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Chen G, Huang L, Lai M, Ran J. Association between erectile dysfunction and the prevalence and prognosis of hyperglycemia in adults in the USA based on NHANES 2001-2004. Sci Rep 2024; 14:17663. [PMID: 39085319 PMCID: PMC11291728 DOI: 10.1038/s41598-024-68208-x] [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: 02/02/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
Prior research has demonstrated that erectile dysfunction (ED) is a significant risk factor for cardiovascular disease (CVD) and premature mortality. Few studies have examined the link between ED and hyperglycemia, and the predictive power of ED for mortality in individuals with hyperglycemia. A cohort of 1584 adults diagnosed with hyperglycemia, consisting of 583 individuals with diabetes and 1001 individuals with prediabetes, was selected from the National Health and Nutrition Examination Survey (NHANES) conducted between 2001 and 2004. The study found a positive correlation between severe ED and hyperglycemia (OR, 2.03; 95% CI 1.53-2.68), while no significant relationship was observed between severe ED and CVD events (OR, 1.60; 95% CI 0.91-2.80). Additionally, no statistical association was found between diabetes or prediabetes status and ED. After multivariable adjustments, severe ED was found to be significantly associated with an increased risk of all-cause mortality (HR, 1.67; 95% CI 1.16-2.39), while no significant association was observed between severe ED and CVD mortality (HR, 1.92; 95% CI 0.92-3.98). Our study indicates a significant correlation between ED and hyperglycemia status. Hyperglycemia Individuals with ED generally exhibited an unfavorable prognosis for mortality due to all causes and CVD, particularly among those with low levels of physical activity.
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Affiliation(s)
- Guangshu Chen
- Department of Endocrinology and Metabolism, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China
| | - Lehua Huang
- Department of Endocrinology and Metabolism, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China
| | - Meizheng Lai
- Department of Endocrinology and Metabolism, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China
| | - Jianmin Ran
- Department of Endocrinology and Metabolism, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China.
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2
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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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3
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Fujita N, Momota M, Ozaki Y, Tobisawa Y, Yoneyama T, Okamoto T, Yamamoto H, Hatakeyama S, Yoneyama T, Hashimoto Y, Yoshikawa K, Ohyama C. Can Erectile Dysfunction Severity Predict Major Adverse Cardiovascular Events in Men Undergoing Dialysis? A Prospective Cohort Study. World J Mens Health 2023; 41:900-908. [PMID: 36792087 PMCID: PMC10523112 DOI: 10.5534/wjmh.220179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/08/2022] [Accepted: 10/24/2022] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To evaluate the impact of severe erectile dysfunction (ED) on future major adverse cardiovascular events (MACE) in men on dialysis. MATERIALS AND METHODS This prospective cohort study included 71 men on dialysis. ED was assessed using the Sexual Health Inventory for Men (SHIM). Men were divided into the mild/moderate ED (SHIM score ≥8) and severe ED (SHIM score ≤7) groups. The primary endpoint was MACE-free survival. MACE was a composite of myocardial infarction, cardiovascular death, and stroke. The secondary endpoints were cardiac event-free survival and overall survival (OS). Moreover, the predictive abilities of severe ED for 5-year MACE, 5-year cardiac events, and 5-year overall mortality were evaluated. RESULTS The median age and follow-up period of the included men were 64 years and 58 months, respectively. The median SHIM score was 4.0; all had a degree of ED, and 64.7% had severe ED. In the background-adjusted multivariable analyses, severe ED was not significantly associated with shorter MACE-free survival (hazard ratio [HR], 1.890; 95% confidence interval [CI], 0.533-6.706; p=0.324), cardiac event-free survival (HR, 2.081; 95% CI, 0.687-6.304; p=0.195), and OS (HR, 0.817; 95% CI, 0.358-1.863; p=0.630). Severe ED did not significantly improve the predictive abilities for 5-year MACE, 5-year cardiac events, and 5-year overall mortality (p=0.110, p=0.101, and p=0.740, respectively). CONCLUSIONS ED severity was not associated with shorter MACE-free survival, cardiac event-free survival, or OS, and ED severity could not improve the predictive abilities for these outcomes in men undergoing dialysis.
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Affiliation(s)
- Naoki Fujita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Masaki Momota
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yusuke Ozaki
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuki Tobisawa
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tohru Yoneyama
- Department of Glycotechnology, Center for Advanced Medical Research, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Teppei Okamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Liu G, Zhang Y, Zhang W, Wu X, Jiang H, Huang H, Zhang X. Novel predictive risk factor for erectile dysfunction: Serum high-sensitivity C-reactive protein. Andrology 2022; 10:1096-1106. [PMID: 35713296 DOI: 10.1111/andr.13206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/23/2022] [Accepted: 06/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND C-reactive protein (CRP), as a marker of inflammation, may be closely related to erectile dysfunction (ED), however, there is no meta-analysis exists for it. OBJECTIVES We aimed to verify the relationship between CRP and erectile dysfunction and to explore the changes of CRP levels in ED patients after first-line treatment. MATERIALS AND METHODS We searched databases including the Cochrane Library, PubMed, and MEDLINE to identify studies up to January 1, 2022. We performed a comprehensive analysis of the included studies by STATA software and calculated standardized mean differences (SMDs) and their corresponding 95% confidence intervals. RESULTS A total of 12 studies were included and the analysis showed that CRP levels were higher significantly in patients with erectile dysfunction than the healthy controls (P < 0.001) and decreased by a mean of 0.38 mg/L after first-line PDE5i drug treatment (P = 0.001). DISCUSSION AND CONCLUSION This novel meta-analysis suggests that CRP is statistically significantly associated with erectile dysfunction and may be a predictor or risk factor for the assessment of ED. However, further original studies with large sample sizes are needed to validate this. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Guodong Liu
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Anhui province, China.,Institute of Urology, the First Affiliated Hospital of Anhui Medical University, Anhui province, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Anhui province, China
| | - Yuyang Zhang
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Anhui province, China.,Institute of Urology, the First Affiliated Hospital of Anhui Medical University, Anhui province, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Anhui province, China
| | - Wei Zhang
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Anhui province, China.,Institute of Urology, the First Affiliated Hospital of Anhui Medical University, Anhui province, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Anhui province, China
| | - Xu Wu
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Anhui province, China.,Institute of Urology, the First Affiliated Hospital of Anhui Medical University, Anhui province, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Anhui province, China
| | - Hui Jiang
- The department of Urology, Peking University Third Hospital, Beijing, China
| | - Houbao Huang
- Department of Urology, The First Affiliated Hospital of Wannan Medical College, Anhui province, China
| | - Xiansheng Zhang
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Anhui province, China.,Institute of Urology, the First Affiliated Hospital of Anhui Medical University, Anhui province, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Anhui province, China
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5
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Juang SE, Ma KSK, Kao PE, Wei JCC, Yip HT, Chou MC, Hung YM, Chin NC. Human Papillomavirus Infection and the Risk of Erectile Dysfunction: A Nationwide Population-Based Matched Cohort Study. J Pers Med 2022; 12:699. [PMID: 35629123 PMCID: PMC9145882 DOI: 10.3390/jpm12050699] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/30/2022] [Accepted: 04/18/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Male patients with genital warts are known for higher rates of sexual dysfunction. This study was conducted to investigate whether human papillomaviruses (HPV) infection is associated with an increased risk of erectile dysfunction (ED). METHODS Patients aged over 18 with HPV infection (n = 13,296) and propensity score-matched controls (n = 53,184) were recruited from the Longitudinal Health Insurance Database (LHID). The primary endpoint was the diagnosis of ED. Chi-square tests were used to analyze the distribution of demographic characteristics. The Cox proportional hazards regression was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the development of ED in both groups, after adjusting for sex, age, relevant comorbidities, co-medication, and surgery. RESULTS ED developed in 181 patients of the study group. The incidence density of ED was 2.53 per 1000 person-years for the HPV group and 1.51 per 1000 person-years for the non-HPV group, with an adjusted HR (95% CI) of 1.63 (1.37-1.94). In stratification analysis, adjusted HR of diabetes-, chronic obstructive pulmonary disease (COPD-), and stroke-subgroup were 2.39, 2.51, and 4.82, with significant p values for interaction, respectively. Sensitivity analysis yields consistent findings. CONCLUSIONS The patients with HPV infection had a higher risk of subsequent ED in comparison to the non-HPV controls. The mechanism behind such association and its possible role in ED prevention deserves further study in the future.
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Affiliation(s)
- Sin-Ei Juang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan;
| | - Kevin Sheng-Kai Ma
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115-5810, USA
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei 11114, Taiwan
| | - Pei-En Kao
- School of Medicine, Chung Shan Medical University, Taichung 40402, Taiwan;
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung 40402, Taiwan;
- Graduate Institute of Integrated Medicine, China Medical University, Taichung 40402, Taiwan
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University, Taichung 40402, Taiwan
| | - Hei-Tung Yip
- Department of Management office for Health Data, China Medical University Hospital, Taichung 40402, Taiwan;
- College of Medicine, China Medical University, Taichung 40402, Taiwan
- Institute of Public Health (Biostatistics), National Yangming University, Taipei 112304, Taiwan
| | - Mei-Chia Chou
- Department of Recreation and Sports Management, Tajen University, Pingtung County 907101, Taiwan;
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Pingtung Branch, Pingtung County 907101, Taiwan
| | - Yao-Min Hung
- Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung 813414, Taiwan
- Shu-Zen Junior College of Medicine and Management, Kaohsiung 813414, Taiwan
| | - Ning-Chien Chin
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40402, Taiwan
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6
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Abstract
The science of penile erection, including recent advances in its molecular physiology and neuroanatomic pathways, is described. The pathophysiology of erectile dysfunction is presented, acknowledging associated disease states, and accordingly follows a practical classification scheme: vasculogenic, neurogenic, endocrine, and psychogenic.
