both ED and TD may now be stronger than accepted risk factors and have the advantages of being easily assessed, being quantitative, symptomatic and clinically relevant, especially in younger men.
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Affiliation(s)
| | - Michael Kirby
- The Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
- The Prostate Centre, London, UK
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Hackett G. The Graham Jackson Memorial Lecture ISSM 2016—“The Man Who Knew Too Much”: Time to Recognize Erectile Dysfunction and Low Testosterone as Independent Risk Factors for Cardiovascular Disease. Sex Med Rev 2017; 5:256-265. [DOI: 10.1016/j.sxmr.2017.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/11/2017] [Accepted: 02/13/2017] [Indexed: 12/27/2022]
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Hackett G, Krychman M, Baldwin D, Bennett N, El-Zawahry A, Graziottin A, Lukasiewicz M, McVary K, Sato Y, Incrocci L. Coronary Heart Disease, Diabetes, and Sexuality in Men. J Sex Med 2017; 13:887-904. [PMID: 27215685 DOI: 10.1016/j.jsxm.2016.01.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 01/09/2016] [Accepted: 01/12/2016] [Indexed: 12/30/2022]
Abstract
Erectile dysfunction (ED) has been well recognized as a marker of increased cardiovascular risk for more than 15 years, especially in younger men. Early detection of ED represents an opportunity to intervene to decrease the risk of future cardiovascular events and limit the progression of ED severity. Evidence suggests there is a window of opportunity of 3 to 5 years from the onset of ED to subsequent cardiovascular events. This opportunity is usually missed if the onus is placed on the patient to seek care for his sexual problems. Unfortunately, these clear messages have not been incorporated into routine cardiovascular care. The reasons for these disparities within specialties are discussed in this article, in addition to management algorithms. Lifestyle modification is usually recommended as the first-line treatment to correct ED and lessen cardiovascular risk, but evidence suggests that this might be effective only in men without established cardiovascular comorbidities. In men with type 2 diabetes mellitus and established cardiovascular disease, lifestyle modification alone is unlikely to be effective. Cardiovascular medications are often associated with sexual dysfunction but changes in medication are more likely to be beneficial in men with milder recent-onset ED. A balanced view must be taken related to medication adverse events, taking into account optimal management of established cardiovascular disease. Testosterone deficiency has been associated with different metabolic disorders, especially metabolic syndrome and type 2 diabetes mellitus. Testosterone deficiency syndrome has been associated with an independent burden on sexual function globally and increased cardiovascular and all-cause mortality. Testosterone replacement therapy has been shown to improve multiple aspects of sexual function and, in some studies, has been associated with a decrease in mortality, especially in men with type 2 diabetes mellitus. Recent studies have suggested that phosphodiesterase type 5 inhibitors, the first-line medications to treat ED, could decrease cardiovascular and all-cause mortality, through multiple mechanisms, predominantly related to improved endothelial function.
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Affiliation(s)
| | - Michael Krychman
- Southern California Center for Sexual Health and Survivorship Medicine, Newport Beach, CA, USA
| | - David Baldwin
- Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Nelson Bennett
- Department of Urology, Lahey Hospital, Burlington, MA, USA
| | - Ahmed El-Zawahry
- Division of Urology, SIU School of Medicine, Springfield, IL, USA
| | | | | | - Kevin McVary
- Division of Urology, SIU School of Medicine, Springfield, IL, USA
| | - Yoshikazu Sato
- Department of Urology, Sanjukai Hospital, Sapporo, Japan
| | - Luca Incrocci
- Erasmus MC Cancer Institute, Department of Radiation Oncology, Rotterdam, The Netherlands
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20
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Abstract
Erectile dysfunction (ED) is one of the most common disorders in male and is often associated with other age-related comorbidities. The aging process affects the structural organization and function of penile erectile components such as smooth muscle cell and vascular architecture. These modifications affect penile hemodynamics by impairing cavernosal smooth muscle cell relaxation, reducing penile elasticity, compliance and promoting fibrosis. This review aims to identify the mechanisms of ED in the penile aging process in experimental and clinical data. It also highlights areas that are in need of more research. The search strategies yielded total records screened from PubMed. Clarification of the molecular mechanisms that accompanies corpus cavernosum aging and aging-associated ED will aid new perspectives in the development of novel mechanism-based therapeutic approaches. Age is not a limiting factor for ED medical management, and it is never too late to treat. Hypogonadism should be managed regardless of age, and synergistic effects have been found during testosterone (T) replacement therapy when used along with oral phosphodiesterase-5 (PDE-5) inhibitors. Therefore, the clinical management of ED related to aging can be done by therapeutic interventions that include PDE-5 inhibitors, and other pharmacological treatments.
