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Prieto LR, Shires DA, Xiong Y. Factors Associated with Erectile Dysfunction Among Older Gay Men. ARCHIVES OF SEXUAL BEHAVIOR 2024:10.1007/s10508-024-02908-3. [PMID: 38839704 DOI: 10.1007/s10508-024-02908-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 04/10/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024]
Abstract
Erectile dysfunction (ED) is a common issue that aging men encounter, but whether internalized gay ageism (i.e., the internalization of ageist messages within the context of aging as a gay man) is related to ED among older gay men is unknown. A cross-sectional web-based survey explored the relationship between internalized gay ageism, health-related and social factors, and ED among older gay men who resided in the Midwest United States (N = 181). Internalized gay ageism was not significantly associated with ED. However, hierarchical regression analysis found that age (β = .224, t = 2.70, p = .008) and overall health (β = -.247, t = -3.05, p = .003) were significantly associated with ED among older gay men, suggesting that older gay men share similar risk factors for ED as the general male population. Future research should continue to explore other factors that are unique to gay men that may be associated with ED.
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Affiliation(s)
- Lucas R Prieto
- Department of Social Work, College of Public Health, George Mason University, Fairfax, VA, 22030, USA.
| | - Deirdre A Shires
- School of Social Work, Michigan State University, East Lansing, MI, USA
| | - Yuan Xiong
- School of Social Work, Michigan State University, East Lansing, MI, USA
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Ziapour A, Kazeminia M, Rouzbahani M, Bakhshi S, Montazeri N, Yıldırım M, Tadbiri H, Moradi F, Janjani P. Global prevalence of sexual dysfunction in cardiovascular patients: a systematic review and meta-analysis. Syst Rev 2024; 13:136. [PMID: 38769586 PMCID: PMC11103881 DOI: 10.1186/s13643-024-02525-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 04/10/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Sexual dysfunction poses a significant challenge for patients with cardiac conditions. Concerning the prevalence of sexual disorders in cardiovascular patients, several seminal studies conducted in various regions of the world have provided diverse facts and figures pertaining to sexual dysfunction among cardiovascular patients. Therefore, the present study aimed to analyze, summarize, and integrate the findings of seminal studies on the effect of underlying factors and estimate the global rate of sexual disorders in cardiovascular patients. METHODS The present systematic review and meta-analysis included studies conducted in 2003-2023. To find the relevant published academic papers, SID, MagIran, PubMed, Scopus, Web of Science (WOS), and Google Scholar databases were searched for keywords using MeSH/Emtree until January 14, 2023. The GRADEpro software was used to evaluate the quality of evidence. The heterogeneity of studies was checked using the I2 index. RESULTS An initial number of 2122 studies were found in the first search. Following a precise screening process based on predefined inclusion criteria, a total of 17 studies were deemed suitable for inclusion in the meta-analysis. The global prevalence of sexual disorders in cardiovascular patients was estimated at 62.6% (95% CI: 49.8-73.8%). As the results of the meta-regression showed that as the sample size increased, there was a significant decrease in the overall prevalence of sexual disorders among cardiovascular patients. Additionally, as the study years progressed, both age and JBI score exhibited an upward trend. CONCLUSION The present findings showed a high prevalence of sexual disorders among cardiovascular patients. Therefore, it is recommended that experts and health policymakers enhance their focus on effectively preventing and controlling these disorders. Besides the evidence achieved very low certainty, it is important for the treatment team to prioritize the sexual relations of cardiovascular patients and focus on improving their sexual function. This should be seen as an essential aspect of their overall recovery process.