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Affiliation(s)
- Susan M MacDonald
- Division of Urology, Penn State Health Milton S. Hershey Medical Center, Mail Code H055, 500 University Drive, Hershey, PA 17033, USA.
| | - Arthur L Burnett
- James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, 600 North Wolfe Street, Marburg 407, Baltimore, MD 21287, USA
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Alwani M, Yassin A, Talib R, Al-Qudimat A, Aboumarzouk O, Al-Zoubi RM, Saad F, Haider KS, Al Ansari A. Cardiovascular Disease, Hypogonadism and Erectile Dysfunction: Early Detection, Prevention and the Positive Effects of Long-Term Testosterone Treatment: Prospective Observational, Real-Life Data. Vasc Health Risk Manag 2021; 17:497-508. [PMID: 34465997 PMCID: PMC8403087 DOI: 10.2147/vhrm.s309714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/30/2021] [Indexed: 12/22/2022] Open
Abstract
Purpose Erectile dysfunction (ED) is associated with testosterone deficiency and is a symptom of functional hypogonadism. A correlation between ED and cardiovascular disease (CVD) has been recognized, and ED has been proposed as an early marker of CVD. However, the relationship between ED and CVD risk in hypogonadism requires clarification and whether testosterone therapy (TTh) can be a beneficial treatment strategy, but long-term data are limited. This study investigates long-term TTh in men with hypogonadism and ED with a history of CVD. Methods Seventy-seven patients with a history of CVD and diagnosed with functional hypogonadism and erectile dysfunction (erectile function domain score <21 on the International Index of Erectile Function questionnaire (IIEF questions 1–5)) were enrolled and TTh effects on anthropometric and metabolic parameters investigated for a maximum duration of 12 years. All men received long-acting injections of testosterone undecanoate at 3-monthly intervals. Eight-year data were analysed. Data collection registry started in November 2004 till January 2015. Results In hypogonadal men receiving TTh, IIEF increased by 5.4 (p<0.001). Total weight loss was 23.6 ± 0.6 kg after 8 years. HbA1c had declined by an average of 2.0% (P<0.0001). Total cholesterol levels significantly declined following TTh after only 1 year (P<0.0001), and HDL increased from 1.6±0.5 at baseline to 2±0.5 mmol/L following 8 years of TTh (P<0.0001). SBP decreased from 164±14 at baseline to 133±9 mmHg, signifying a reduction of 33±1 mmHg (P<0.0001). Conclusion In hypogonadal men with a history of CVD, TTh improves and preserves erectile function over prolonged periods with concurrent sustained improvements in cardiometabolic risk factors. Measuring ED and testosterone status may serve as an important male health indicator predicting subsequent CVD-related events and mortality and TTh may be an effective add-on treatment in secondary prevention of cardiovascular events in hypogonadal men with a history of CVD.
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Affiliation(s)
- Mustafa Alwani
- Jordan University of Science and Technology, School of Medicine, Irbid, Jordan.,Hamad Medical Corporation, Department of Surgery, Division of Urology/Andrology and Section of Surgical Research, Doha, Qatar
| | - Aksam Yassin
- Hamad Medical Corporation, Department of Surgery, Division of Urology/Andrology and Section of Surgical Research, Doha, Qatar.,Weill Cornell Medical College, New York, NY, USA.,Weill Cornell Medical College, Doha, Qatar
| | - Raidh Talib
- Hamad Medical Corporation, Department of Surgery, Division of Urology/Andrology and Section of Surgical Research, Doha, Qatar
| | - Ahmad Al-Qudimat
- Hamad Medical Corporation, Department of Surgery, Division of Urology/Andrology and Section of Surgical Research, Doha, Qatar
| | - Omar Aboumarzouk
- Hamad Medical Corporation, Department of Surgery, Division of Urology/Andrology and Section of Surgical Research, Doha, Qatar
| | - Raed M Al-Zoubi
- Hamad Medical Corporation, Department of Surgery, Division of Urology/Andrology and Section of Surgical Research, Doha, Qatar.,Jordan University of Science and Technology, Department of Chemistry, Irbid, Jordan
| | - Farid Saad
- Dresden International University, Center of Medicine and Health Sciences, Dresden, Germany
| | - Karim S Haider
- Klinikum Bremen-Mitte, Department of Urology, Bremen, Germany
| | - Abdulla Al Ansari
- Hamad Medical Corporation, Department of Surgery, Division of Urology/Andrology and Section of Surgical Research, Doha, Qatar
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Zhao S, Wu W, Wu P, Ding C, Xiao B, Xu Z, Hu Y, Shen M, Feng L. Significant Increase of Erectile Dysfunction in Men With Post-stroke: A Comprehensive Review. Front Neurol 2021; 12:671738. [PMID: 34393971 PMCID: PMC8355431 DOI: 10.3389/fneur.2021.671738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/25/2021] [Indexed: 11/13/2022] Open
Abstract
Men with erectile dysfunction (ED) are considered to be at risk from stroke events. Conversely, post-stroke patients are also at high risk of ED, whereas a quantitative result from all the relevant studies has not been previously addressed. Therefore, we have performed a comprehensive review and meta-analysis on this issue. This study was registered on PROSPERO (ID No. CRD42021226618). Twenty studies with a total of 3,382 stroke events were included, of which six studies were included for quantitative analysis, and the remaining 14 studies were calculated for the ratio of ED. Synthetic results from four eligible studies providing the ED cases showed that stroke patients were associated with a significantly higher risk of ED than the general population [pooled relative risk (RR) = 3.32, 95% confidence interval (CI): 1.25–8.82, P = 0.016]. Men with stroke were also found to be associated with a significant decline in International Index of Erectile Function −5 (IIEF-5) score as compared with the healthy controls [three studies, standard mean differences (SMD) = −1.8, 95% CI: −2.94 to −0.67, P = 0.002]. The prevalence of ED in post-stroke patients among 14 studies ranged from 32.1 to 77.8%, which was dramatically higher than that of the general population. The result of the GRADE-pro revealed that the quality of the evidence in this study was moderate. The present study has confirmed the high prevalence of ED in men with stroke. ED in stroke patients is a result of both neurological and psychological factors. Rehabilitative interventions rather than phosphodiesterase-5 (PDE-5) inhibitors are recommended to improve the erectile function for those survivors with ED.
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Affiliation(s)
- Shankun Zhao
- Department of Urology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Weizhou Wu
- Department of Urology, Maoming People's Hospital, Maoming, China
| | - Panxing Wu
- Department of Neurosurgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Chao Ding
- Department of Neurosurgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Bingxiang Xiao
- Department of Neurosurgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Zhengbao Xu
- Department of Neurosurgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Yan Hu
- Department of Obstetrics and Gynecology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Maolei Shen
- Department of Urology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Lu Feng
- Department of Neurosurgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
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9
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[62/m with Type 2 diabetes mellitus : Preparation for the medical specialist examination: part 64]. Internist (Berl) 2021; 62:429-434. [PMID: 34196738 DOI: 10.1007/s00108-021-01069-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
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10
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Imprialos K, Koutsampasopoulos K, Manolis A, Doumas M. Erectile Dysfunction as a Cardiovascular Risk Factor: Time to Step Up? Curr Vasc Pharmacol 2021; 19:301-312. [PMID: 32286949 DOI: 10.2174/1570161118666200414102556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Erectile dysfunction (ED) is a major health problem that affects a significant proportion of the general population, and its prevalence is even higher in patients with CV risk factors and/or disease. ED and cardiovascular (CV) disease share several common pathophysiological mechanisms, and thus, the potential role of ED as a predictor of CV events has emerged as a significant research aspect. OBJECTIVE The purpose of this review is to present and critically discuss data assessing the relation between ED and CV disease and the potential predictive value of ED for CV events. METHODS A comprehensive review of the literature has been performed to identify studies evaluating the association between ED and CV disease. RESULTS Several cross-sectional and prospective studies have examined the association between ED and CV disease and found an increased prevalence of ED in patients with CV disease. ED was shown to independently predict future CV events. Importantly, ED was found to precede the development of overt coronary artery disease (CAD) by 3 to 5 years, offering a "time window" to properly manage these patients before the clinical manifestation of CAD. Phosphodiesterase type 5 inhibitors are the first-line treatment option for ED and were shown to be safe in terms of CV events in patients with and without CV disease. CONCLUSION Accumulating evidence supports a strong predictive role of ED for CV events. Early identification of ED could allow for the optimal management of these patients to reduce the risk for a CV event to occur.
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Affiliation(s)
- Konstantinos Imprialos
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Konstantinos Koutsampasopoulos
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | | | - Michael Doumas
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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Verri V, Nascimento AR, Brandao AA, Tibirica E. Effects of chronic type 5 phosphodiesterase inhibition on penile microvascular reactivity in hypertensive patients with erectile dysfunction: a randomized crossover placebo-controlled trial. J Hum Hypertens 2021; 35:360-370. [PMID: 32366927 DOI: 10.1038/s41371-020-0343-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 01/29/2023]
Abstract
This randomized crossover and placebo-controlled trial evaluated the effects of daily use of sildenafil citrate (SIL, 1-month 50 mg twice daily) on penile and systemic endothelial microvascular function in hypertensive patients presenting with erectile dysfunction. The effects of SIL on arterial pressure were evaluated using ambulatory blood pressure monitoring (ABPM). Fifty patients diagnosed with primary arterial hypertension and erectile dysfunction (aged 57.4 ± 5.6 years), recruited in a tertiary public hospital, were treated with SIL (50 mg twice daily) or placebo (PLA) for two 30-day periods with a 30-day washout between them. Laser speckle contrast imaging coupled with acetylcholine skin iontophoresis was used to evaluate penile and systemic (forearm) cutaneous microvascular reactivity. SIL treatment increased penile basal microvascular flow (P = 0.002) and maximal endothelial-dependent peak response to skin iontophoresis of acetylcholine (ACh, P = 0.006). The area under the curve of microvascular vasodilation induced by ACh was also significantly increased (P = 0.02). Lastly, SIL treatment did not modify systemic microvascular reactivity. Twenty-four-hour ABPM (P = 0.0002) and daytime (P = 0.002) and nighttime (P = 0.001) mean diastolic blood pressure values were significantly reduced after SIL treatment. The scores of the Simplified International Index of Erectile Function (P < 0.0001) and the number of patients with positive responses to Sexual Encounter Profile question 3 (P < 0.0001) also increased after SIL treatment. Penile endothelium-dependent microvascular reactivity improved after continuous use of sildenafil in hypertensive patients with erectile dysfunction; the treatment also reduced blood pressure, suggesting that, in addition to improving erectile function, daily use of sildenafil could improve blood pressure control.
