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Chiang CH, Hung WT, Liu ES, Yang TH, Cheng CC, Huang WC, Mar GY, Kuo FY. The influence of testosterone on the risk of cardiovascular events after percutaneous coronary intervention. Front Cardiovasc Med 2022; 9:998056. [PMID: 36620620 PMCID: PMC9815835 DOI: 10.3389/fcvm.2022.998056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
Methods Between 2015 and 2018, 580 men undergoing PCI at a tertiary referral hospital were divided into low (<3.25 ng/mL) and normal (≥3.25 ng/mL) testosterone groups. Major adverse cardiovascular event (MACE) was defined as the composite outcome of CV death, myocardial infarction, and target lesion revascularization/target vessel revascularization (TLR/TVR) during up to 48 months follow-up after PCI. Results There were 111 and 469 patients in the low and normal testosterone groups, respectively, with the overall MACE rate of the former being higher than the latter (26.13% vs. 13.01%, p = 0.0006). Moreover, the overall TLR/TVR (20.72% vs. 11.73%, p = 0.0125) and myocardial infarction (3.6% vs. 0.85%, p = 0.0255) rates were significantly higher in those with low serum testosterone who also had a shorter average event-free survival analysis of MACE (25.22 ± 0.88 months) than those with normal testosterone levels (35.09 ± 0.47 months, log-rank p = 0.0004). Multiple logistic regression demonstrated an association between low serum testosterone (<3.25 ng/mL) and a higher MACE rate [odds ratio: 2.06, 95% confidence interval (CI) 1.21-3.51, p = 0.0081]. After adjusting for variables in a Cox regression model, hazard ratios (HRs) for MACE (HR: 1.88, 95% CI: 1.20-2.95, p = 0.0058) and TLR/TVR (HR: 1.73, 95% CI: 1.06-2.83, p = 0.0290) rates were higher in the low testosterone group than those in the normal testosterone group. Conclusion Low serum testosterone concentrations were associated with a higher risk of MACE and TLR/TVR after PCI than those with normal testosterone levels.
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Affiliation(s)
- Cheng-Hung Chiang
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wan-Ting Hung
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - En-Shao Liu
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Tse-Hsuan Yang
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chin-Chang Cheng
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Chun Huang
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan,Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Guang-Yuan Mar
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Feng-Yu Kuo
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,Department of Pharmacy and Master Program, College of Pharmacy and Health Care, Tajen University, Pingtung, Taiwan,*Correspondence: Feng-Yu Kuo,
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Jósvai A, Török M, Hetthéssy J, Mátrai M, Monori-Kiss A, Makk J, Vezér M, Sára L, Szabó I, Székács B, Nádasy GL, Várbíró S. Additive damage in the thromboxane related vasoconstriction and bradykinin relaxation of intramural coronary resistance arterioles in a rodent model of andropausal hypertension. Heliyon 2022; 8:e11533. [PMID: 36406706 PMCID: PMC9667244 DOI: 10.1016/j.heliyon.2022.e11533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/17/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022] Open
Abstract
Hypertension and andropause both accelerate age–related vascular deterioration. We aimed to evaluate the effects of angiotensin-II induced hypertension and deficiency of testosterone combined regarding the resistance coronaries found intramurally. Four male groups were formed from the animals: control group (Co, n = 10); the group that underwenr orchidectomy (ORC, n = 13), those that received an infusion of angiotensin-II (AII, n = 10) and a grous that received AII infusion and were also surgically orchidectomized (AII + ORC, n = 8). AII and AII + ORC animals were infused with infusing angiotensin-II (100 ng/min/kg) using osmotic minipumps. Orchidectomy was perfomed in the ORC and the AII + ORC groupsto establish deficiency regarding testosterone. Following four weeks of treatment, pressure-arteriography was performed in vitro, and the tone induced by administration of thromboxane-agonist (U46619) and bradykinin during analysis of the intramural coronaries (well-known to be resistance arterioles) was studied. U46619-induced vasoconstriction poved to be significantly decreased in the ORC and AII + ORC groups when compared with Co and AII animals. In ORC and AII + ORC groups, the bradykinin-induced relaxation was also significantly reduced to a greater extent compared to Co and AII rats. Following orchidectomy, the vasocontraction and vasodilatation capacity of blood vessels is reduced. The effect of testosterone deficiency on constrictor tone and relaxation remains pronounced even in AII hypertension: testosterone deficiency further narrows adaptation range in the double noxa (AII + ORC) group. Our studies suggest that vascular changes caused by high blood pressure and testosterone deficiency together may significantly increase age-related cardiovascular risk.