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Affiliation(s)
- Arash Ziapour
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Kazeminia
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Rouzbahani
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Saeedeh Bakhshi
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nafiseh Montazeri
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Murat Yıldırım
- Department of Psychology, Faculty of Science and Letters, Agri Ibrahim Cecen University, Ağrı, Türkiye
- Graduate Studies and Research, Lebanese American University, Beirut, Lebanon
| | - Hani Tadbiri
- Islamic Azad University, Tehran Medical Branch, Tehran, Iran
| | - Farideh Moradi
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parisa Janjani
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Hu D, Zhang Y, Zhang Y, Liu Y, Han J. The relationship between social support and erectile dysfunction in middle-aged and older males. Front Public Health 2024; 12:1332561. [PMID: 38784589 PMCID: PMC11112009 DOI: 10.3389/fpubh.2024.1332561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
Background Erectile dysfunction (ED) is a prevalent condition that affects middle-aged and older men, impacting their sexual health and overall wellbeing. We aimed to investigate the relationship between social support and ED among this specific population. Methods Data were collected from the National Health and Nutrition Examination Survey. Social support was assessed through various dimensions, including emotional support, material support, and network support. Multivariate logistic regression was performed to examine the association between social support and ED, and a propensity-score-matched (PSM) analysis was further conducted. Results Among 1938 middle-aged and older males in the United States, 49.9% had a history of ED. ED was more prevalent in older individuals and those with comorbidities such as hypertension, prostate disease, higher serum creatinine level, and mental problems. Males with lower social support scores had a higher weighted rate of ED (P < 0.001). After adjusting for multiple variables in logistic regression analysis, a higher social support score was associated with a 19% lower likelihood of ED (weighted odds ratio [OR] 0.81, 95% confidence interval [CI] 0.66-0.98, P = 0.032). The association remained consistent after propensity score matching (OR 0.80, 95% CI 0.66-0.98, P = 0.028). Conclusion Social support appears to be associated with a reduced risk of ED in middle-aged and older men. Further research is needed to better understand this relationship and explore interventions that enhance social support, potentially leading to improved sexual health outcomes.
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Affiliation(s)
- Danqing Hu
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Yan Zhang
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
| | - Yue Zhang
- Department of Women's Health Care, Qingdao Maternal & Child Health and Family Planning Service Center, Qingdao, Shandong, China
| | - Yu Liu
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jing Han
- School of Nursing, Qingdao University, Qingdao, Shandong, China
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Lou IX, Chen J, Ali K, Chen Q. Relationship Between Hypertension, Antihypertensive Drugs and Sexual Dysfunction in Men and Women: A Literature Review. Vasc Health Risk Manag 2023; 19:691-705. [PMID: 37941540 PMCID: PMC10629452 DOI: 10.2147/vhrm.s439334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023] Open
Abstract
Sexual dysfunction pertains to any issue that hinders an individual from attaining sexual contentment. This health issue can have a significant impact on the quality of life and psychological health of affected individuals. Sexual dysfunction can generate stress, anxiety, depression, and low self-esteem, which can lead to a reduction in overall life satisfaction and the quality of interpersonal relationships. Sexual dysfunction can manifest as erectile dysfunction in men or lack of sexual desire in women. Although both sexes can experience sexual problems, there are some significant differences in the manifestation of sexual dysfunction between men and women. In men, sexual dysfunction is usually physical and associated with problems such as erectile dysfunction, while in women, sexual dysfunction is usually related to psychological factors. Additionally, there was an association between hypertension and sexual dysfunction in both the sexes. In men, hypertension can cause erection problems, whereas in women, it can cause vaginal dryness and a decrease in sexual desire. Furthermore, antihypertensive drugs can negatively impact sexual function, which can decrease adherence to drug treatment. However, nebivolol, an antihypertensive drug, has beneficial effects on erectile dysfunction in men. This is believed to be because nebivolol improves blood flow to the penis by producing nitric oxide, which can help improve erections.