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Affiliation(s)
- Valéria Verri
- National Institute of Cardiology, Ministry of Health, Rio de Janeiro, Brazil
| | | | | | - Eduardo Tibirica
- National Institute of Cardiology, Ministry of Health, Rio de Janeiro, Brazil.
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Kaya-Sezginer E, Gur S. The Inflammation Network in the Pathogenesis of Erectile Dysfunction: Attractive Potential Therapeutic Targets. Curr Pharm Des 2021; 26:3955-3972. [PMID: 32329680 DOI: 10.2174/1381612826666200424161018] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/17/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Erectile dysfunction (ED) is an evolving health problem in the aging male population. Chronic low-grade inflammation is a critical component of ED pathogenesis and a probable intermediate stage of endothelial dysfunction, especially in metabolic diseases, with the inclusion of obesity, metabolic syndrome, and diabetes. OBJECTIVE This review will present an overview of preclinical and clinical data regarding common inflammatory mechanisms involved in the pathogenesis of ED associated with metabolic diseases and the effect of antiinflammatory drugs on ED. METHODS A literature search of existing pre-clinical and clinical studies was performed on databases [Pubmed (MEDLINE), Scopus, and Embase] from January 2000 to October 2019. RESULTS Low-grade inflammation is a possible pathological role in endothelial dysfunction as a consequence of ED and other related metabolic diseases. Increased inflammation and endothelial/prothrombotic markers can be associated with the presence and degree of ED. Pharmacological therapy and modification of lifestyle and risk factors may have a significant role in the recovery of erectile response through reduction of inflammatory marker levels. CONCLUSION Inflammation is the least common denominator in the pathology of ED and metabolic disorders. The inflammatory process of ED includes a shift in the complex interactions of cytokines, chemokines, and adhesion molecules. These data have established that anti-inflammatory agents could be used as a therapeutic opportunity in the prevention and treatment of ED. Further research on inflammation-related mechanisms underlying ED and the effect of therapeutic strategies aimed at reducing inflammation is required for a better understanding of the pathogenesis and successful management of ED.
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Affiliation(s)
- Ecem Kaya-Sezginer
- Department of Biochemistry and Pharmacology, Faculty of Pharmacy, Ankara University, Ankara, Turkey
| | - Serap Gur
- Department of Biochemistry and Pharmacology, Faculty of Pharmacy, Ankara University, Ankara, Turkey
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Cimen S, Dursun M, Sulukaya M, Besiroglu H. Could the monocyte/HDL cholesterol ratio be an early marker of erectile dysfunction? Aging Male 2020; 23:694-699. [PMID: 30777468 DOI: 10.1080/13685538.2019.1574735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Research evaluating the relationship between the Monocyte/HDL-C ratio (MHR) and ED is limited in number. We aimed for determining whether MHR could be an early marker of ED in our study. MATERIAL AND METHODS Eighty-nine patients diagnosed with ED during the period of April 2018-November 2018 and 100 patients that did not have any systemic diseases and erectile dysfunction were included in our study. The presence of ED was evaluated with International Erectile Function Index (IIEF-5). Peripheral blood samples were collected from the patients for complete blood count and biochemical analyses. The relationship between ED and MHR was evaluated for both groups. RESULTS Body mass indices (BMI) of the ED group and the control group were significantly different in statistical terms. While a significant difference was observed for fasting blood glucose, total testosterone, luteinizing hormone values between the ED group and the control group, and follicle stimulant hormone values were found to be similar with each other. MHR values of two groups were found to be significantly different. DISCUSSION MHR can be used as a marker for the determination of ED's severity and for its monitoring. We also believe that a large series of clinical and research studies are required for it to be applicable in clinical practice. Being the first prospective study in literature, we believe that our study would provide important contributions to the literature.
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Affiliation(s)
- Serhan Cimen
- Department of Urology, Malatya Education and Research Hospital, Malatya, Turkey
| | - Murat Dursun
- Department of Urology, Malatya Education and Research Hospital, Malatya, Turkey
| | - Muhammed Sulukaya
- Department of Urology, Malatya Education and Research Hospital, Malatya, Turkey
| | - Huseyin Besiroglu
- Department of Urology, Catalca Ilyas Cokay State Hospital, Istanbul, Turkey
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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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The association between gut microbiome and erectile dysfunction: a community-based cross-sectional study in Japan. Int Urol Nephrol 2020; 52:1421-1428. [PMID: 32193686 DOI: 10.1007/s11255-020-02443-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 03/10/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE We investigated the gut microbiome in subjects with erectile dysfunction (ED) in a community-based population. METHODS This cross-sectional study surveyed comprehensive health status in 408 men who participated in the Iwaki Health Promotion Project in 2015 in Hirosaki, Japan. The gut microbiome was assessed by tag sequencing of the 16S rRNA gene, which we extracted from fecal samples. Erectile function was evaluated with the five-item International Index of Erectile Function (IIEF-5), and the men were divided into two groups: low-IIEF-5 (≤ 16) and high-IIEF-5 (> 16). Of those, we selected age-adjusted 192 men (96 each) for analysis. We investigated the association of gut microbiome with IIEF-5 between the two groups. RESULTS Median age was 50 years. No significant difference was seen in the history of hypertension, DM, CKD, and CVD between the low-IIEF-5 and high-IIEF-5 groups. However, the relative abundance of Alistipes (related with anti-inflammation) and Clostoridium XVIII (related with bowel movement) was significantly different between the two groups. Multivariate logistic analysis demonstrated that the relative abundance of Clostridium XVIII (OR, 2.06; 95% CI, 1.20-3.55, P = 0.009) and Alistipes (OR, 0.81; 95% CI, 0.66-0.99, P = 0.040) and, with an IPSS ≥ 8, were independent factors for low IIEF-5. CONCLUSION We observed significant association between the low-IIEF-5 and high-IIEF-5 groups in Alistipes and Clostoridium XVIII. Further study is necessary to access the causal relationship between the gut microbiome and ED.
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Okamoto T, Hatakeyama S, Imai A, Konishi S, Okita K, Yamamoto H, Tobisawa Y, Yoneyama T, Mori K, Yoneyama T, Hashimoto Y, Nakaji S, Ohyama C. The Relationship Between Gait Function and Erectile Dysfunction: Results from a Community-Based Cross-Sectional Study in Japan. J Sex Med 2019; 16:1922-1929. [DOI: 10.1016/j.jsxm.2019.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/14/2019] [Accepted: 08/20/2019] [Indexed: 12/16/2022]
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17
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Zhao B, Hong Z, Wei Y, Yu D, Xu J, Zhang W. Erectile Dysfunction Predicts Cardiovascular Events as an Independent Risk Factor: A Systematic Review and Meta-Analysis. J Sex Med 2019; 16:1005-1017. [DOI: 10.1016/j.jsxm.2019.04.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/31/2019] [Accepted: 04/06/2019] [Indexed: 02/03/2023]
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Karabakan M, Bozkurt A, Saylam B, Kucuksu Z, Hirik E, Kagan Aktas B. A new proof for the relationship between erectile dysfunction and atherosclerosis: fragmented QRS? Int J Impot Res 2019; 32:302-307. [PMID: 31243353 DOI: 10.1038/s41443-019-0166-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 04/10/2019] [Accepted: 05/28/2019] [Indexed: 11/09/2022]
Abstract
In patients with coronary artery disease (CAD), fragmented QRS (fQRS) is a practical marker of myocardial ischemia evaluated on electrocardiography (ECG).The current study investigated the connection between FQRS and erectile dysfunction (ED), which is commonly accepted as an early sign and independent predictor of CAD. The study consisted of a 190 ED patients; 47 of them having severe, 44 moderate, 49 mild-to-moderate, and 50 mild ED, and a control group of 51 otherwise healthy adult men. None of the participants had a history of cardiac disease. There was a significant difference among the groups in terms of fQRS; severe, moderate, and mild-to-moderate ED groups had significantly higher rates of fQRS presence on ECG (27.5%, 23.5%, and 22.5%, respectively) in comparison with those of mild ED and the control groups (13.7% and 12.7%, respectively) (p < 0.001). In patients presenting with ED complaints, a fQRS finding on a simple ECG recording may serve as a first sign of the presence of CAD. As far as we know, the present study is the first in the literature assessing the possible relationship between ED and fQRS. On the ECG, the existence of fQRS was considered to be connected with ED; thus, including this basic parameter into the clinical decisions for ED patients may initiate an extensive diagnostic approach for their underlying cardiovascular diseases.