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Affiliation(s)
- Attila Jósvai
- Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Neurosurgery, Hungarian Defense Forces Medical Centre, Budapest, Hungary
| | - Marianna Török
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
- Workgroup of Science Management, Doctoral School, Semmelweis University, Budapest, Hungary
- Corresponding author.
| | - Judit Hetthéssy
- Workgroup of Science Management, Doctoral School, Semmelweis University, Budapest, Hungary
- Department of Orthopedics, Semmelweis University, Budapest, Hungary
| | - Máté Mátrai
- Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Anna Monori-Kiss
- Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Jennifer Makk
- Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Márton Vezér
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Levente Sára
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - István Szabó
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Béla Székács
- Department Internal Medicine, Department Section of Geriatrics, Szt Imre Teaching Hospital, Budapest, Hungary
| | - György L. Nádasy
- Department of Physiology, Semmelweis University, Budapest, Hungary
| | - Szabolcs Várbíró
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
- Workgroup of Science Management, Doctoral School, Semmelweis University, Budapest, Hungary
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Cannarella R, Barbagallo F, Condorelli RA, Gusmano C, Crafa A, La Vignera S, Calogero AE. Erectile Dysfunction in Diabetic Patients: From Etiology to Management. DIABETOLOGY 2021; 2:157-164. [DOI: 10.3390/diabetology2030014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Diabetes mellitus (DM) is a widespread chronic disease with a prevalence that is expected to further increase in the near future. The classical management of DM includes the normalization of the glycometabolic profile and the evaluation of cardiac and cerebral vascular health by the intervention of an array of different specialists. However, so far, sexual dysfunctions are still a neglected complication in patients with DM, although there is an elevated prevalence of this long-term complication in male and female patients. Furthermore, some of them may represent a sign of vascular alteration and/or hypogonadism and require timely management to prevent the onset of major adverse cardiac events. This narrative review briefly summarizes the current evidence on epidemiology, pathogenesis, diagnosis, and therapy of erectile dysfunction in male patients with DM to support diabetologists in clinical practice.
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East L, Jackson D, Manias E, Dunning T, Hutchinson M. Patient perspectives and experiences of sexual health conversations and cardiovascular disease: A qualitative study. J Clin Nurs 2021; 30:3194-3204. [PMID: 33931920 DOI: 10.1111/jocn.15820] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 03/28/2021] [Accepted: 04/06/2021] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to explore the experiences of individuals discussing sexual well-being with healthcare professions within the context of their cardiac illness to determine their sexual health information needs. BACKGROUND Cardiovascular disease is the leading cause of morbidity and mortality worldwide and known to have a detrimental impact on sexual health. Despite sexual health being recognised as a fundamental component of well-being, it may be a neglected aspect of care within the context of cardiovascular disease. DESIGN A qualitative exploratory study conducted in accordance with COREQ guidelines. METHODS We conducted semi-structured interviews with participants (n = 13) aged between 30-77 years who had been diagnosed with a cardiovascular disease. Data were transcribed and subject to thematic analysis. RESULTS/FINDINGS Analysis revealed two major themes-Sexual healthcare information and expectations: I expect them to tell me and Experiences of sexual adversity: it's really scary. Although participants expected and welcomed information in relation to their illness and sexual health, this was rarely received. Subsequently, when some participants experienced sexual adversity including erectile dysfunction, they felt anxious and distressed which impacted their intimated relationships. It was often when participants sought information associated with adversity that information was provided and this was primarily in relation to medication associated with assisting dysfunction. CONCLUSION Individuals who have cardiovascular disease may require sexual health care. Nurses are well placed to provide information and education associated with cardiovascular disease and associated sexual well-being to promote positive outcomes for individuals and minimise distress around sexual adversity. RELEVANCE TO CLINICAL PRACTICE Findings highlight the importance of providing clear and accurate information about sexual well-being and function to patients experiencing cardiovascular disease. Provision of information should be considered an essential and routine aspect of care with patients being afforded opportunities to discuss concerns associated with their sexual well-being.
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Affiliation(s)
- Leah East
- Faculty of Medicine and Health, School of Health, University of New England/Hunter New England Health, Armidale, New South Wales, Australia
| | - Debra Jackson
- Susan Wakil School of Nursing, University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth Manias
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Trisha Dunning
- Centre for quality and Patient safety Research, School of Nursing and Midwifery, Deakin University Barwon Health Partnership, Geelong, Victoria, Australia
| | - Marie Hutchinson
- School of Health and Human Sciences, Southern Cross University, Coffs Harbour, New South Wales, Australia
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Zhang X, Zhao H, Horney J, Johnson N, Saad F, Haider KS, Haider A, Xu X. Recent testosterone drop-off and risk of cardiovascular events. Aging Male 2020; 23:1611-1619. [PMID: 33724145 DOI: 10.1080/13685538.2021.1896700] [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] [Indexed: 10/21/2022] Open
Abstract
Low baseline testosterone level has been associated with the development of risk factors for cardiovascular disease such as insulin resistance and obesity. In addition to the absolute testosterone level, remarkable changes in testosterone level may have an acute effect on cardiovascular disease development and progression, which has been rarely investigated. In this study, we used a clinical dataset of 376 hypogonadal men whose testosterone levels were measured every six months for up to 11 years from a registry study in Germany, and conducted survival analyses to investigate the effect of testosterone changes since the last visit (time-varying) on the risk of cardiovascular events. Given the potential discrepancies in comorbidity conditions among patients with prior cardiovascular events and those without, all the analyses were stratified by patients' prior cardiovascular event status. We found the effects were not different among patients with prior cardiovascular events and those without. Regardless of patients' prior cardiovascular event status, patients with larger testosterone declines (≥3.12 nmol/L, 90th percentile) since the last visit were more likely to experience myocardial infarction. In conclusion, recent pronounced testosterone drop-offs may affect the risk of cardiovascular events among hypogonadal men. Future longitudinal studies are needed to confirm our exploratory study findings.
