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Izu-Belloso R, Gainza-Apraiz I, Ortiz-Romero P, Servitje-Bedate O, Fernández de Misa-Cabrera R, Peñate Y, Hernandez-Machin B, Estrach-Panella T, Llamas-Velasco M, Yanguas-Bayona JI, Morillo-Andujar M, Acebo-Mariñas E, Perez-Gala S, Armario-Hita JC, Sanchez-Sambucety P, Ortiz-Brugues A, Eguren-Michelena C, Bielsa-Marsol I, Lopez-Pestaña A, Blanes-Martinez M, Fernandez-Guarino M, Lopez-Lerma I. Experience With Bexarotene to Treat Cutaneous T-Cell Lymphomas: A Study of the Spanish Working Group of Cutaneous Lymphomas. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T547-T554. [PMID: 38653368 DOI: 10.1016/j.ad.2024.04.017] [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: 07/25/2023] [Accepted: 12/04/2023] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Bexarotene has been approved to treat advanced stage cutaneous T-cell lymphomas (CTCL) since 1999. However, very few data have been published on its long-term safety and efficacy profile. The aim of this study is to determine the tolerability to bexarotene and outcomes by collecting the 2nd largest case series to date on its long-term use vs CTCL. MATERIAL AND METHOD This was a multicenter retrospective review of 216 patients with mycosis fungoides (174), or Sézary syndrome (42) on a 10-year course of bexarotene alone or in combination with other therapies at 19 tertiary referral teaching hospitals. RESULTS A total of 133 men (62%) and 83 women (38%) were included, with a mean age of 63.5 year (27-95). A total of 45% were on bexarotene monotherapy for the entire study period, 22% started on bexarotene but eventually received an additional therapy, 13% were on another treatment but eventually received bexarotene while the remaining 20% received a combination therapy since the beginning. The median course of treatment was 20.78 months (1-114); and the overall response rate, 70.3%. Complete and partial response rates were achieved in 26% and 45% of the patients, respectively. Treatment was well tolerated, being the most common toxicities hypertriglyceridemia (79%), hypercholesterolemia (71%), and hypothyroidism (52%). No treatment-related grade 5 adverse events were reported. CONCLUSIONS Our study confirms bexarotene is a safe and effective therapy for the long-term treatment of CTCL.
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Affiliation(s)
| | | | | | | | | | - Y Peñate
- Complejo Hospitalario Universitario Insular Materno-Infantil, Gran Canaria, España
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2
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Izu-Belloso R, Gainza-Apraiz I, Ortiz-Romero P, Servitje-Bedate O, Fernández de Misa-Cabrera R, Peñate Y, Hernandez-Machin B, Estrach-Panella T, Llamas-Velasco M, Yanguas-Bayona JI, Morillo-Andujar M, Acebo-Mariñas E, Perez-Gala S, Armario-Hita JC, Sanchez-Sambucety P, Ortiz-Brugues A, Eguren-Michelena C, Bielsa-Marsol I, Lopez-Pestaña A, Blanes-Martinez M, Fernandez-Guarino M, Lopez-Lerma I. Experience With Bexarotene to Treat Cutaneous T-Cell Lymphomas: A Study of the Spanish Working Group of Cutaneous Lymphomas. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:547-554. [PMID: 38395224 DOI: 10.1016/j.ad.2023.12.007] [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: 07/25/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Bexarotene has been approved to treat advanced stage cutaneous T-cell lymphomas (CTCL) since 1999. However, very few data have been published on its long-term safety and efficacy profile. The aim of this study is to determine the tolerability to bexarotene and outcomes by collecting the 2nd largest case series to date on its long-term use vs CTCL. MATERIAL AND METHOD This was a multicenter retrospective review of 216 patients with mycosis fungoides (174), or Sézary syndrome (42) on a 10-year course of bexarotene alone or in combination with other therapies at 19 tertiary referral teaching hospitals. RESULTS A total of 133 men (62%) and 83 women (38%) were included, with a mean age of 63.5 year (27-95). A total of 45% were on bexarotene monotherapy for the entire study period, 22% started on bexarotene but eventually received an additional therapy, 13% were on another treatment but eventually received bexarotene while the remaining 20% received a combination therapy since the beginning. The median course of treatment was 20.78 months (1-114); and the overall response rate, 70.3%. Complete and partial response rates were achieved in 26% and 45% of the patients, respectively. Treatment was well tolerated, being the most common toxicities hypertriglyceridemia (79%), hypercholesterolemia (71%), and hypothyroidism (52%). No treatment-related grade 5 adverse events were reported. CONCLUSIONS Our study confirms bexarotene is a safe and effective therapy for the long-term treatment of CTCL.