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Affiliation(s)
- Ecem Kaya
- a Department of Biochemistry and Pharmacology , Faculty of Pharmacy, Ankara University , Ankara , Turkey and
| | - Suresh C Sikka
- b Department of Urology and Pharmacology , Tulane University Health Sciences Center , New Orleans , LA , USA
| | - Philip J Kadowitz
- b Department of Urology and Pharmacology , Tulane University Health Sciences Center , New Orleans , LA , USA
| | - Serap Gur
- a Department of Biochemistry and Pharmacology , Faculty of Pharmacy, Ankara University , Ankara , Turkey and
- b Department of Urology and Pharmacology , Tulane University Health Sciences Center , New Orleans , LA , USA
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22
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Compostella L, Compostella C, Truong LVS, Russo N, Setzu T, Iliceto S, Bellotto F. History of erectile dysfunction as a predictor of poor physical performance after an acute myocardial infarction. Eur J Prev Cardiol 2017; 24:460-467. [PMID: 28067536 DOI: 10.1177/2047487316686434] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Erectile dysfunction may predict future cardiovascular events and indicate the severity of coronary artery disease in middle-aged men. The aim of this study was to evaluate whether erectile dysfunction (expression of generalized macro- and micro-vascular pathology) could predict reduced effort tolerance in patients after an acute myocardial infarction. Patients and methods One hundred and thirty-nine male patients (60 ± 12 years old), admitted to intensive cardiac rehabilitation 13 days after a complicated acute myocardial infarction, were evaluated for history of erectile dysfunction using the International Index of Erectile Function questionnaire. Their physical performance was assessed by means of two six-minute walk tests (performed two weeks apart) and by a symptom limited cardiopulmonary exercise test (CPET). Results Patients with erectile dysfunction (57% of cases) demonstrated poorer physical performance, significantly correlated to the degree of erectile dysfunction. After cardiac rehabilitation, they walked shorter distances at the final six-minute walk test (490 ± 119 vs. 564 ± 94 m; p < 0.001); at CPET they sustained lower workload (79 ± 28 vs. 109 ± 34 W; p < 0.001) and reached lower oxygen uptake at peak effort (18 ± 5 vs. 21 ± 5 ml/kg per min; p = 0.003) and at anaerobic threshold (13 ± 3 vs.16 ± 4 ml/kg per min; p = 0.001). The positive predictive value of presence of erectile dysfunction was 0.71 for low peak oxygen uptake (<20 ml/kg per min) and 0.69 for reduced effort capacity (W-max <100 W). Conclusions As indicators of generalized underlying vascular pathology, presence and degree of erectile dysfunction may predict the severity of deterioration of effort tolerance in post-acute myocardial infarction patients. In the attempt to reduce the possibly associated long-term risk, an optimization of type, intensity and duration of cardiac rehabilitation should be considered.
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Affiliation(s)
- Leonida Compostella
- 1 Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo (BL), Italy.,2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Caterina Compostella
- 3 Department of Medicine, School of Emergency Medicine, University of Padua, Italy
| | - Li Van Stella Truong
- 1 Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo (BL), Italy
| | - Nicola Russo
- 1 Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo (BL), Italy.,2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Tiziana Setzu
- 1 Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo (BL), Italy
| | - Sabino Iliceto
- 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Fabio Bellotto
- 1 Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo (BL), Italy.,2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
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Kouidrat Y, Zaitouni A, Amad A, Diouf M, Desailloud R, Loas G, Lalau JD. Skin autofluorescence (a marker for advanced glycation end products) and erectile dysfunction in diabetes. J Diabetes Complications 2017; 31:108-113. [PMID: 27847146 DOI: 10.1016/j.jdiacomp.2016.10.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/11/2016] [Accepted: 10/26/2016] [Indexed: 11/19/2022]
Abstract
AIM Although diabetes-related erectile dysfunction (ED) has many etiological factors, little is known about the putative pathophysiological role of advanced glycation end products (AGEs). Skin autofluorescence is a noninvasive marker of AGEs. Recent studies have evidenced a relationship between skin autofluorescence and several complications of diabetes. We hypothesized that AGEs (assessed by skin autofluorescence) are associated with ED in diabetes patients. METHODS Between March 2014 and April 2015, 42 patients with type 1 diabetes (T1D) and 44 patients with type 2 diabetes (T2D) were consecutively enrolled in a descriptive, cross-sectional study and compared to 54 healthy controls. ED was evaluated via the 5-item version of the International Index of Erectile Function (IIEF-5). Skin autofluorescence was measured on the volar aspect of the arm with an AGE-Reader. RESULTS Patients with diabetes had a mean±standard deviation age of 50±15 and a mean duration of diabetes of 16±12years. Skin autofluorescence was strongly and significantly correlated with the IIEF-5 score in the T1D subgroup (r=-0.52; P=0.004), the T2D subgroup (r=-0.32; P<0.03) and in the whole group of diabetic patients (r=-0.49; P<0.0001). In multivariate analyses that controlled for potentially confounding clinical and biochemical factors, only skin autofluorescence was still significantly correlated with the IIEF-5 score (P<0.0001). A receiver operating characteristic analysis revealed that a skin autofluorescence value ≥3.2AU determined severe ED with a sensitivity of 60% and a specificity of 87% in diabetic patients. CONCLUSION Skin autofluorescence is significantly associated with ED in diabetes, independently of classical confounding factors.
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Affiliation(s)
- Youssef Kouidrat
- Department of Nutrition, AP-HP, Hôpital Maritime de Berck, F-62600 Berck, France; Department of Endocrinology-Nutrition, University of Picardie Jules Verne, F-80054 Amiens, France.