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Affiliation(s)
- Inmaculada Xu Lou
- Department of Cardiology, International Education College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, People’s Republic of China
- Department of Cardiology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, 310025, People’s Republic of China
| | - Jiayue Chen
- Department of Cardiology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, 310025, People’s Republic of China
- Department of Cardiology, Hangzhou Clinical Medical College Internal Medicine of Traditional Chinese Medicine of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, People’s Republic of China
| | - Kamran Ali
- Department of Oncology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, Zhejiang, 322000, People’s Republic of China
| | - Qilan Chen
- Department of Cardiology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, 310025, People’s Republic of China
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Defeudis G, Mazzilli R, Tenuta M, Rossini G, Zamponi V, Olana S, Faggiano A, Pozzilli P, Isidori AM, Gianfrilli D. Erectile dysfunction and diabetes: A melting pot of circumstances and treatments. Diabetes Metab Res Rev 2022; 38:e3494. [PMID: 34514697 PMCID: PMC9286480 DOI: 10.1002/dmrr.3494] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/03/2021] [Indexed: 02/06/2023]
Abstract
Diabetes mellitus (DM), a chronic metabolic disease characterised by elevated levels of blood glucose, is among the most common chronic diseases. The incidence and prevalence of DM have been increasing over the years. The complications of DM represent a serious health problem. The long-term complications include macroangiopathy, microangiopathy and neuropathy as well as sexual dysfunction (SD) in both men and women. Erectile dysfunction (ED) has been considered the most important SD in men with DM. The prevalence of ED is approximately 3.5-fold higher in men with DM than in those without DM. Common risk factors for the development of DM and its complications include sedentary lifestyle, overweight/obesity and increased caloric consumption. Although lifestyle changes may help improve sexual function, specific treatments are often needed. This study aims to review the definition and prevalence of ED in DM, the impact of DM complications and DM treatment on ED and, finally, the current and emerging therapies for ED in patients with DM.
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Affiliation(s)
- Giuseppe Defeudis
- Unit of Endocrinology and DiabetesDepartment of MedicineUniversity Campus Bio‐Medico di RomaRomeItaly
| | - Rossella Mazzilli
- Department of Clinical and Molecular MedicineSapienza University of RomeRomeItaly
| | - Marta Tenuta
- Department of Experimental MedicineSapienza University of RomeRomeItaly
| | - Giovanni Rossini
- Unit of Endocrinology and DiabetesDepartment of MedicineUniversity Campus Bio‐Medico di RomaRomeItaly
| | - Virginia Zamponi
- Department of Clinical and Molecular MedicineSapienza University of RomeRomeItaly
| | - Soraya Olana
- Department of Clinical and Molecular MedicineSapienza University of RomeRomeItaly
| | - Antongiulio Faggiano
- Department of Clinical and Molecular MedicineSapienza University of RomeRomeItaly
| | - Paolo Pozzilli
- Unit of Endocrinology and DiabetesDepartment of MedicineUniversity Campus Bio‐Medico di RomaRomeItaly
| | - Andrea M. Isidori
- Department of Experimental MedicineSapienza University of RomeRomeItaly
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Foy CG, Newman JC, Russell GB, Berlowitz DR, Bates JT, Burgner AM, Carson TY, Chertow GM, Doumas MN, Hughes RY, Kostis JB, Buren PV, Wadley VG. Effect of Intensive vs Standard Blood Pressure Treatment Upon Erectile Function in Hypertensive Men: Findings From the Systolic Blood Pressure Intervention Trial. J Sex Med 2019; 17:238-248. [PMID: 31862174 DOI: 10.1016/j.jsxm.2019.11.256] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The effect of intensive blood pressure control upon erectile function in men with hypertension, but without diabetes, is largely unknown. AIM To examine the effects of intensive systolic blood pressure (SBP) lowering on erectile function in a multiethnic clinical trial of men with hypertension. METHODS We performed subgroup analyses from the Systolic Blood Pressure Intervention Trial ([SPRINT]; ClinicalTrials.gov: NCT120602, in a sample of 1255 men aged 50 years or older with hypertension and increased cardiovascular disease risk. Participants were randomly assigned to an intensive treatment group (SBP goal of <120 mmHg) or a standard treatment group (SBP goal of <140 mmHg). MAIN OUTCOME MEASURE The main outcome measure was change in erectile function from baseline, using the 5-item International Index of Erectile Function (IIEF-5) total score, and erectile dysfunction ([ED]; defined as IIEF-5 score ≤21) after a median follow-up of 3 years. RESULTS At baseline, roughly two-thirds (66.1%) of the sample had self-reported ED. At 48 months after randomization, we determined that the effects of more intensive blood pressure lowering were significantly moderated by race-ethnicity (p for interaction = 0.0016), prompting separate analyses stratified by race-ethnicity. In non-Hispanic whites, participants in the intensive treatment group reported slightly, but significantly better change in the IIEF-5 score than those in the standard treatment group (mean