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Affiliation(s)
| | | | | | | | | | - Y Peñate
- Complejo Hospitalario Universitario Insular Materno-Infantil, Gran Canaria, Spain
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3
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Chihaoui M, Terzi A, Hammami B, Oueslati I, Khessairi N, Chaker F, Yazidi M, Feki M. Effects of high-intensity statin therapy on steroid hormones and vitamin D in type 2 diabetic men: A prospective self-controlled study. Lipids 2024. [PMID: 38764377 DOI: 10.1002/lipd.12399] [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: 11/26/2023] [Revised: 05/07/2024] [Accepted: 05/07/2024] [Indexed: 05/21/2024]
Abstract
The study aimed to assess the effect of high-intensity statin therapy on testicular and adrenal steroids and vitamin D levels in type 2 diabetic men. A prospective study, conducted between March 2021 and July 2022, including 60 men with type 2 diabetes, aged 40-65 years, statin-free, and in whom treatment with high-intensity statin was indicated. The patients had two visits, before and 6 months after a daily intake of 40 mg of atorvastatin. During each visit, they underwent a clinical examination, and a fasting blood sample was collected for biological and hormonal measurements. There was a significant increase in the prevalence of decreased libido (from 22% to 47%, p = 0.001) and a significant decrease in the frequency of sexual intercourse (from 4 [1-8] to 3 [0-4] per month, p = 0.005). The median ADAM's score significantly increased (from 4 [2-7] to 6 [3-8], p = 0.000). Twenty-two percent of the patients developed gynecomastia. The median total, bioavailable and free testosterone significantly decreased from 15.1 (11.4-17.4), 6.3 (5.0-7.8), and 0.27 (0.22-0.33) nmol/L to 12.7 (10.7-15.9), 5.7 (4.4-7.0), and 0.24 (0.19-0.30) nmol/L, respectively, with no change in FSH and LH levels. Three patients (5%) developed hypogonadism (testosterone <8 nmol/L). There was a significant decrease in DHEAS from 4.5 (2.8-6.1) to 3.8 μmol/L (2.6-5.6) and no change in cortisol and vitamin D levels. High-intensity statin therapy decreased androgen levels in type 2 diabetic men with significant clinical impact.