| | - Ahmad Zaitouni
- Department of Endocrinology-Nutrition, University of Picardie Jules Verne, F-80054 Amiens, France
| | - Ali Amad
- Department of Psychiatry, Univ. Lille, CNRS, CHU de Lille, UMR9193-PsychiC-SCALab, F-59000 Lille, France
| | - Momar Diouf
- Department of Endocrinology-Nutrition, University of Picardie Jules Verne, F-80054 Amiens, France
| | - Rachel Desailloud
- Department of Endocrinology-Nutrition, University of Picardie Jules Verne, F-80054 Amiens, France
| | - Gwenole Loas
- Department of Psychiatry, Erasme Hospital, ULB, B-1070 Brussels, Belgium
| | - Jean-Daniel Lalau
- Department of Endocrinology-Nutrition, University of Picardie Jules Verne, F-80054 Amiens, France
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Mulhall JP, Luo X, Zou KH, Stecher V, Galaznik A. Relationship between age and erectile dysfunction diagnosis or treatment using real-world observational data in the USA. Int J Clin Pract 2016; 70:1012-1018. [PMID: 28032424 PMCID: PMC5540144 DOI: 10.1111/ijcp.12908] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 10/07/2016] [Indexed: 01/05/2023] Open
Abstract
AIMS With self-reporting of erectile dysfunction (ED) in population-based surveys, men with ED may not represent men who are bothered sufficiently to seek an ED diagnosis and treatment. We used real-world observational data to assess: 1) the prevalence of ED diagnosis or treatment by age subgroups; and 2) the relationship of age with ED diagnosis or treatment after controlling for ED-related comorbidities in the USA. METHODS This cross-sectional study used de-identified claims data (MarketScan® databases; primary analysis). Sensitivity analysis was conducted using electronic health records (Humedica® database). Inclusion criteria were men aged ≥18 years with a 360-day continuous enrollment before the index date. We assessed the prevalence of ED diagnosis or phosphodiesterase type 5 inhibitor (PDE5I) prescription by age and the risk for ED diagnosis or treatment by age after controlling for comorbidities (hypertension, other cardiovascular disease, diabetes mellitus, depression and benign prostatic hyperplasia). RESULTS Of 19,833,939 men meeting inclusion criteria in the primary analysis, only 1 108 842 (5.6%) had an ED diagnosis or PDE5I prescription (mean [SD] age: 55.2 [11.2] years). Prevalence of ED diagnosis or treatment increased from age 18-29 years (0.4%) to 60-69 years (11.5%), then decreased in the seventh (11.0%), eighth (4.6%), and ninth (0.9%) decades. Men with ED diagnosis or treatment had a higher prevalence of any comorbidity (63.1% vs 29.3% for men without ED) and of each comorbid condition. In multivariate analyses, age was an independent risk factor for ED diagnosis or treatment. Sensitivity analysis provided consistent results. CONCLUSIONS In a real-world setting in the USA, the prevalence of ED diagnosis or PDE5I treatment is generally low, increases with age, decreases in very old men, and is associated with increased prevalence of comorbidities. Age is an independent risk factor for ED diagnosis or treatment after controlling for comorbidities.
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Affiliation(s)
- John P. Mulhall
- Memorial Sloan Kettering Cancer Center Urology Service, Department of Surgery, New York, NY, USA
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Dursun M, Besiroglu H, Otunctemur A, Ozbek E. Association between cardiometabolic index and erectile dysfunction: A new index for predicting cardiovascular disease. Kaohsiung J Med Sci 2016; 32:620-623. [PMID: 27914613 DOI: 10.1016/j.kjms.2016.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 10/03/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022] Open
Abstract
Over the past decade, it has been suggested that erectile dysfunction (ED) is an early indicator of cardiovascular disease. In a recent study, a new index, termed as cardiometabolic index (CMI), was defined and measured as the product of triglyceride (TG)/high-density lipoprotein-cholesterol (HDL-C) ratio and waist-to-height ratio, which are good predictors of coronary artery disease and main components of metabolic syndrome (MetS). All components of the CMI are also included in MetS criteria. Thus, we decided to evaluate the correlation between CMI, including the criteria of MetS, and ED. A total of 95 men with ED (ED group) and 82 healthy men (control group) were included in the study. Sexual functions were evaluated using the International Index of Erectile Function-5 items scale. CMI was measured as the product of waist-to-height ratio and TG/HDL-C ratio. Mean CMI level was 2.33±0.11 in the study group and 1.14±0.076 in the control group. CMI levels were significantly higher in the ED group (p<0.001). Because of the simplicity of measuring waist circumference, height measurement, and TG and HDL levels, CMI is an easily applicable index for evaluating cardiovascular dysfunction. ED is thought to be a precursor sign for vascular disease and a potential marker for atherosclerosis, endothelial dysfunction, and cardiovascular disease. In this context, CMI can be a useful index for the evaluation and calculation of ED risk, which was used for evaluation of cardiometabolic risk.
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Affiliation(s)
- Murat Dursun
- Department of Urology, Bahcelievler State Hospital, Istanbul, Turkey.
| | | | - Alper Otunctemur
- Department of Urology, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Emin Ozbek
- Department of Urology, Istanbul Training and Research Hospital, Istanbul, Turkey
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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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Vlachopoulos C, Ioakeimidis N, Stefanadis C. Biomarkers, erectile dysfunction, and cardiovascular risk prediction: the latest of an evolving concept. Asian J Androl 2016; 17:17-20. [PMID: 25412676 PMCID: PMC4291868 DOI: 10.4103/1008-682x.143250] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A number of circulating and imaging biomarkers are robustly associated with cardiovascular (CV) risk. The overall expectation from a biomarker in the erectile dysfunction (ED) setting is to enhance the optimal management of a man with this disorder but no clinical atherosclerosis. Evidence demonstrating that these biomarkers enhance risk prediction for individuals with ED is at this stage still limited for most of them. A better identification of the subsets of the ED population that require further risk stratification, as well as the initiation of randomized trials that will formally test the ability of biomarkers to predict CV risk, could make biomarker-guided prevention an attainable goal.
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Affiliation(s)
- Charalambos Vlachopoulos
- Department of Cardiology, Cardiovascular Diseases and Sexual Health Unit, Athens Medical School, Hippokration Hospital, Athens, Greece
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Abstract
Prescription sales of Testosterone and erectile aids such as phosphodiesterase-5 inhibitors are at an all-time high, underscoring the importance of hypogonadism (HG) and erectile dysfunction (ED) to men’s health. The effect of these debilitating conditions has a major impact on the quality of men’s lives. Some risk factors for HG or ED including aging, obesity, smoking, and a sedentary lifestyle. Notably, these are the same risk factors for several other medical co-morbidities that contribute to significant morbidity and mortality in men. HG and ED often co-exist with cardiovascular disease, diabetes, and osteoporosis. This review will explore these three co-morbidities that overlap with HG and ED, and will provide a review of their relationship with each other.