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Affiliation(s)
- Mehmet Karabakan
- Department of Urology, Mersin Toros State Hospital, Mersin, Turkey.
| | - Aliseydi Bozkurt
- Department of Urology, Erzincan University Mengucek Gazi Research and Training Hospital, Erzincan, Turkey
| | - Barıs Saylam
- Department of Urology, Mersin Research and Training Hospital, Mersin, Turkey
| | - Zafer Kucuksu
- Department of Cardiology, Erzincan University Mengucek Gazi Research and Training Hospital, Erzincan, Turkey
| | - Erkan Hirik
- Department of Urology, Erzincan University Mengucek Gazi Research and Training Hospital, Erzincan, Turkey
| | - Binhan Kagan Aktas
- Department of Urology, Ankara Numune Research and Training Hospital, Ankara, Turkey
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Association between serum high-sensitivity C-reactive protein levels and erectile dysfunction: a cross-sectional study of Chinese male population. Sci Rep 2019; 9:5929. [PMID: 30976039 PMCID: PMC6459846 DOI: 10.1038/s41598-019-42342-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 03/29/2019] [Indexed: 01/14/2023] Open
Abstract
Inflammation has been known to affect endothelial function and is involved in the progression of erectile dysfunction (ED). Thus, our present study was conducted to investigate the association between inflammatory marker high-sensitivity C-reactive protein (hs-CRP) and ED in a Chinese male population. A total of 1515 participants with anthropometric measurements, serum analyses and hs-CRP values available were included in our cross-sectional study. Data involving socioeconomic and lifestyle factors were also collected. ED was assessed by the 5-item International Index Erectile Function (IIEF-5), and hs-CRP levels were measured by the immunoturbidimetric assay. Logistic regression was applied to estimate the association between the serum hs-CRP and the risk of ED, and receiver operating characteristics (ROC) curve analysis was performed to identify the predictive value of hs-CRP. Serum hs-CRP levels were significantly higher in ED patients, and increased progressively with the incremental severity of ED (P < 0.001 for trend). In the multivariate-adjusted model, men in the highest quartile of hs-CRP level versus those in the lowest quartile had a 50% increased likelihood for ED (OR = 1.50; 95% CI = 1.08–2.08). When subjects were stratified by age, the risk of ED was more prominently in the middle-aged and elderly men. Based on the ROC analysis, serum hs-CRP has a poor diagnostic value for ED with an AUC of 0.58 (95% CI: 0.56–0.61) but has a good diagnostic performance for differentiating severe ED (AUC: 0.79; 95% CI: 0.77–0.81). Our study indicates that increased serum hs-CRP levels are associated with the severity of ED and an increased ED risk in a Chinese male population. These findings suggest that hs-CRP may be of value as an inflammatory marker for the assessment of ED risk and may play an important role in the etiology of ED.
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20
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Chen YF, Lin CS, Hong CF, Lee DJ, Sun C, Lin HH. Design of a Clinical Decision Support System for Predicting Erectile Dysfunction in Men Using NHIRD Dataset. IEEE J Biomed Health Inform 2018; 23:2127-2137. [PMID: 30369456 DOI: 10.1109/jbhi.2018.2877595] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Erectile dysfunction (ED) affects millions of men worldwide. Men with ED generally complain failure to attain or maintain an adequate erection during sexual activity. The prevalence of ED is strongly correlated with age, affecting about 40% of men at age 40 and nearly 70% at age 70. A variety of chronic diseases, including diabetes, ischemic heart disease, congestive heart failure, hypertension, depression, chronic renal failure, obstructive sleep apnea, prostate disease, gout, and sleep disorder, were reported to be associated with ED. In this study, data retrieved from a subset of the National Health Insurance Research Database of Taiwan were used for designing the clinical decision support system (CDSS) for predicting ED incidences in men. The positive cases were male patients aged 20-65 who were diagnosed with ED between January 2000 and December 2010 confirmed by at least three outpatient visits or at least one inpatient visit, while the negative cases were randomly selected from the database without a history of ED and were frequency (1:1), age, and index year matched with the ED patients. Data of a total of 2832 ED patients and 2832 non-ED patients, each consisting of 41 features including index age, 10 comorbidities, and 30 other comorbidity-related variables, were retrieved for designing the predictive models. Integrated genetic algorithm and support vector machine was adopted to design the CDSSs with two experiments of independent training and testing (ITT) conducted to verify their effectiveness. In the 1st ITT experiment, data extracted from January 2000 till December 2005 (61.51%, 1742 positive cases and 1742 negative cases) were used for training and validating and the data retrieved from January 2006 till December 2010 were used for testing (38.49%), whereas in the 2nd ITT experiment, data in the training set (77.78%) were extracted from January 2000 till Deceber 2007 and those in the testing set (22.22%) were retrieved afterward. Tenfold cross validation and three different objective functions were adopted for obtaining the optimal models with best predictive performance in the training phase. The testing results show that the CDSSs achieved a predictive performance with accuracy, sensitivity, specificity, g-mean, and area under ROC curve of 74.72%-76.65%, 72.33%-83.76%, 69.54%-77.10%, 0.7468-0.7632, and 0.766-0.817, respectively. In conclusion, the CDSSs designed based on cost-sensitive objective functions as well as salient comorbidity-related features achieve satisfactory predictive performance for predicting ED incidences.
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Sexual dysfunction as a determinant of cardiovascular outcome in patients undergoing chronic hemodialysis. Int J Impot Res 2017; 30:14-20. [DOI: 10.1038/s41443-017-0001-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 07/19/2017] [Accepted: 08/25/2017] [Indexed: 01/08/2023]
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Roumeguère T, Van Antwerpen P, Fathi H, Rousseau A, Vanhamme L, Franck T, Costa C, Morelli A, Lelubre C, Hauzeur C, Raes M, Serteyn D, Wespes E, Vanhaeverbeek M, Zouaoui Boudjeltia K. Relationship between oxidative stress and erectile function. Free Radic Res 2017; 51:924-931. [PMID: 29041845 DOI: 10.1080/10715762.2017.1393074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The aim of this study was to investigate markers of inflammation and oxidative stress in the corpus cavernosum (CC) and to compare levels of inflammatory markers recorded in CC to venous blood from the arm to examine the potential impact of inflammatory parameters on erectile function and endothelial dysfunction in vitro. Ninety-seven patients with no complaint of erectile dysfunction (ED) at inclusion were prospectively included and completed the Erectile Function domain of the IIEF questionnaire. Several parameters, including lipids, MPO-dependent oxidised LDL (Mox-LDL), IL-8, IL-18, were measured. After RNA extraction, the expression of eNOS was analysed. A paired t-test was used for comparisons between arm and CC blood results. A two-way ANOVA was used to estimate the effects of IL-18 and IL-8 on the IIEF score. Mean patient age was 59 ± 14.5 years. IL-18, Mox-LDL, and Mox-LDL/ApoB levels were significantly increased in CC compared to arm blood. The IIEF score was correlated with IL-18 levels in the venous blood (R = -0.31, p = .003) and in the CC (R = -0.37, p = .004) and with IL-8 (R = -0.31, p = .009 and R = -0.28, respectively, p = .02). There was a significant effect with the IL-18 on IIEF potentiated by high serum IL-8 concentrations. IL-18 and Mox-LDL significantly decreased eNOS mRNA expression in human aortic endothelial cell line (HAEC). These preliminary results address the importance of inflammation in the CC and highlight a difference in marker concentrations between venous and CC blood. However, they do not show any difference in terms of clinical erectile score predictivity. Involvement of inflammatory cytokines isolated in CC in the genesis of ED requires further studies.
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Affiliation(s)
- Thierry Roumeguère
- a Experimental Medicine Laboratory, ULB 222 Unit , ISPPC, CHU de Charleroi, A. Vésale Hospital , Montigny-Le-Tilleul , Belgium.,b Department of Urology , Erasme University Hospital, ULB , Brussels , Belgium
| | - Pierre Van Antwerpen
- c Laboratory of Pharmaceutical Chemistry , Institute of Pharmacy, ULB , Brussels , Belgium
| | - Henda Fathi
- b Department of Urology , Erasme University Hospital, ULB , Brussels , Belgium
| | - Alexandre Rousseau
- a Experimental Medicine Laboratory, ULB 222 Unit , ISPPC, CHU de Charleroi, A. Vésale Hospital , Montigny-Le-Tilleul , Belgium
| | - Luc Vanhamme
- d Institute for Molecular Biology and Medicine (IBMM), ULB , Gosselies , Belgium
| | - Thierry Franck
- e Center for Oxygen Research and Development , Institute of Chemistry B6a, University of Liège , Liège , Belgium
| | - Carla Costa
- f Department of Experimental Biology and Department of Biochemistry (U38-FCT), Faculty of Medicine of Porto , Porto , Portugal
| | - Annamaria Morelli
- g Sexual Medicine and Andrology Unit, Department of Clinical Physiopathology , University of Florence , Florence , Italy
| | - Christophe Lelubre
- a Experimental Medicine Laboratory, ULB 222 Unit , ISPPC, CHU de Charleroi, A. Vésale Hospital , Montigny-Le-Tilleul , Belgium
| | - Claude Hauzeur
- h Department of Urology , CHU de Charleroi , Charleroi , Belgium
| | - Martine Raes
- i Namur Research Institute for Life Sciences , Namur University , Namur , Belgium
| | - Didier Serteyn
- e Center for Oxygen Research and Development , Institute of Chemistry B6a, University of Liège , Liège , Belgium
| | - Eric Wespes
- h Department of Urology , CHU de Charleroi , Charleroi , Belgium
| | - Michel Vanhaeverbeek
- a Experimental Medicine Laboratory, ULB 222 Unit , ISPPC, CHU de Charleroi, A. Vésale Hospital , Montigny-Le-Tilleul , Belgium
| | - Karim Zouaoui Boudjeltia
- a Experimental Medicine Laboratory, ULB 222 Unit , ISPPC, CHU de Charleroi, A. Vésale Hospital , Montigny-Le-Tilleul , Belgium
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Mobley DF, Khera M, Baum N. Recent advances in the treatment of erectile dysfunction. Postgrad Med J 2017; 93:679-685. [PMID: 28751439 DOI: 10.1136/postgradmedj-2016-134073] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 02/21/2017] [Accepted: 04/23/2017] [Indexed: 01/01/2023]
Abstract
Erectile dysfunction (ED) is one of the most common conditions affecting middle-aged and older men. Nearly every primary care physician, internist and geriatrician will be called upon to manage this condition or to make referrals to urologists, endocrinologists and cardiologists who will assist in the treatment of ED. This article will briefly discuss the diagnosis and management of ED. In addition, emerging concepts in ED management will be discussed, such as the use of testosterone to treat ED, the role of the endothelium in men with ED and treating the partner of the man with ED. Finally, future potential therapies for ED will be discussed.