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Affiliation(s)
- Melika Chihaoui
- Department of Endocrinology, La Rabta University Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Amani Terzi
- Department of Endocrinology, La Rabta University Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Bessam Hammami
- Department of Biochemistry, La Rabta University Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Ibtissem Oueslati
- Department of Endocrinology, La Rabta University Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Nadia Khessairi
- Department of Endocrinology, La Rabta University Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Fatma Chaker
- Department of Endocrinology, La Rabta University Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Meriem Yazidi
- Department of Endocrinology, La Rabta University Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Moncef Feki
- Department of Biochemistry, La Rabta University Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
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Su Q, Wang R, Luo Y, Tang Q, Wang K. Genetic association of lipid-lowering drug target genes with erectile dysfunction and male reproductive health. Front Endocrinol (Lausanne) 2024; 15:1362499. [PMID: 38390206 PMCID: PMC10881712 DOI: 10.3389/fendo.2024.1362499] [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: 12/28/2023] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Objective The effect of hypolipidemic drugs on male erectile function is still controversial. This Mendelian randomization (MR) study aimed to explore the potential impact of lipid-lowering drug targets on ED. Methods We collected seven genetic variants encoding lipid-lowering drug targets (LDLR, HMGCR, NPC1L1, PCSK9, APOB, APOC3 and LPL) from published genome-wide association study (GWAS) statistics, and performed drug target MR analysis. The risk of ED was defined as the primary outcome, sex hormone levels and other diseases as the secondary outcomes. Mediation analyses were performed to explore potential mediating factors. Results The results showed that LDLR, LPL agonists and APOC3 inhibitors were significantly associated with a reduced risk of ED occurrence. APOB inhibitors were associated with an increased risk of ED occurrence. In terms of sex hormone levels, LDLR and LPL agonists were significantly associated with increased TT levels, and HMGCR was associated with decreased TT and BT levels significantly. In terms of male-related disease, MR results showed that LDLR agonists and PCSK9 inhibitors were significantly associated with an elevated risk of PH; HMGCR, NPC1L1 inhibitors were associated with a reduced risk of PCa; and LDLR agonists were significantly associated with a reduced risk of AS and MI; in addition, HMGCR inhibitors were associated with a reduced risk of PCa. Conclusion After performing drug-targeted MR analysis, we found that that there was a causal relationship between lipid-lowering drug targets and ED. APOC3, APOB, LDLR and LPL may be new candidate drug targets for the treatment of ED.
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Affiliation(s)
- Quanxin Su
- Department of Urology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Rui Wang
- Department of Urology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yayin Luo
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Qizhen Tang
- Department of Urology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Kenan Wang
- Department of Urology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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Zhang JL, Lv M, Yang CF, Zhu YX, Li CJ. Mevalonate pathway and male reproductive aging. Mol Reprod Dev 2023; 90:774-781. [PMID: 37733694 DOI: 10.1002/mrd.23705] [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: 07/17/2022] [Revised: 08/27/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023]
Abstract
Male fertility declines with age. The mevalonate pathway, through which cholesterol and nonsteroidal isoprenoids are synthesized, plays key role in metabolic processes and is an essential pathway for cholesterol production and protein prenylation. Male reproductive aging is accompanied by dramatic changes in the metabolic microenvironment of the testis. Since the mevalonate pathway has an important role in spermatogenesis, we attempted to explore the association between male reproductive aging and the mevalonate pathway to explain the mechanism of male reproductive aging. Alterations in the mevalonate pathway may affect male reproductive aging by decreasing cholesterol synthesis and altering testis protein prenylation. Decreased cholesterol levels affect cholesterol modification, testosterone production, and remodeling of germ cell membranes. Aging-related metabolic disorders also affect the metabolic coupling between somatic cells and spermatogenic cells, leading to male fertility decline. Therefore, we hypothesized that alterations in the mevalonate pathway represent one of the metabolic causes of reproductive aging.