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Affiliation(s)
- Kelly A Chiles
- 1 Department of Urology, George Washington University, Washington, DC, USA ; 2 Weill Cornell Medical College, New York, NY, USA
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Affiliation(s)
- Amanda B Reed-Maldonado
- University of California San Francisco, 400 Parnassus Avenue, Suite A610, San Francisco, CA 94143, USA
| | - Tom F Lue
- University of California San Francisco, 400 Parnassus Avenue, Suite A610, San Francisco, CA 94143, USA
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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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Prevalence and risk factors for erectile dysfunction and lower urinary tract symptoms in Russian Federation men: analysis from a national population-based multicenter study. Int J Impot Res 2016; 28:74-9. [DOI: 10.1038/ijir.2016.8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 10/04/2015] [Accepted: 11/23/2015] [Indexed: 11/09/2022]
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Pastuszak AW, Hyman DA, Yadav N, Godoy G, Lipshultz LI, Araujo AB, Khera M. Erectile dysfunction as a marker for cardiovascular disease diagnosis and intervention: a cost analysis. J Sex Med 2015; 12:975-84. [PMID: 25728904 DOI: 10.1111/jsm.12848] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) is a risk factor for cardiovascular disease (CVD). We examine the costs of screening men with ED for CVD risk factors and the cost savings of treating these at risk men. AIM This study aims to evaluate the effect of screening men presenting with ED for CVD risk factors and to determine the cost effectiveness of this screening protocol. METHODS The known incidence and prevalence of ED and CVD, the rate of undiagnosed CVD, and the effects of CVD treatment were used to model the change in prevalence of acute CVD events and ED as a function of the number of men with ED and CVD. The cost savings associated with reduction in acute cardiovascular (CV) events and ED prevalence was estimated over 20 years. MAIN OUTCOME MEASURES Acute CVD event rate reduction and associated cost savings were modeled over 20 years. RESULTS The relative risk of ED in men with CVD is 1.47 and the coprevalence of both ED and CVD was estimated at 1,991,520 men. Approximately 44% of men with CVD risk factors are unaware of their risk. If all men presenting with ED were screened for CVD, 5.8 million men with previously unknown CVD risk factors would be identified over 20 years, costing $2.7 billion to screen. Assuming a 20% decrease in CV events as a result of screening and treatment, 1.1 million cardiovascular events would be avoided, saving $21.3 billion over 20 years. Similarly, 1.1 million cases of ED would be treated, saving $9.7 billion. Together, the reduction in acute CVD and ED treatment cost would save $28.5 billion over 20 years. CONCLUSIONS Screening for CVD in men presenting with ED can be a cost-effective intervention for secondary prevention of both CVD and, over the longer term, ED.
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Affiliation(s)
- Alexander W Pastuszak
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
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Kovac JR, Labbate C, Ramasamy R, Tang D, Lipshultz LI. Effects of cigarette smoking on erectile dysfunction. Andrologia 2014; 47:1087-92. [PMID: 25557907 DOI: 10.1111/and.12393] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2014] [Indexed: 11/27/2022] Open
Abstract
Cigarette smoking is a leading cause of preventable morbidity and mortality in the United States. Although public policies have resulted in a decreased number of new smokers, smoking rates remain stubbornly high in certain demographics with 20% of all American middle-aged men smoking. In addition to the well-established harmful effects of smoking (i.e. coronary artery disease and lung cancer), the past three decades have led to a compendium of evidence being compiled into the development of a relationship between cigarette smoking and erectile dysfunction. The main physiologic mechanism that appears to be affected includes the nitric oxide signal transduction pathway. This review details the recent literature linking cigarette smoking to erectile dysfunction, epidemiological associations, dose dependency and the effects of smoking cessation on improving erectile quality.
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Affiliation(s)
| | - C Labbate
- Department of Urology and The Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
| | - R Ramasamy
- Department of Urology and The Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
| | - D Tang
- Department of Urology and The Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
| | - L I Lipshultz
- Department of Urology and The Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
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Effects of Icariside II on corpus cavernosum and major pelvic ganglion neuropathy in streptozotocin-induced diabetic rats. Int J Mol Sci 2014; 15:23294-306. [PMID: 25517034 PMCID: PMC4284767 DOI: 10.3390/ijms151223294] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 11/28/2014] [Accepted: 12/04/2014] [Indexed: 02/07/2023] Open
Abstract
Diabetic erectile dysfunction is associated with penile dorsal nerve bundle neuropathy in the corpus cavernosum and the mechanism is not well understood. We investigated the neuropathy changes in the corpus cavernosum of rats with streptozotocin-induced diabetes and the effects of Icariside II (ICA II) on improving neuropathy. Thirty-six 8-week-old Sprague-Dawley rats were randomly distributed into normal control group, diabetic group and ICA-II treated group. Diabetes was induced by a one-time intraperitoneal injection of streptozotocin (60 mg/kg). Three days later, the diabetic rats were randomly divided into 2 groups including a saline treated placebo group and an ICA II-treated group (5 mg/kg/day, by intragastric administration daily). Twelve weeks later, erectile function was measured by cavernous nerve electrostimulation with real time intracorporal pressure assessment. The penis was harvested for the histological examination (immunofluorescence and immunohistochemical staining) and transmission electron microscopy detecting. Diabetic animals exhibited a decreased density of dorsal nerve bundle in penis. The neurofilament of the dorsal nerve bundle was fragmented in the diabetic rats. There was a decreased expression of nNOS and NGF in the diabetic group. The ICA II group had higher density of dorsal nerve bundle, higher expression of NGF and nNOS in the penis. The pathological change of major pelvic nerve ganglion (including the microstructure by transmission electron microscope and the neurite outgrowth length of major pelvic nerve ganglion tissue cultured in vitro) was greatly attenuated in the ICA II-treated group (p < 0.01). ICA II treatment attenuates the diabetes-related impairment of corpus cavernosum and major pelvic ganglion neuropathy in rats with Streptozotocin-Induced Diabetes.