difference = 0.67; 95% CI = 0.03, 1.32; P = 0.041). In non-Hispanic blacks, participants in the intensive group reported slightly worse change in the IIEF-5 score than those in the standard group (mean difference = -1.17; 95% CI = -1.92, -0.41; P = 0.0025). However, in non-Hispanic whites and non-Hispanic blacks, further adjustment for the baseline IIEF-5 score resulted in nonsignificant differences (P > 0.05) according to the treatment group. In Hispanic/other participants, there were no significant differences in change in the IIEF-5 score between the two treatment groups (P = 0.40). In a subgroup of 280 participants who did not report ED at baseline, the incidence of ED did not differ in the two treatment groups (P = 0.53) and was without interaction by race-ethnicity. CLINICAL IMPLICATIONS The effect of intensive treatment of blood pressure on erectile function was very small overall and likely not of great clinical magnitude. STRENGTH & LIMITATIONS Although this study included a validated measure of erectile function, testosterone, other androgen, and estrogen levels were not assessed. CONCLUSION In a sample of male patients at high risk for cardiovascular events but without diabetes, targeting a SBP of less than 120 mm Hg, as compared with less than 140 mm Hg, resulted in statistically significant effects on erectile function that differed in accordance with race-ethnicity, although the clinical importance of the differences may be of small magnitude. Foy CG, Newman JC, Russell GB, et al. Effect of Intensive vs Standard Blood Pressure Treatment Upon Erectile Function in Hypertensive Men: Findings From the Systolic Blood Pressure Intervention Trial. J Sex Med 2020;17:238-248.
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Affiliation(s)
- Capri G Foy
- Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Jill C Newman
- Division of Public Health Sciences, Department of Biostatistic and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Greg B Russell
- Division of Public Health Sciences, Department of Biostatistic and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Dan R Berlowitz
- Bedford VA Hospital, Bedford, MA, and Boston University School of Medicine and Boston University School of Public Health, Boston, MA, USA
| | - Jeffrey T Bates
- Michael E. DeBakey Veterans' Administration Medical Center, Houston, TX, USA
| | - Anna M Burgner
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Thaddeus Y Carson
- Division of Internal Medicine, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Glenn M Chertow
- Division of Nephrology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Michael N Doumas
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Robin Y Hughes
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | - John B Kostis
- Robert Wood Johnson Medical School, Rutgers University, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ, USA
| | - Peter van Buren
- Department of Internal Medicine, Dallas Veterans' Administration Medical Center and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Virginia G Wadley
- Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
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Male sexual dysfunction: A review of literature on its pathological mechanisms, potential risk factors, and herbal drug intervention. Biomed Pharmacother 2019; 112:108585. [DOI: 10.1016/j.biopha.2019.01.046] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/16/2019] [Accepted: 01/16/2019] [Indexed: 02/07/2023] Open
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Penile Doppler ultrasonography and elastography evaluation in patients with erectile dysfunction. Pol J Radiol 2018; 83:e491-e499. [PMID: 30655929 PMCID: PMC6334185 DOI: 10.5114/pjr.2018.80301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 08/08/2018] [Indexed: 01/23/2023] Open
Abstract
Purpose To evaluate the relationship between erection grade, erectile function score, Doppler ultrasonography (US) indexes, and elasticity score (ES) according to Doppler US diagnosis in patients with erectile dysfunction (ED). Material and methods Real-time strain type penile elastography was performed during penile Doppler US examination for 88 patients with ED. The diagnosis according to Doppler US was determined. Erection score according to the Erection Hardness Grading Scale was evaluated. A scoring for erectile function was performed with the International Index of Erectile Function (IIEF-5), and the Sexual Health Inventory for Men (SHIM) was defined. The relationships, according to Doppler diagnosis, of ES, IIEF-5 score, SHIM scale, and erection score were evaluated. Results Among the patients, 50 (57%) had abnormal penile Doppler US findings. According to Doppler US findings, patients were classified as normal (n = 38), borderline for arterial insufficiency (n = 4), arterial insufficiency (n = 5), and venous insufficiency (n = 41). The lowest erection hardness grades and IIEF-5 scores were detected in patients with arterial failure. When compared to the normal group, in terms of ES, the arterial failure borderline group and venous failure group had lower scores, and the arterial failure group had a higher score. However, the only significant difference was obtained in the left cavernous body of the venous failure group. Conclusions Sonoelastography seems to add additional value for determination of stiffness of the penile cavernous body in routine evaluation of ED.