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Affiliation(s)
- David F Mobley
- Department of Urology, Weill-Cornell Medicine, Houston, Texas, USA
| | - Mohit Khera
- Department of Urology, Baylor College of Medicine, Houston, Texas, USA
| | - Neil Baum
- Department of Urology, Tulane Medical School, New Orleans, Louisiana, USA
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Goldstein I, Tseng LJ, Creanga D, Stecher V, Kaminetsky JC. Efficacy and Safety of Sildenafil by Age in Men With Erectile Dysfunction. J Sex Med 2017; 13:852-9. [PMID: 27114196 DOI: 10.1016/j.jsxm.2016.02.166] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 01/13/2016] [Accepted: 02/10/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Sildenafil, an oral phosphodiesterase type 5 inhibitor, has been extensively investigated for the treatment of erectile dysfunction in randomized controlled trials. AIM To assess the efficacy and safety of sildenafil vs placebo according to age subgroups (<65, 65-74, and ≥75 years) in 11,364 men with erectile dysfunction using pooled data from 48 randomized, double-blinded, placebo-controlled, parallel-group, flexible-dose trials. METHODS Most trials had a 12-week treatment duration. The starting sildenafil dose was 50 mg, taken 1 hour before sexual activity, with subsequent adjustment to 100 or 25 mg based on efficacy and safety. Men taking nitrate therapy or nitric oxide donors and men with severe cardiac failure, unstable angina, or recent stroke or myocardial infarction were excluded. Efficacy analyses included all subjects with baseline and at least one postrandomization evaluation. Safety analyses included subjects who received study medication. MAIN OUTCOME MEASURES The International Index of Erectile Function and a global assessment question ("Did the treatment improve your erections?"). RESULTS Mean International Index of Erectile Function scores for question 3 (frequency of penetration), question 4 (maintenance of erections after penetration), and the erectile function domain were statistically significantly improved with sildenafil vs placebo for each age subgroup; orgasmic function, intercourse satisfaction, sexual desire, and overall satisfaction domain scores also were statistically significantly improved with sildenafil vs placebo. The percentage of men reporting improved erections on the global assessment question was statistically significantly higher with sildenafil vs placebo for all age subgroups; the percentage with sildenafil tended to decrease with increasing age (<65 years, 80%; 65-74 years, 69%; ≥75 years, 59%). The most common adverse events with sildenafil were headache and flushing in each age subgroup. CONCLUSION Sildenafil is an effective and well-tolerated treatment for erectile dysfunction regardless of patient age, including men at least 75 years old.
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Affiliation(s)
- Irwin Goldstein
- San Diego Sexual Medicine, Alvarado Hospital, San Diego, CA, USA.
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Higashi Y. Lower urinary tract symptoms/benign prostatic hypertrophy and vascular function: Role of the nitric oxide-phosphodiesterase type 5-cyclic guanosine 3',5'-monophosphate pathway. Int J Urol 2017; 24:412-424. [PMID: 28332240 DOI: 10.1111/iju.13336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/19/2017] [Indexed: 11/30/2022]
Abstract
It is well known that there is an association of lower urinary tract symptoms/benign prostatic hypertrophy with cardiovascular disease, suggesting that lower urinary tract symptoms/benign prostatic hypertrophy is a risk factor for cardiovascular events. Vascular function, including endothelial function and vascular smooth muscle function, is involved in the pathogenesis, maintenance and development of atherosclerosis, leading to cardiovascular events. Vascular dysfunction per se should also contribute to lower urinary tract symptoms/benign prostatic hypertrophy. Both lower urinary tract symptoms/benign prostatic hypertrophy and vascular dysfunction have cardiovascular risk factors, such as hypertension, dyslipidemia, diabetes mellitus, aging, obesity and smoking. Inactivation of the phosphodiesterase type 5-cyclic guanosine 3',5'-monophosphate-nitric oxide pathway causes lower urinary tract symptoms/benign prostatic hypertrophy through an enhancement of sympathetic nervous activity, endothelial dysfunction, increase in Rho-associated kinase activity and vasoconstriction, and decrease in blood flow of pelvic viscera. Both endogenous nitric oxide and exogenous nitric oxide act as vasodilators on vascular smooth muscle cells through an increase in the content of cyclic guanosine 3',5'-monophosphate, which is inactivated by phosphodiesterase type 5. In a clinical setting, phosphodiesterase type 5 inhibitors are widely used in patients with lower urinary tract symptoms/benign prostatic hypertrophy. Phosphodiesterase type 5 inhibitors might have beneficial effects on vascular function through not only inhibition of cyclic guanosine 3',5'-monophosphate degradation, but also increases in testosterone levels and nitric oxide bioavailability, increase in the number and improvement of the function of endothelial progenitor cells, and decrease in insulin resistance. In the present review, the relationships between lower urinary tract symptoms/benign prostatic hypertrophy, the phosphodiesterase type 5-nitric oxide-cyclic guanosine 3',5'-monophosphate pathway, vascular function and cardiovascular outcomes are examined.
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Affiliation(s)
- Yukihito Higashi
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University Hospital, Hiroshima, Japan.,Divivsion of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
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Sanchez E, Pastuszak AW, Khera M. Erectile dysfunction, metabolic syndrome, and cardiovascular risks: facts and controversies. Transl Androl Urol 2017; 6:28-36. [PMID: 28217448 PMCID: PMC5313297 DOI: 10.21037/tau.2016.10.01] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Erectile dysfunction (ED) is the most common male sexual dysfunction, and shares many risk factors with systemic conditions including cardiovascular disease (CVD) and the metabolic syndrome (MetS). ED is considered to be an independent risk factor for CVD and can be a harbinger of future cardiovascular events. Given this relationship, each encounter for ED should be viewed by healthcare providers as an opportunity to screen for CVD and other comorbid conditions, including the MetS, that can significantly affect a man's overall health. While universally accepted screening guidelines are lacking, expert panels do recommend an approach to risk stratification in men with ED. In this review, we discuss the current state of understanding of the relationship between ED, the MetS, and CV risk, and how this impacts the approach to the patient presenting with ED.
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Affiliation(s)
- Edward Sanchez
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Alexander W Pastuszak
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
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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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Penile constitutive nitric oxide synthase expression in rats exposed to unpredictable chronic mild stress: role of inflammation. Int J Impot Res 2016; 29:76-81. [DOI: 10.1038/ijir.2016.50] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/04/2016] [Accepted: 10/28/2016] [Indexed: 11/08/2022]
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Mollace V, Malara N, Gratteri S, Palma E, Zappia L, Costa N, Rosano G, Paone S. Bergamot polyphenolic fraction counteracts erectile dysfunction occurring in patients suffering from type 2 diabetes. PHARMANUTRITION 2016. [DOI: 10.1016/j.phanu.2015.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Maseroli E, Fanni E, Cipriani S, Scavello I, Pampaloni F, Battaglia C, Fambrini M, Mannucci E, Jannini EA, Maggi M, Vignozzi L. Cardiometabolic Risk and Female Sexuality: Focus on Clitoral Vascular Resistance. J Sex Med 2016; 13:1651-1661. [PMID: 27692844 DOI: 10.1016/j.jsxm.2016.09.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/17/2016] [Accepted: 09/02/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The relation between sexual and cardiovascular health in women is not well defined. Clitoral color Doppler ultrasound (CDU) with assessment of the pulsatility index (PI), reflecting resistance to blood flow, has been proposed as an objective measurement of sexual functioning. AIM To investigate associations between clitoral PI and cardiometabolic risk factors, sexual and intrapsychic parameters, and self-perception of body image. METHODS Seventy-one adult heterosexual women in a stable relationship attending our clinic for sexual dysfunction were consecutively recruited. MAIN OUTCOME MEASURES Patients underwent physical, laboratory, and clitoral color Doppler ultrasound examinations and completed the Female Sexual Function Index, the Middlesex Hospital Questionnaire, and the Body Uneasiness Test (BUT). RESULTS Clitoral PI was positively correlated with body mass index (r = 0.441, P < .0001), waist circumference (r = 0.474, P < .0001), glycemia (r = 0.300, P = .029), insulin (r = 0.628, P = .002), homeostatic model assessment index (r = 0.605, P = .005), triglycerides (r = 0.340, P = .011), total cholesterol (r = 0.346, P = .010), and low-density lipoprotein cholesterol (r = 0.334, P = .016). All relations, with the exception of glycemia, retained statistical significance after adjusting for age, smoking habit, and years since menopause (P < .0001 for body mass index, waist circumference, and triglycerides; P < .05 for all other associations). Analysis of covariance, after adjusting for confounders, showed that women with obesity or metabolic syndrome (MetS) showed significantly higher PI values (obesity: F = 17.79, P = .001; MetS: F = 7.37, P = .019). In particular, a stepwise increase of PI was found as a function of increasing MetS components (β = 0.434, P = .007). Clitoral PI was negatively associated with Female Sexual Function Index arousal (β = -0.321, P = .014) and satisfaction (β = -0.289, P = .026) scores and positively associated with Middlesex Hospital Questionnaire somatized anxiety symptoms, even after adjusting for age, smoking habit, years since menopause, and current use of psychiatric medication (β = 0.354, P = .011). A positive association also was observed between PI and the BUT positive symptom distress index (β = 0.322, P = .039) and BUT for dislike of the womb, genitals, and breast (β = 0.538, P < .0001; β = 0.642, P < .0001; β = 0.549, P < .0001, respectively). After introducing waist circumference as another covariate, the associations between clitoral PI and the BUT positive symptom distress index and BUT dislike of the womb, genitals, and breast retained statistical significance (P = .038 for positive symptom distress index; P < .0001 for dislike of womb, genitals, and breast). CONCLUSION Clitoral vascular resistance is positively associated with MetS (in particular insulin resistance), decreased sexual arousal, body image concerns, and increased somatized anxiety symptoms. Further studies are needed to establish whether treatment of metabolic abnormalities might improve clitoral color Doppler ultrasound indices and sexual outcomes.
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Affiliation(s)
- Elisa Maseroli
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Egidia Fanni
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Sarah Cipriani
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Irene Scavello
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Francesca Pampaloni
- Gynecology and Obstetrics Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Cesare Battaglia
- Department of Gynecology and Pathophysiology of Human Reproduction, University of Bologna, Bologna, Italy
| | - Massimiliano Fambrini
- Gynecology and Obstetrics Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Edoardo Mannucci
- Diabetes Section Geriatric Unit, Department of Critical Care, University of Florence, Florence, Italy
| | | | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy; Istituto Nazionale Biostrutture e Biosistemi, Rome, Italy
| | - Linda Vignozzi
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy; Istituto Nazionale Biostrutture e Biosistemi, Rome, Italy.