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Martínez-Salamanca JI, La Fuente JM, Cardoso J, Fernández A, Cuevas P, Wright HM, Angulo J. Nebivolol potentiates the efficacy of PDE5 inhibitors to relax corpus cavernosum and penile arteries from diabetic patients by enhancing the NO/cGMP pathway. J Sex Med 2014; 11:1182-92. [PMID: 24877179 DOI: 10.1111/jsm.12477] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The efficacy of oral pharmacotherapy for erectile dysfunction (ED) (i.e., type 5 phosphodiesterase[PDE5] inhibitors) is significantly reduced in diabetic patients. Nebivolol is a selective β1-blocker used for treatinghy pertension that has been shown to increase the efficacy of sildenafil to reverse ED in diabetic rats. AIM To evaluate the effects of nebivolol on the efficacy of the PDE5 inhibitors, sildenafil, tadalafil, and vardenafil to relax human corpus cavernosum (HCC) and vasodilate human penile resistance arteries (HPRA) from diabetic patients with ED (DMED). The influence of nebivolol on the capacity of these three PDE5 inhibitors to stimulate cyclic guanosine monophosphate (cGMP) production in HCC was also evaluated. METHODS HCC and HPRA were obtained from organ donors without ED (NEND; n = 18) or patients with diabetes undergoing penile prosthesis implantation (DMED; n = 19). Relaxations of HCC strips and HPRA to sildenafil,tadalafil, and vardenafil were evaluated in organ chambers and wire myographs. cGMP content in HCC was determined by ether extraction and quantification by ELISA. MAIN OUTCOME MEASURES Effects of nebivolol on PDE5 inhibitor-induced relaxation of HCC, vasodilation ofHPRA and cGMP accumulation in HCC. RESULTS Treatment with nebivolol (1 μM) significantly potentiated sildenafil-, tadalafil- and vardenafil-induced relaxations of HCC and vasodilations of HPRA from both NEND and DMED. Enhancement of relaxant capacity by nebivolol resulted in reversion of the impairment of PDE5 inhibition-induced responses in DMED and it was accompanied by enhancing the ability of PDE5 inhibitors to increase cGMP in HCC restoring reduced cGMP levelsin HCC from DMED. CONCLUSIONS Nebivolol potentiated the capacity of PDE5 inhibitors to relax vascular structures of erectile tissue from diabetic patients by enhancing the nitric oxide (NO)/cGMP pathway in these tissues. These effects suggest a potential therapeutic utility of nebivolol as an adjunct to PDE5 inhibitors for the treatment of ED associated with diabetes.
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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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Jackson G. Erectile Dysfunction. Hypertension 2014; 64:463-4. [DOI: 10.1161/hypertensionaha.114.03505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vlachopoulos C, Ioakeimidis N, Stefanadis C. Determining the Prognostic Implications of Erectile Dysfunction for Future Cardiovascular Disease with Noninvasive Testing. CURRENT SEXUAL HEALTH REPORTS 2014. [DOI: 10.1007/s11930-014-0020-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Martin SA, Atlantis E, Lange K, Taylor AW, O'Loughlin P, Wittert GA. Predictors of sexual dysfunction incidence and remission in men. J Sex Med 2014; 11:1136-47. [PMID: 24548342 DOI: 10.1111/jsm.12483] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The progress and determinants of sexual dysfunction in middle-aged and elderly men remain unclear. AIM To describe the incidence or remission and biopsychosocial predictors of erectile dysfunction (ED) and low sexual desire (SD). MAIN OUTCOME MEASURES Erectile function (International Index of Erectile Function) and sexual desire (Sexual Desire Inventory 2) were assessed at follow-up. Sociodemographic, lifestyle, and health-related factors were examined in multivariate models of ED and low SD. METHODS Data were collected from 810 randomly selected men residing in northern and western Adelaide, Australia, and aged 35-80 years at baseline, who made clinic visits 5 years apart. RESULTS At baseline, 23.2% (n = 123) of men had ED. ED incidence and remission were observed in 31.7% (n = 179) and 29.0% (n = 71) of eligible men, respectively. At baseline, 19.2% (n = 165) had low solitary sexual desire, and 6.0% (n = 50) had low dyadic sexual desire; incidence of low sexual desire occurred in 17.6% (n = 83) (solitary) and 8.3% (n = 51) (dyadic), while remission occurred in 15.4% (n = 68) (solitary) and 22.6% (n = 40) (dyadic) of men. In the final regression models, predictors of incident ED were higher age, lower income, higher abdominal fat mass, low alcohol intake, higher risk of obstructive sleep apnea (OSA) risk, voiding lower urinary tract symptoms (LUTS), depression, and diabetes. Predictors of ED remission were lower age, current employment, and absence of voiding LUTS, angina, diabetes, and dyslipidemia. Predictors of low dyadic SD incidence included higher age, never having been married, widowhood, being unemployed, being retired, insufficient physical activity, and low alcohol intake. Predictors of low dyadic SD remission were being married, not being widowed, higher income, lower abdominal fat mass, lower OSA risk, and higher plasma testosterone. Predictors of low solitary SD included never having been married, being unemployed, low alcohol intake, lower testosterone, storage LUTS, and hypertension. Predictors of low solitary SD remission were being married, being employed, higher income, higher physical activity, moderate alcohol intake, and depression. CONCLUSIONS Sexual dysfunction in aging men is a dynamic disorder whose incidence and remission are predicted by a range of modifiable risk factors.