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Affiliation(s)
- Xiao Zhang
- Department of Epidemiology and Biostatistics, Texas A&M University, College Station, TX, USA
| | - Hongwei Zhao
- Department of Epidemiology and Biostatistics, Texas A&M University, College Station, TX, USA
| | - Jennifer Horney
- College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Natalie Johnson
- Department of Environmental and Occupational Health, Texas A&M University, College Station, TX, USA
| | - Farid Saad
- Research Department, Gulf Medical University, Ajman, UAE
| | | | | | - Xiaohui Xu
- Department of Epidemiology and Biostatistics, Texas A&M University, College Station, TX, USA
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Jósvai A, Török M, Mátrai M, Hetthéssy J, Monori-Kiss A, Makk J, Székács B, Nádasy GL, Várbíró S. Effects of Testosterone Deficiency and Angiotensin II-Induced Hypertension on the Biomechanics of Intramural Coronary Arteries. J Sex Med 2020; 17:2322-2330. [PMID: 33067160 DOI: 10.1016/j.jsxm.2020.09.003] [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: 06/01/2020] [Revised: 08/14/2020] [Accepted: 09/12/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Andropause and hypertension also increase the risk of coronary artery damage. AIM To investigate the effect of testosterone deficiency and hypertension on intramural coronary vessels. METHODS 4 groups of 8-week-old Sprague-Dawley rats were studied: control male (Co, n=10), orchidectomized male (OCT, n=13), angiotensin (AII) hypertensive male (AII, n=10), and AII hypertensive and OCT (AII + OCT, n=8). Surgical orchidectomy was performed, and an osmotic minipump was inserted for chronic angiotensin II infusion (100 ng/min/kg). After 4 weeks, spontaneous tone and biomechanical properties of the intramural coronary resistance artery were investigated in vitro, by pressure microarteriography. OUTCOMES Morphology and biomechanics of the intramural coronaries were evaluated: the outer diameter, wall thickness-to-lumen diameter ratio, and tangential wall stress in the contracted and relaxed states. RESULTS The outer diameter was reduced in OCT and AII + OCT groups (on 50 mmHg 315 ± 20 Co; 237 ± 21 OCT; 291 ± 16 AII, and 166 ± 12 μm AII + OCT). The increased wall thickness-to-lumen diameter ratio resulted in lower tangential wall stress in AII + OCT rats (on 50 mmHg 19 ± 2 Co; 24 ± OCT; 26 ± 5 AII, and 9 ± 1 kPa AII + OCT). Spontaneous tone was increased in the hypertensive rats (AII and AII + OCT groups) (on 50 mmHg 7.7 ± 1.8 Co; 6.1 ± 1.4 OCT; 14.5 ± 3.0 AII, and 17.4 ± 4.1 % AII + OCT). CLINICAL IMPLICATIONS Andropause alone can be considered as a cardiovascular risk factor that will further exacerbate vascular damage in hypertension. STRENGTHS & LIMITATIONS A limitation of our study is that it was performed on relatively young rats, and the conclusions might not apply to coronary remodelling in older animals with slower adaptation processes. CONCLUSIONS Testosterone deficiency and hypertension damage the mechanical adaptation of the vessel wall additively: double noxa caused inward eutrophic remodeling and increased tone. Jósvai A, Török M, Mátrai M, et al. Effects of Testosterone Deficiency and Angiotensin II-Induced Hypertension on the Biomechanics of Intramural Coronary Arteries. J Sex Med 2020;17:2322-2330.
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Affiliation(s)
- Attila Jósvai
- Department of Neurosurgery, Hungarian Defence Forces Medical Centre, Budapest, Hungary.
| | - Marianna Török
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Máté Mátrai
- Institute of Clinical Experimental Research, Semmelweis University, Budapest, Hungary
| | - Judit Hetthéssy
- Department of Orthopedics, Semmelweis University, Budapest, Hungary
| | - Anna Monori-Kiss
- Institute of Clinical Experimental Research, Semmelweis University, Budapest, Hungary
| | - Jennifer Makk
- Institute of Clinical Experimental Research, Semmelweis University, Budapest, Hungary
| | - Béla Székács
- 2nd Department Internal Medicine, Department Section of Geriatrics, Szt Imre Teaching Hospital, Budapest, Hungary
| | - György L Nádasy
- Department of Physiology, Semmelweis University, Budapest, Hungary
| | - Szabolcs Várbíró
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
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