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Kapoor R, Kapoor A. Erectile dysfunction: A present day coronary disease risk equivalent. Indian J Med Res 2016; 144:307-310. [PMID: 28139526 PMCID: PMC5320833 DOI: 10.4103/0971-5916.198669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rohit Kapoor
- Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226 014, Uttar Pradesh, India
| | - Aditya Kapoor
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226 014, Uttar Pradesh, India
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Raheem OA, Su JJ, Wilson JR, Hsieh TC. The Association of Erectile Dysfunction and Cardiovascular Disease: A Systematic Critical Review. Am J Mens Health 2016; 11:552-563. [PMID: 26846406 DOI: 10.1177/1557988316630305] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Despite strong association between erectile dysfunction (ED) and cardiovascular disease (CVD), there is a paucity of clear clinical guidelines detailing when and how to evaluate for ED in patients with known CVD, or vice versa. This systematic review discuss the role of cardiologists and urologists in the characterization of risk and management of CVD in the setting of ED, as well as contrasting the current evaluation of CVD and ED from the standpoint of published consensus statements. A comprehensive literature review utilizing MEDLINE®, the Cochrane Library® Central Search, and the Web of Science was performed to identify all published peer-reviewed articles in the English language describing ED and CVD across various disciplines. There is strong consensus that men with ED should be considered at high risk of CVD. Available risk assessment tools should be used to stratify the coronary risk score in each patient. The 2012 Princeton III Consensus Conference expanded on existing cardiovascular recommendations, proposing an approach to the evaluation and management of cardiovascular risk in men with ED and no known CVD. This systematic review highlights the similarities and differences of the existing clinical guidelines and recommendations regarding assessment and management of ED and CVD, as well as the pathophysiological linkage between ED and CVD, which may permit physicians, including urologists, to perform opportunistic screening and initiate secondary prophylaxis with regard to cardiovascular risk factors, particularly in young, nondiabetic men with ED.
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Affiliation(s)
- Omer A Raheem
- 1 University of California, San Diego, Department of Urology, San Diego, CA, USA
| | - Jeannie J Su
- 2 Yale School of Medicine, Department of Urology, New Haven, CT, USA
| | - Joel R Wilson
- 3 University of California, San Diego, Department of Medicine, Division of Cardiovascular Medicine, San Diego, CA, USA
| | - Tung-Chin Hsieh
- 1 University of California, San Diego, Department of Urology, San Diego, CA, USA
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Musicki B, Bella AJ, Bivalacqua TJ, Davies KP, DiSanto ME, Gonzalez-Cadavid NF, Hannan JL, Kim NN, Podlasek CA, Wingard CJ, Burnett AL. Basic Science Evidence for the Link Between Erectile Dysfunction and Cardiometabolic Dysfunction. J Sex Med 2015; 12:2233-55. [PMID: 26646025 DOI: 10.1111/jsm.13069] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Although clinical evidence supports an association between cardiovascular/metabolic diseases (CVMD) and erectile dysfunction (ED), scientific evidence for this link is incompletely elucidated. AIM This study aims to provide scientific evidence for the link between CVMD and ED. METHODS In this White Paper, the Basic Science Committee of the Sexual Medicine Society of North America assessed the current literature on basic scientific support for a mechanistic link between ED and CVMD, and deficiencies in this regard with a critical assessment of current preclinical models of disease. RESULTS A link exists between ED and CVMD on several grounds: the endothelium (endothelium-derived nitric oxide and oxidative stress imbalance); smooth muscle (SM) (SM abundance and altered molecular regulation of SM contractility); autonomic innervation (autonomic neuropathy and decreased neuronal-derived nitric oxide); hormones (impaired testosterone release and actions); and metabolics (hyperlipidemia, advanced glycation end product formation). CONCLUSION Basic science evidence supports the link between ED and CVMD. The Committee also highlighted gaps in knowledge and provided recommendations for guiding further scientific study defining this risk relationship. This endeavor serves to develop novel strategic directions for therapeutic interventions.
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Affiliation(s)
- Biljana Musicki
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Anthony J Bella
- Division of Urology, Department of Surgery and Department of Neuroscience, Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, ON, Canada
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kelvin P Davies
- Department of Urology, Albert Einstein College of Medicine, New York, NY, USA
| | - Michael E DiSanto
- Department of Surgery/Division of Urology, Cooper University Hospital, Camden, NJ, USA
| | - Nestor F Gonzalez-Cadavid
- Division of Urology, Department of Surgery, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA.,Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Johanna L Hannan
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Noel N Kim
- Institute for Sexual Medicine, San Diego, CA, USA
| | - Carol A Podlasek
- Departments of Urology, Physiology, and Bioengineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Christopher J Wingard
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Arthur L Burnett
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
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Significant improvement of erectile function after Roux-en-Y gastric bypass surgery in obese Chinese men with erectile dysfunction. Obes Surg 2015; 25:838-44. [PMID: 25361762 DOI: 10.1007/s11695-014-1465-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND We aimed to examine the effect of Roux-en-Y gastric bypass surgery (RYGB) on erectile dysfunction (ED), cavernosal morphological vasculopathy, and carotid wall alterations in severely obese Chinese men. METHODS We performed a retrospective cohort study of 39 obese men with ED who underwent RYGB between 2011 and 2012. Erectile function was assessed by the International Index of Erectile Function-5 (IIEF-5) before and 1 year after surgery. Intima-media thickness of carotid and cavernosal arteries and cavernosal peak systolic velocity (PSV) were investigated by color Doppler ultrasound. Endothelial function was assessed with the L-arginine test. RESULTS Eighteen (46.2%) men had cavernosal vasculopathy and 21 (53.8%) had carotid vasculopathy before surgery, and these proportions decreased to 15.4% and 23.1% after surgery, respectively. There was a significant improvement in carotid and cavernosal intima-media thickness postoperatively. IIEF-5 (17.3 to 23.8, P < 0.05), PSV (23 to 37, P < 0.05), and endothelial scores (6.1 to 8.2, P < 0.05) were all improved after RYGB. The increase in endothelial function scores was positively associated with changes in pre- to postoperative IIEF-5 scores (r = 0.438, P = 0.017). Younger age, being married, and lower preoperative IIEF-5 scores were independently related to greater improvement in erectile function. CONCLUSIONS ED can be relieved after RYGB in obese Chinese patients, accompanied by the improvement of cavernosal morphological vasculopathy and carotid wall alterations. Changes in endothelial function may contribute to this improvement, while preoperative body mass index and the amount of weight loss do not.
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36
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Chen YF, Lin HH, Lu CC, Hung CT, Lee MH, Hsu CY, Chung WS. Gout and a Subsequent Increased Risk of Erectile Dysfunction in Men Aged 64 and Under: A Nationwide Cohort Study in Taiwan. J Rheumatol 2015; 42:1898-905. [DOI: 10.3899/jrheum.141105] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2015] [Indexed: 02/07/2023]
Abstract
Objective.Few studies have examined the relationship between gout and erectile dysfunction (ED). We investigated whether patients with gout exhibited an increased risk of ED.Methods.This longitudinal nationwide cohort study investigated the incidence and risk of ED in 19,368 men with gout who were newly diagnosed between January 2002 and December 2008. A total of 77,472 controls without gout were randomly selected from the general population and frequency-matched according to age and sex. The patients were followed up from the date on which they were included in the study cohort to the date of an ED event, censoring, or December 31, 2010. We conducted the Cox proportional hazard model to estimate the effects of gout on ED risk including age and comorbidities.Results.The gout cohort exhibited a 1.21-fold adjusted HR of subsequent ED development compared with the non-gout cohort (95% CI 1.03–1.44). The incidence of ED increased with age in both cohorts and was higher among the patients in the gout cohort than among those in the non-gout cohort. Compared to the patients without gout and comorbidities, the patients with both gout and any type of comorbidity exhibited a 2.04-fold risk of developing ED (95% CI 1.63–2.57). Further, the patients with gout who had numerous comorbidities exhibited the dose-response effect in developing ED.Conclusion.This nationwide cohort study revealed that ED risk is significantly higher in patients with gout than in the general population.
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Evaluation of high sensitive troponin in erectile dysfunction. DISEASE MARKERS 2015; 2015:548951. [PMID: 25960595 PMCID: PMC4415735 DOI: 10.1155/2015/548951] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 07/15/2014] [Accepted: 09/08/2014] [Indexed: 12/14/2022]
Abstract
Background. Evidence is accumulating in favour of a link between erectile dysfunction (ED) and coronary artery diseases. We investigated the presence of cardiac injury in patients who have had arteriogenic and nonarteriogenic ED using the hs-Tn levels. Methods. The diagnosis of ED was based on the International Index of Erectile Function 5-questionnaire (IIF-5) and patients were classified as arteriogenic (A-ED, n = 40), nonarteriogenic (NA-ED, n = 48), and borderline (BL-ED, n = 32) patients in relation to the results of echo-color-Doppler examination of cavernous arteries. The level of hs-TnT and hs-TnI was measured in 120 men with a history of ED of less than one year with no clinical evidence of cardiac ischemic disease. Results. The levels of both hs-TnT and hs-TnI were within the reference range and there was no significant (P > 0.05) difference between patients of the three groups. The hs-CRP values were higher in A-ED men compared with NA-ED (P = 0.048) but not compared with BL-ED (P = 0.136) and negatively correlated with IIF-5 (r = −0.480; P = 0.031). Conclusions. In ED patients of the three groups the measurement of hs-Tn allows us to exclude the presence of cardiac involvement at least when the history of ED is less than one year and the men are without atherosclerotic risk factors.