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Affiliation(s)
- Sean A Martin
- Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia, Australia; Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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Vlachopoulos C, Ioakeimidis N, Miner M, Aggelis A, Pietri P, Terentes-Printzios D, Tsekoura D, Stefanadis C. Testosterone deficiency: a determinant of aortic stiffness in men. Atherosclerosis 2014; 233:278-83. [PMID: 24529157 DOI: 10.1016/j.atherosclerosis.2013.12.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 12/14/2013] [Accepted: 12/16/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Low testosterone levels and increased aortic stiffness are predictors of cardiovascular events. The influence of androgen level on the age- and blood pressure-related increase in aortic stiffness is unknown. METHODS From January 2007 to June 2011 we enrolled 455 consecutive men with no evidence of cardiovascular disease from a large cohort followed in our Department for arterial function studies. Their total testosterone (TT) levels were measured and carotid-femoral pulse wave velocity (PWVc-f) was measured as an index of aortic stiffness. RESULTS In multivariable analysis, PWVc-f values were inversely correlated to TT after adjustment for confounders (β = -0.365, P < 0.001). In younger age categories (<50 yrs and 50-59 yrs), patients with testosterone deficiency (TD) had higher blood pressure-adjusted PWVc-f (P < 0.001 and P = 0.005, respectively) compared to subjects with normal TT, indicating an "aging effect" of 10 years, whereas in older age categories such a difference was not observed. Furthermore, in men with a higher mean pressure (102-108 mmHg and >108 mmHg), patients with TD had higher age-adjusted PWVc-f (P < 0.001) compared to subjects with normal TT, indicating a synergistic unfavorable effect of testosterone deficiency and blood pressure on aortic stiffness. CONCLUSIONS TT levels are independently associated with aortic stiffening. The effect of low testosterone concentration on aortic stiffness is more prominent in young men and in subjects with higher blood pressure levels. These findings identify testosterone as a marker of arterial damage with special emphasis on young and hypertensive individuals and support its role as predictor of events.
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Affiliation(s)
- Charalambos Vlachopoulos
- Peripheral Vessels and Hypertension Unit, 1st Department of Cardiology, Hippokration Hospital, Athens Medical School, Greece.
| | - Nikolaos Ioakeimidis
- Peripheral Vessels and Hypertension Unit, 1st Department of Cardiology, Hippokration Hospital, Athens Medical School, Greece
| | - Martin Miner
- Men's Health Center, Chief of Family and Community Medicine, Miriam Hospital, 164 Summit Avenue, Providence, RI 02906, USA
| | - Athanassios Aggelis
- Peripheral Vessels and Hypertension Unit, 1st Department of Cardiology, Hippokration Hospital, Athens Medical School, Greece
| | - Panagiota Pietri
- Peripheral Vessels and Hypertension Unit, 1st Department of Cardiology, Hippokration Hospital, Athens Medical School, Greece
| | - Dimitrios Terentes-Printzios
- Peripheral Vessels and Hypertension Unit, 1st Department of Cardiology, Hippokration Hospital, Athens Medical School, Greece
| | - Dorothea Tsekoura
- Peripheral Vessels and Hypertension Unit, 1st Department of Cardiology, Hippokration Hospital, Athens Medical School, Greece
| | - Christodoulos Stefanadis
- Peripheral Vessels and Hypertension Unit, 1st Department of Cardiology, Hippokration Hospital, Athens Medical School, Greece
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Bouwman II, Kollen BJ, van der Meer K, Nijman RJM, van der Heide WK. Are lower urinary tract symptoms in men associated with cardiovascular diseases in a primary care population: a registry study. BMC FAMILY PRACTICE 2014; 15:9. [PMID: 24422708 PMCID: PMC3898227 DOI: 10.1186/1471-2296-15-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 01/03/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although lower urinary tract symptoms (LUTS) seem to be related to cardiovascular disease (CVD) in men, it is unclear whether this relationship is unbiased. In order to investigate this relationship, we used longitudinal data for establishing the possible predictive value of LUTS for the development of CVD in a primary care population. METHODS We performed a registry study using data from the Registration Network Groningen (RNG). All data from men aged 50 years and older during the study period from 1 January 1998 up to 31 December 2008 were collected. Cox proportional hazard regression analysis was used to determine the association between the proportions of CVD (outcome) and LUTS in our population. RESULTS Data from 6614 men were analysed. The prevalence of LUTS increased from 92/1000 personyears (py) in 1998 up to 183/1000 py in 2008. For cardiovascular diseases the prevalence increased from 176/1000 py in 1998 up to 340/1000 py in 2008. The incidence numbers were resp. 10.2/1000 py (1998) and 5.1/1000 py (2008) for LUTS, and 12.9/1000 py (1998) and 10.4/1000 py (2008) for CVD. Of all men, 23.2% reported CVD (41.1% in men with LUTS vs 19.5% in men without LUTS, p < 0.01). The hazard ratio of LUTS for cardiovascular events, compared to no LUTS, in the adjusted multivariate model, was 0.921(95% CI: 0.824 - 1.030; p = 0.150). CONCLUSION Based on the results, LUTS is not a factor that must be taken into account for the early detection of CVD in primary care.