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Dzenkeviciute V, Petrulioniene Z, Rinkuniene E, Sapoka V, Petrylaite M, Badariene J. Cardiorenal Determinants of Erectile Dysfunction in Primary Prevention: A Cross-Sectional Study. Med Princ Pract 2018; 27:73-79. [PMID: 29131062 PMCID: PMC5968257 DOI: 10.1159/000484949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 11/05/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the association between the severity of erectile dysfunction (ED), cardiovascular risk, and target organ damage (heart, renal, vascular) in men free of cardiovascular diseases (CVD). SUBJECTS AND METHODS ED was assessed using the International Index of Erectile Function (IIEF-5). The study included 182 men: 100 with ED (IIEF mean score ≤21) and 82 without ED (IIEF mean score >21). Ultrasound was used to evaluate carotid plaques and left ventricular mass, geometry, and diastolic function. Cardiovascular anamnesis, CVD risk factors, and anthropometric and biochemical parameters were obtained. The European Society of Cardiology-Systematic Coronary Risk Evaluation Score (ESC-SCORE) was used to calculate total patient cardiovascular risk. Continuous variables between groups were compared using the Student t test and Mann-Whitney U test, while categorical data were compared using the χ2 test. Multiple linear regression was used to test the association between the severity of ED and presence of target organ damage. RESULTS The following parameters were significantly higher in the ED group compared to the controls: family history of coronary heart disease (43.7 vs. 26.7%, p = 0.047), ESC-SCORE (2.27 ± 1.79 vs. 1.61 ± 1.13, p = 0.012), and waist circumference (109.28 ± 10.82 vs. 106.17 ± 10.07, p = 0.047). Impaired renal function (p = 0.081), albuminuria (p = 0.545), vascular damage (p = 0.602), and diastolic function (p = 0.724) were similar in both groups. However, left ventricular hypertrophy (LVH; odds ratio 2.231, 95% CI 1.069-4.655, p = 0.22) was more frequent in the ED group (29.9 vs. 16.0%). The multiple linear regression analysis revealed that LVH (β = 1.761, p = 0.002) and impaired renal function assessed using the estimated glomerular filtration rate (<60 mL/min/1.73 m2; β = 6.207, p = 0.0001) were the independent risk factors for severity of ED. CONCLUSION This study showed that LVH and impaired renal function are associated with ED severity.
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Affiliation(s)
- Vilma Dzenkeviciute
- Clinic of Internal Medicine, Oncology and Family Medicine, Vilnius University, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- *Vilma Dzenkeviciute, Clinic of Internal Medicine, Oncology and Family Medicine, Faculty of Medicine, Vilnius University, Santariškių 2, LT-08611 Vilnius (Lithuania), E-Mail
| | - Zaneta Petrulioniene
- Clinic of Heart and Vascular Medicine, Vilnius University, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Egidija Rinkuniene
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Virginijus Sapoka
- Clinic of Internal Medicine, Oncology and Family Medicine, Vilnius University, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | - Jolita Badariene
- Clinic of Heart and Vascular Medicine, Vilnius University, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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