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Tibaek S, Gard G, Dehlendorff C, Iversen HK, Erdal J, Biering-Sørensen F, Dorey G, Jensen R. The effect of pelvic floor muscle training on sexual function in men with lower urinary tract symptoms after stroke. Top Stroke Rehabil 2015; 22:185-93. [PMID: 25779892 DOI: 10.1179/1074935714z.0000000019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Erectile dysfunction and lower urinary tract symptoms (LUTS) are common sequelae in men after stroke. OBJECTIVE The objective of this study was to evaluate the effect of pelvic floor muscle training (PFMT) on measured erectile function as an indicator of sexuality in men with LUTS after stroke. METHOD A sample of 516 men with stroke was invited to participate in this single-blinded, randomized controlled trial according to in- and exclusion criteria. This resulted in 31 participants who were randomized to either a Treatment Group (n = 16) or a Control Group (n = 15). The intervention included 12♣weeks of PFMT. The effect was measured on the International Index of Erectile Function (IIEF-5) questionnaire. RESULTS Thirty participants (median age: 68 years; interquartile range: 60-74 years) completed the study, 15 in each group. The results of the IIEF-5 sum score showed a significant improvement (P < 0.04) from pre-test to post-test in the Treatment Group, but not in the Control Group. Within pre-test and 6-month follow-up, the median sum score decreased in both groups, worsened in the Control Group [Treatment Group, 3 (17%) versus Control Group, 5 (31%)]. There were differences between the groups at post-test and at follow-up, but they were not statistically significant. CONCLUSION The results showed that, as measured by erectile function in men with LUTS after stroke, PFMT may have short-term and long-term effect, although no statistically significant effect was demonstrated between the groups.
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Popp R, Kleemann Y, Burger M, Pfeifer M, Arzt M, Budweiser S. Impaired Vigilance Is Associated with Erectile Dysfunction in Patients with Sleep Apnea. J Sex Med 2015; 12:405-15. [DOI: 10.1111/jsm.12789] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Nassar OH, Aklan HM. Erectile Dysfunction among Yemenis: Does Chewing Khat Play a Role? Eurasian J Med 2015; 46:69-73. [PMID: 25610301 DOI: 10.5152/eajm.2014.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 12/23/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Khat, a type of plant that grows in Yemen and some African countries like Somalia, Ethiopia and Kenya, is considered to be addictive and contains some stimulating substances that may affect different body organs. This study was conducted to identify the causes of erectile dysfunction (ED) and to investigate the effect of chewing Khat on this disease in Yemenis. MATERIALS AND METHODS A total of 236 patients who were treated at University of Science and Technology Hospital and complained of ED were examined with penile Doppler ultrasonography (US). Biodata and health data were collected from the patients' records and via mobile interviews. RESULTS The causes of ED were psychological causes (72%), venous leakage (19%) and arterial disease (9%). Psychological ED was most common in 15-29-year-olds, while pathological ED increased with increasing age (p=0.041). Heart diseases and diabetes showed a significant association with pathological ED (p<0.05). Although 81% of the ED patients in this study chewed Khat, there was no significant association between chewing Khat and either pathological or psychological ED (p>0.05). CONCLUSION Psychological problems are the main causes of ED among Yemenis especially in the younger age group. It is too early to exclude Khat as a factor contributing to this health problem, and this topic warrants further case-control studies with a larger sample size.
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Affiliation(s)
- Omar H Nassar
- Department of Radiology, University of Science and Technology Hospital, Sana'a, Yemen
| | - Hameed M Aklan
- Department of Radiology, University of Science and Technology Faculty of Medicine, Sara'a, Yemen
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Fang SC, Rosen RC, Vita JA, Ganz P, Kupelian V. Changes in erectile dysfunction over time in relation to Framingham cardiovascular risk in the Boston Area Community Health (BACH) Survey. J Sex Med 2014; 12:100-8. [PMID: 25293632 DOI: 10.1111/jsm.12715] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Erectile dysfunction (ED) is associated with cardiovascular disease (CVD); however, the association between change in ED status over time and future underlying CVD risk is unclear. AIM The aim of this study was to investigate the association between change in ED status and Framingham CVD risk, as well change in Framingham risk. METHODS We studied 965 men free of CVD in the Boston Area Community Health (BACH) Survey, a longitudinal cohort study with three assessments. ED was assessed with the five-item International Index of Erectile Function at BACH I (2002-2005) and BACH II (2007-2010) and classified as no ED/transient ED/persistent ED. CVD risk was assessed with 10-year Framingham CVD risk algorithm at BACH I and BACH III (2010-2012). Linear regression models controlled for baseline age, socio-demographic and lifestyle factors, as well as baseline Framingham risk. Models were also stratified by age (≥/< 50 years). MAIN OUTCOME MEASURES Framingham CVD risk and change in Framingham CVD risk were the main outcome measures. RESULTS Transient and persistent ED was significantly associated with increased Framingham risk and change in risk over time in univariate and age-adjusted models. In younger men, persistent ED was associated with a Framingham risk that was 1.58 percentage points higher (95% confidence interval [CI]: 0.11, 3.06) and in older men, a Framingham risk that was 2.54 percentage points higher (95% CI: -1.5, 6.59), compared with those without ED. Change in Framingham risk over time was also associated with transient and persistent ED in men <50 years, but not in older men. CONCLUSIONS Data suggest that even after taking into account other CVD risk factors, transient and persistent ED is associated with Framingham CVD risk and a greater increase in Framingham risk over time, particularly in younger men. Findings further support clinical assessment of CVD risk in men presenting with ED, especially those under 50 years.
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Affiliation(s)
- Shona C Fang
- Division of Epidemiology, New England Research Institutes, Inc., Watertown, MA, USA; Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
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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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Shen YC, Weng SF, Wang JJ, Tien KJ. Erectile dysfunction and risk of end stage renal disease requiring dialysis: a nationwide population-based study. PLoS One 2014; 9:e102055. [PMID: 25013905 PMCID: PMC4094485 DOI: 10.1371/journal.pone.0102055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 06/13/2014] [Indexed: 11/18/2022] Open
Abstract
Background Previous studies have suggested that erectile dysfunction (ED) is an independent risk factor for macrovascular disease. Very few studies have evaluated the relationship between ED and risk of end stage renal disease (ESRD) requiring dialysis. Methods A random sample of 1,000,000 individuals from Taiwan's National Health Insurance database was collected. We selected the control group by matching the subjects and controls by age, diabetes, hypertension, coronary heart disease, hyperlipidemia, area of residence, monthly income and index date. We identified 3985 patients with newly-diagnosed ED between 2000 and 2008 and compared them with a matched cohort of 23910 patients without ED. All patients were tracked from the index date to identify which patients subsequently developed a need for dialysis. Results The incidence rates of dialysis in the ED cohort and comparison groups were 10.85 and 9.06 per 10000 person-years, respectively. Stratified by age, the incidence rate ratio for dialysis was greater in ED patients aged <50 years (3.16, 95% CI: 1.62–6.19, p = 0.0008) but not in aged 50–64 (0.94, 95% CI: 0.52–1.69, p = 0.8397) and those aged ≧65 (0.69, 95% CI: 0.32–1.52, p = 0.3594). After adjustment for patient characteristics and medial comorbidities, the adjusted HR for dialysis remained greater in ED patients aged <50 years (adjusted HR: 2.08, 95% CI: 1.05–4.11, p<0.05). The log-rank test revealed that ED patients <50-years-old had significantly higher cumulative incidence rates of dialysis than those without (p = 0.0004). Conclusion Patients with ED, especially younger patients, are at an increased risk for ESRD requiring dialysis later in life.
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Affiliation(s)
- Yuan-Chi Shen
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Cheng Shiu University, Kaohsiung, Taiwan
| | - Shih-Feng Weng
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Kai-Jen Tien
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- The Center of General Education, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
- * E-mail:
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Abstract
Erectile dysfunction (ED) affects a growing number of men in the USA and abroad, with significant impacts on sexual function and overall quality of life. The risk factors for ED are numerous and include a strong link to cardiovascular disease, such that men with ED should be screened for cardiovascular disease. The evaluation of men presenting with ED includes a comprehensive history and physical exam to aid in the identification of comorbidities as well as laboratory testing to evaluate hormone and lipid levels and sugar metabolism. Adjunct studies are also available, though their utility is often limited to specific subtypes of ED. Once the etiology of ED is established, treatment can be initiated using appropriate medical therapies, including phosphodiesterase type 5 (PDE5) inhibitors, and transurethral or intracavernosal therapies, with surgical intervention via revascularization or penile prosthesis placement in men demonstrating a lack of response to medical therapy. In all cases of ED, a psychogenic component is present and referral for psychological intervention with or without medical therapy should be considered.
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45
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Cho SY, Son H, Kim SW, Paick JS. Should men with mild erectile dysfunction be closely evaluated for cardiovascular diseases in the Korean population? Aging Male 2014; 17:81-6. [PMID: 24397687 DOI: 10.3109/13685538.2013.873782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
This study compared demographic characteristics and prevalence of cardiovascular comorbidities between men with mild erectile dysfunction (ED) and men with more severe ED. Men with 6-month history of ED and in monogamous heterosexual relationships were included. Non-responders to type 5 phosphodiesterase inhibitors or patients receiving regular treatment with nitrate, anticoagulants, androgens, and anti-androgens were excluded. ED was defined according to the International Index of Erectile Function questionnaire score: no ED (≥26), mild ED (22-25), and others (<22). The review identified 70 patients with mild ED (6.0%, group A) and 1098 patients with more severe ED (94.0%, group B) were included. Of the patients in group B, 365 had mild-to-moderate ED (30.5%), 505 had moderate ED (43.2%), and 233 had severe ED (20.0%). Mean ages and body mass indices showed no differences between groups A and B. Group A had shorter mean duration of ED (p = 0.025). Although patients in group A had milder ED with shorter duration than group B patients, cardiovascular risk factors such as diabetes, hypertension and lipid disorder were still common for group A. The most common comorbidity was diabetes, which was twice as likely for patients in group B. Except for diabetes the prevalence of all diseases was comparable between the two groups. In conclusion, patients with mild ED should be closely evaluated for cardiovascular comorbidities.