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Affiliation(s)
- Inge I Bouwman
- Department of general practice, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, Groningen, AV 9713, Netherlands
| | - Boudewijn J Kollen
- Department of general practice, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, Groningen, AV 9713, Netherlands
| | - Klaas van der Meer
- Department of general practice, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, Groningen, AV 9713, Netherlands
| | - Rien JM Nijman
- Department of urology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, GZ 9713, Netherlands
| | - Wouter K van der Heide
- Department of general practice, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, Groningen, AV 9713, Netherlands
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Hatzimouratidis K, Hatzichristou D. How to treat erectile dysfunction in men with diabetes: from pathophysiology to treatment. Curr Diab Rep 2014; 14:545. [PMID: 25193347 DOI: 10.1007/s11892-014-0545-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Erectile dysfunction (ED) is highly prevalent affecting at least 50 % of men with diabetes mellitus (DM). DM may cause ED through a number of pathophysiological pathways. These include neuropathy, endothelial dysfunction, cavernosal smooth muscle structural/functional changes, and hormonal changes. Lifestyle changes, diabetes control, and treatment of hypogonadism are important as the first step in ED management since there is no curative treatment for ED. Phosphodiesterase type 5 inhibitors (PDE5i) are the first-line treatment option. Intracavernous administration of vasoactive drugs is commonly used as a second-line medical treatment when PDE5i have failed. Alprostadil is the most widely used drug in this second-line setting. The combination of papaverine, phentolamine, and alprostadil represents the most efficacious intracavernous pharmacologic treatment option that may save non-responders to alprostadil. Penile prosthesis implantation can be considered in treatment refractory cases, with excellent functional and safety results in the properly informed patients.
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Ioakeimidis N, Kostis JB. Pharmacologic therapy for erectile dysfunction and its interaction with the cardiovascular system. J Cardiovasc Pharmacol Ther 2013; 19:53-64. [PMID: 24281316 DOI: 10.1177/1074248413504034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Phosphodiesterase (PDE) enzymes are widely distributed throughout the body, having numerous effects and functions. The PDE type 5 (PDE5) inhibitors are widely used to treat erectile dysfunction (ED). Recent, intense preclinical and clinical research with PDE5 inhibitors has shed light on new mechanisms and has revealed a number of pleiotropic effects on the cardiovascular (CV) system. To date, PDE5 inhibition has been shown to be effective for the treatment of idiopathic pulmonary arterial hypertension, and both sildenafil and tadalafil are approved for this indication. However, current or future PDE5 inhibitors have the potential of becoming clinically useful in a variety of CV conditions such as heart failure, coronary artery disease, and hypertension. The present review discusses recent findings regarding pharmacologic treatment of ED and its interaction with the CV system and highlights current and future clinical applications beyond ED.
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Affiliation(s)
- Nikolaos Ioakeimidis
- 1First Department of Cardiology, Cardiovascular Diseases and Sexual Health Unit, Athens Medical School, Hippokration Hospital, Athens, Greece
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Jackson G. Erectile dysfunction and asymptomatic coronary artery disease: frequently detected by computed tomography coronary angiography but not by exercise electrocardiography. Int J Clin Pract 2013; 67:1159-62. [PMID: 23981083 DOI: 10.1111/ijcp.12275] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 07/22/2013] [Accepted: 08/01/2013] [Indexed: 11/30/2022] Open
Abstract
AIMS Erectile dysfunction (ED) and vascular disease, in particular coronary artery disease (CAD), have the common denominator of endothelial dysfunction. ED frequently precedes a CAD event by between 2 and 5 years (average 3 years). ED also predicts an acute coronary syndrome as well as increased mortality, suggesting the rupture of an asymptomatic coronary plaque. This study compares multi-detector cardiac computed tomography (MDCT) with maximal treadmill exercising in men with ED and no coronary symptoms as a means of detecting coronary lesions. METHODS Sixty-five men with organic ED and no cardiac symptoms were prospectively screened for CAD. All underwent maximal exercise testing and MDCT in the same 7-day period. The Sexual Health Inventory for Men questionnaire established the presence of ED. FINDINGS The exercise ECG was borderline abnormal in three men and normal in 62. CT calcium was present in 53 (score 5-1671) and non-calcified plaque in seven. The MDCT angiogram was normal in only 5 (3.25%). CONCLUSION Erectile dysfunction may predict CAD in the absence of cardiac symptoms. MDCT detects subclinical plaque which may be vulnerable to rupture and which is not flow limiting enough to influence the exercise ECG. The window of 2-5 years between ED and a CAD event offers an opportunity for aggressive risk factor reduction. ED should be a routine question in any risk calculator.
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Affiliation(s)
- G Jackson
- London Bridge Hospital, London, UK; Guy's and St Thomas' Hospitals NHS Trust, London, UK
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Matos G, Hirotsu C, Alvarenga TA, Cintra F, Bittencourt L, Tufik S, Andersen ML. The association between TNF-α and erectile dysfunction complaints. Andrology 2013; 1:872-8. [DOI: 10.1111/j.2047-2927.2013.00136.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 08/07/2013] [Accepted: 08/29/2013] [Indexed: 01/10/2023]
Affiliation(s)
- G. Matos
- Departamento de Psicobiologia; Universidade Federal de São Paulo; São Paulo Brazil
| | - C. Hirotsu
- Departamento de Psicobiologia; Universidade Federal de São Paulo; São Paulo Brazil
| | - T. A. Alvarenga
- Departamento de Psicobiologia; Universidade Federal de São Paulo; São Paulo Brazil
| | - F. Cintra
- Departamento de Psicobiologia; Universidade Federal de São Paulo; São Paulo Brazil
| | - L. Bittencourt
- Departamento de Psicobiologia; Universidade Federal de São Paulo; São Paulo Brazil
| | - S. Tufik
- Departamento de Psicobiologia; Universidade Federal de São Paulo; São Paulo Brazil
| | - M. L. Andersen
- Departamento de Psicobiologia; Universidade Federal de São Paulo; São Paulo Brazil
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Turek SJ, Hastings SM, Sun JK, King GL, Keenan HA. Sexual dysfunction as a marker of cardiovascular disease in males with 50 or more years of type 1 diabetes. Diabetes Care 2013; 36:3222-6. [PMID: 23780949 PMCID: PMC3781490 DOI: 10.2337/dc13-0294] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Vascular dysfunction is a major contributor to diabetes complications. It is also the primary physiologic cause of erectile dysfunction and considered an independent predictor of cardiovascular disease (CVD) in males over age 40 years. A cohort of individuals with 50 or more years of type 1 diabetes, Joslin Medalists, have low rates of small but not large vessel complications. This study aims to identify the prevalence and longitudinal association of sexual dysfunction (SD) with CVD in Joslin Medalists. RESEARCH DESIGN AND METHODS Description and association of self-assessment of SD in males of the Medalist cohort by self-reported sexual problems with CVD. SD is validated through the use of the abbreviated International Index of Erectile Dysfunction (IIEF). RESULTS Of 301 males in the Medalist Study, 69.8% reported a history of SD. Unadjusted risk factors included elevated glycated hemoglobin (HbA1c) (P=0.02), elevated BMI (P=0.03), higher total cholesterol (P=0.02), lower HDL (P<0.01), and increased levels of interleukin-6 (P=0.03). SD was independently associated with CVD (age-, HbA1c-, and BMI-adjusted OR 1.9 [95% CI 1.0-3.5]). In adjusted analyses, retinal, neural, and renal complications were not associated (P>0.05) with SD. Current report of SD (IIEF score≤17) in a subset of Medalists was significantly correlated with self-reported longitudinal SD. CONCLUSIONS SD in those with extreme-duration type 1 diabetes is independently associated with CVD, representing a large-vessel pattern. The findings suggest that SD may predict CVD in those with type 1 diabetes of long duration. These individuals have also been found to be relatively free of microvascular complications.
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Salonia A, Capogrosso P, Clementi MC, Castagna G, Damiano R, Montorsi F. Is erectile dysfunction a reliable indicator of general health status in men? Arab J Urol 2013; 11:203-11. [PMID: 26558083 PMCID: PMC4443011 DOI: 10.1016/j.aju.2013.07.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 07/25/2013] [Indexed: 12/19/2022] Open
Abstract
Introduction Erectile dysfunction (ED) is a common risk factor in men and its incidence increases with age. Ageing and older men frequently have comorbidities such as cardiovascular diseases (CVD), diabetes mellitus (DM), hypertension, chronic obstructive pulmonary disease and dyslipidaemia; likewise, they concurrently refer to a clinician for impairments in sexual function, mostly for ED. The association of ED and other organic, multi-organic or even systemic diseases is widely described, with a specific emphasis on the fact that they often share common pathophysiological factors and mechanisms. Thus we reviewed previous reports assessing the role of ED as a sentinel marker of overall men’s health. Discussion ED is considered an important sentinel marker for CVD. Numerous studies have highlighted the predictive role of ED for subsequent CV events in patients with a silent history of coronary artery disease. Indeed, ED might be considered as a clinical manifestation of a generalised vascular disease, and it should provoke clinicians to check for CVDs in those patients complaining of impaired erectile function. This concept appears to be even more important for men with DM, where ED has already been shown to have a significant predictive ability for major vascular complications. Moreover, data from large population-based studies showed that ED is a significant predictor of all-cause mortality, in addition to CV outcomes. The severity of erectile function is assessed with the International Index of Erectile Function-Erectile Function domain score, and this has emerged as a proxy for men’s general health status, as assessed with the Charlson Comorbidity Index score. Conclusions Patients complaining of ED should be evaluated with a comprehensive medical and sexual history, and a thorough physical examination, regardless of their age, considering ED as an opportunity to screen for the presence of health-threatening concomitant comorbidities.
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Key Words
- CAD, coronary artery disease
- CCI, Charlson Comorbidity Index
- CHD, coronary heart disease
- COPD, chronic obstructive pulmonary disease
- CVD, cardiovascular disease
- Clinical practice
- Comorbidities
- DM, diabetes mellitus
- ED, erectile dysfunction
- EF, erectile function
- Erectile dysfunction
- HF, heart failure
- Health status
- IIEF, International Index of Erectile Function
- International Index of Erectile Function
- MMAS, Massachusetts Male Aging Study
- MeS, metabolic syndrome
- QoL, quality of life
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Affiliation(s)
- Andrea Salonia
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy
| | - Paolo Capogrosso
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
| | | | - Giulia Castagna
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
| | - Rocco Damiano
- Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy
| | - Francesco Montorsi
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
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Rajfer J, Miner MM. Hypertension: The Link Between Erectile Dysfunction and Coronary Artery Disease. JOURNAL OF MEN'S HEALTH 2013. [DOI: 10.1089/jomh.2013.1503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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50
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Corona G, Maggi M. Conventional and unconventional cardiovascular risk factors in men with erectile dysfunction. J Sex Med 2013; 10:305-8. [PMID: 23350612 DOI: 10.1111/jsm.12075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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