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Affiliation(s)
- Sung Yong Cho
- Department of Urology, Seoul National University Boramae Medical Center , Seoul , Republic of Korea and
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Moore CS, Grant MD, Zink TA, Panizzon MS, Franz CE, Logue MW, Hauger RL, Kremen WS, Lyons MJ. Erectile dysfunction, vascular risk, and cognitive performance in late middle age. Psychol Aging 2014; 29:163-72. [PMID: 24660805 DOI: 10.1037/a0035463] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Vascular disease is the most common etiology of erectile dysfunction (ED). Men with ED are at a 65% increased relative risk of developing coronary heart disease and a 43% increased risk of stroke within 10 years. Vascular disease is associated with cognitive impairment; ED-an overt manifestation of vascular dysfunction-could also signal early compromised cognition. We sought to determine whether cognitive differences existed between men with ED and healthy peers. Our sample consisted of 651 men (ages 51-60 years) from the Vietnam Era Twin Study of Aging. ED was associated with poorer cognitive performance, particularly on attention-executive-psychomotor speed tasks. ED remained significantly associated with cognition after inclusion of other cardiovascular risk factors (including hypertension, high cholesterol, body mass index, and smoking). These findings underscore the importance of further study of ED as a predictor of cognitive and cardiovascular health. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | - Mark W Logue
- Biomedical Genetics, Boston University School of Medicine
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47
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Khajehei M. Why is there a need for an interdisciplinary approach to assess erectile dysfunction? World J Clin Urol 2014; 3:1-8. [DOI: 10.5410/wjcu.v3.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 12/16/2013] [Indexed: 02/06/2023] Open
Abstract
Erectile dysfunction is a prevalent complaint among men. The majority of patients suffering erectile dysfunction exhibit various risk factors of vascular diseases. Erectile dysfunction used to be recognised as one of the consequences of vascular diseases in patients suffering heart attack or myocardial infarction. During the last decade, however, the role of endothelial dysfunction in the occurrence of erectile dysfunction has been signified, and it has been suggested that erectile dysfunction may not be simply a consequence of vascular diseases but an indicator of future vascular problems. Erectile dysfunction has been known as “the tip of iceberg” of a generalised vascular dysfunction, which typically happens before serious vascular problems. Considerable evidence shows a link between erectile dysfunction and vascular disorders. Several theories have been considered for the association between erectile dysfunction and vascular diseases. One of them is the “artery size” theory focusing on the differences between the diameter of the penile artery and other arteries. Another theory is based on “endothelial dysfunction”, which highlights inappropriate vasoconstriction as a cause of erectile dysfunction and vascular diseases. “Age” has also been reported to have pivotal role in the development of vascular dysfunction resulting in erectile dysfunction and ultimately vascular diseases. Another theory explaining the pathophysiology of erectile dysfunction and its relationship with vascular diseases focuses on the formation of atherosclerosis plaques. This article endeavours to review the current literature and discuss why a multidisciplinary approach is needed while assessing erectile dysfunction.
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48
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Miner M, Nehra A, Jackson G, Bhasin S, Billups K, Burnett AL, Buvat J, Carson C, Cunningham G, Ganz P, Goldstein I, Guay A, Hackett G, Kloner RA, Kostis JB, LaFlamme KE, Montorsi P, Ramsey M, Rosen R, Sadovsky R, Seftel A, Shabsigh R, Vlachopoulos C, Wu F. All men with vasculogenic erectile dysfunction require a cardiovascular workup. Am J Med 2014; 127:174-82. [PMID: 24423973 DOI: 10.1016/j.amjmed.2013.10.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 10/15/2013] [Accepted: 10/15/2013] [Indexed: 11/18/2022]
Abstract
An association between erectile dysfunction and cardiovascular disease has long been recognized, and studies suggest that erectile dysfunction is an independent marker of cardiovascular disease risk. Therefore, assessment and management of erectile dysfunction may help identify and reduce the risk of future cardiovascular events, particularly in younger men. The initial erectile dysfunction evaluation should distinguish between predominantly vasculogenic erectile dysfunction and erectile dysfunction of other etiologies. For men believed to have predominantly vasculogenic erectile dysfunction, we recommend that initial cardiovascular risk stratification be based on the Framingham Risk Score. Management of men with erectile dysfunction who are at low risk for cardiovascular disease should focus on risk-factor control; men at high risk, including those with cardiovascular symptoms, should be referred to a cardiologist. Intermediate-risk men should undergo noninvasive evaluation for subclinical atherosclerosis. A growing body of evidence supports the use of emerging prognostic markers to further understand cardiovascular risk in men with erectile dysfunction, but few markers have been prospectively evaluated in this population. In conclusion, we support cardiovascular risk stratification and risk-factor management in all men with vasculogenic erectile dysfunction.
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Affiliation(s)
- Martin Miner
- Departments of Family Medicine and Urology, Miriam Hospital and Brown University, Providence, RI.
| | - Ajay Nehra
- Department of Urology, Rush University, Chicago, Ill
| | | | - Shalender Bhasin
- Department of Medicine, Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Mass
| | - Kevin Billups
- Department of Urologic Surgery, University of Minnesota, Minneapolis; The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Md
| | - Arthur L Burnett
- The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Md
| | - Jacques Buvat
- Centre d'Etude et de Traitement de la Pathologie de l'Appareil Reproducteur et de la Psychosomatique, Lille, France
| | - Culley Carson
- Department of Surgery, Division of Urologic Surgery, University of North Carolina, Chapel Hill
| | - Glenn Cunningham
- Departments of Medicine, and Molecular & Cellular Biology, Baylor College of Medicine and St. Luke's Episcopal Hospital, Houston, Tex
| | - Peter Ganz
- Division of Cardiology, San Francisco General Hospital and University of California, San Francisco, Calif
| | | | - Andre Guay
- Center For Sexual Function/Endocrinology, Lahey Clinic Medical Center, Peabody, Mass, Tufts University School of Medicine, Boston, Mass
| | | | - Robert A Kloner
- Heart Institute, Good Samaritan Hospital and Keck School of Medicine at University of Southern California, Los Angeles
| | - John B Kostis
- Cardiovascular Institute, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Piero Montorsi
- Centro Cardiologico Monzino, IRCCS, Institute of Cardiology University of Milan, Italy
| | - Melinda Ramsey
- Complete Healthcare Communications, Inc., Chadds Ford, Pa
| | - Raymond Rosen
- New England Research Institutes, Inc., Watertown, Mass
| | - Richard Sadovsky
- Department of Family Medicine, SUNY-Downstate Medical Center, Brooklyn, NY
| | - Allen Seftel
- Department of Urology, Cooper University Hospital, Camden, NJ
| | - Ridwan Shabsigh
- Division of Urology, Maimonides Medical Center, Brooklyn, NY, and College of Physicians and Surgeons of Columbia University, New York, NY
| | | | - Frederick Wu
- Andrology Research Unit, Developmental & Regenerative Biomedicine Research Group, University of Manchester, Manchester Academic Health Science Centre, Manchester Royal Infirmary, UK
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Abstract
Diabetes mellitus is one of the most common chronic diseases in nearly all countries. It has been associated with sexual dysfunction, both in males and in females. Diabetes is an established risk factor for sexual dysfunction in men, as a threefold increased risk of erectile dysfunction was documented in diabetic men, as compared with nondiabetic men. Among women, evidence regarding the association between diabetes and sexual dysfunction are less conclusive, although most studies have reported a higher prevalence of female sexual dysfunction in diabetic women as compared with nondiabetic women. Female sexual function appears to be more related to social and psychological components than to the physiological consequence of diabetes. Hyperglycemia, which is a main determinant of vascular and microvascular diabetic complications, may participate in the pathogenetic mechanisms of sexual dysfunction in diabetes. Moreover, diabetic people may present several clinical conditions, including hypertension, overweight and obesity, metabolic syndrome, cigarette smoking, and atherogenic dyslipidemia, which are themselves risk factors for sexual dysfunction, both in men and in women. The adoption of healthy lifestyles may reduce insulin resistance, endothelial dysfunction, and oxidative stress - all of which are desirable achievements in diabetic patients. Improved well-being may further contribute to reduce and prevent sexual dysfunction in both sexes.
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Affiliation(s)
- Maria Ida Maiorino
- Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy
| | - Giuseppe Bellastella
- Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy
| | - Katherine Esposito
- Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
- Correspondence: Katherine Esposito, Endocrinology and Metabolic Diseases Unit, University Hospital at Second University of Naples, Piazza L Miraglia no 2, 80138 Napoli, Italy, Tel +39 081 566 5031, Fax +39 081 566 5054, Email
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50
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Jackson G, Nehra A, Miner M, Billups KL, Burnett AL, Buvat J, Carson CC, Cunningham G, Goldstein I, Guay AT, Hackett G, Kloner RA, Kostis JB, Montorsi P, Ramsey M, Rosen R, Sadovsky R, Seftel AD, Shabsigh R, Vlachopoulos C, Wu FCW. The assessment of vascular risk in men with erectile dysfunction: the role of the cardiologist and general physician. Int J Clin Pract 2013; 67:1163-72. [PMID: 23714173 DOI: 10.1111/ijcp.12200] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 04/23/2013] [Indexed: 12/26/2022] Open
Abstract
Erectile dysfunction (ED) and cardiovascular disease (CVD) share risk factors and frequently coexist, with endothelial dysfunction believed to be the pathophysiologic link. ED is common, affecting more than 70% of men with known CVD. In addition, clinical studies have demonstrated that ED in men with no known CVD often precedes a CVD event by 2-5 years. ED severity has been correlated with increasing plaque burden in patients with coronary artery disease. ED is an independent marker of increased CVD risk including all-cause and especially CVD mortality, particularly in men aged 30-60 years. Thus, ED identifies a window of opportunity for CVD risk mitigation. We recommend that a thorough history, physical exam (including visceral adiposity), assessment of ED severity and duration and evaluation including fasting plasma glucose, lipids, resting electrocardiogram, family history, lifestyle factors, serum creatinine (estimated glomerular filtration rate) and albumin:creatinine ratio, and determination of the presence or absence of the metabolic syndrome be performed to characterise cardiovascular risk in all men with ED. Assessment of testosterone levels should also be considered and biomarkers may help to further quantify risk, even though their roles in development of CVD have not been firmly established. Finally, we recommend that a question about ED be included in assessment of CVD risk in all men and be added to CVD risk assessment guidelines.
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Affiliation(s)
- G Jackson
- Department of Cardiology, Guy's and St Thomas' Hospitals London, London, UK
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