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Affiliation(s)
- Jia-Le Zhang
- State Key Laboratory of Reproductive Medicine and China International Joint Research Center on Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Meng Lv
- State Key Laboratory of Reproductive Medicine and China International Joint Research Center on Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Chao-Fan Yang
- State Key Laboratory of Reproductive Medicine and China International Joint Research Center on Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Ying-Xi Zhu
- State Key Laboratory of Reproductive Medicine and China International Joint Research Center on Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Chao-Jun Li
- State Key Laboratory of Reproductive Medicine and China International Joint Research Center on Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
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Testosterone Deficiency as One of the Major Endocrine Disorders in Chronic Kidney Disease. Nutrients 2022; 14:nu14163438. [PMID: 36014945 PMCID: PMC9415930 DOI: 10.3390/nu14163438] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/11/2022] [Accepted: 08/19/2022] [Indexed: 11/28/2022] Open
Abstract
Reduced testosterone concentration is nowadays thought to be one of the main endocrine disorders in chronic kidney disease (CKD). It is caused by the dysfunction of the hypothalamic-pituitary-gonadal axis. The role of testosterone is multifactorial. Testosterone is responsible not only for reproductive processes, but it is a hormone which increases bone and muscle mass, improves lipid profile, insulin sensitivity, erythropoiesis, reduces blood pressure, and ameliorates mood and perception. The implications of hypogonadism in CKD are infertility and loss of libido, reduction of muscle mass and strength, disorders in bone mineralization, the development of sarcopenia and protein energy wasting (PEW), progression of atherosclerosis, increased visceral adiposity, insulin resistance, and anaemia. Reduced testosterone serum concentrations in CKD are associated with increased mortality rate. Testosterone supplementation improves sexual functions, reduces the level of inflammatory markers and blood pressure, stimulates muscle protein synthesis, improves insulin sensitivity and lipid profile, and increases muscle mass, bone mineral density, and haemoglobin concentration. It positively affects mood and well-being. The modes of testosterone supplementation are intramuscular injections, subcutaneous pellets, and percutaneous methods—patches and gels. Successful kidney transplantation may improve gonadal function and testosterone production, however, half of men with low testosterone concentrations before kidney transplantation do not restore hormonal function.
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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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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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Lopez DS, Huang D, Tsilidis KK, Canfield S, Khera M, Baillargeon JG, Kuo YF, Peek MK, Platz EA, Markides K. The role of testosterone replacement therapy and statin use, and their combination, in prostate cancer. Cancer Causes Control 2021; 32:965-976. [PMID: 34041642 DOI: 10.1007/s10552-021-01450-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/18/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Previous studies have reported conflicting results in the associations of testosterone replacement therapy (TTh) and statins use with prostate cancer (PCa). However, the combination of these treatments with PCa stage and grade at diagnosis and prostate cancer-specific mortality (PCSM) and by race/ethnicity remains unclear. METHODS We identified non-Hispanic White (NHW, N = 58,576), non-Hispanic Black (NHB, n = 9,703) and Hispanic (n = 4,898) men diagnosed with PCa in SEER-Medicare data 2007-2011. Pre-diagnostic prescription of TTh and statins was ascertained for this analysis. Multivariable-adjusted logistic and Cox proportional hazards models were used to evaluate the association of TTh and statins use with PCa stage and grade and PCSM. RESULTS 22.5% used statins alone, 1.2% used TTh alone, and 0.8% used both. TTh and statins were independently, inversely associated with PCa advanced stage and high grade. TTh plus statins was associated with 44% lower odds of advanced stage PCa (OR 0.56, 95% CI 0.35-0.91). As expected, similar inverse associations were present in NHWs as the overall cohort is mostly comprised NHW men. In Hispanic men, statin use with or without TTh was inversely associated with aggressive PCa. CONCLUSIONS Pre-diagnostic use of TTh or statins, independent or in combination, was inversely associated with aggressive PCa, including in NHW and Hispanics men, but was not with PCSM. The findings for use of statins with aggressive PCa are consistent with cohort studies. Future prospective studies are needed to explore the independent inverse association of TTh and the combined inverse association of TTh plus statins on fatal PCa.
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Affiliation(s)
- David S Lopez
- Deparment of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA.
| | - Danmeng Huang
- Deparment of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.,Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Steven Canfield
- Division of Urology, UTHealth McGovern Medical School, Houston, TX, USA
| | - Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Jacques G Baillargeon
- Deparment of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Deparment of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - M Kristen Peek
- Deparment of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Elizabeth A Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Sidney Kimmel Comprehensive Cancer Center At Johns Hopkins, Baltimore, MD, USA.,Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kyriakos Markides
- Deparment of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
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10
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Environmental Factors-Induced Oxidative Stress: Hormonal and Molecular Pathway Disruptions in Hypogonadism and Erectile Dysfunction. Antioxidants (Basel) 2021; 10:antiox10060837. [PMID: 34073826 PMCID: PMC8225220 DOI: 10.3390/antiox10060837] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 01/09/2023] Open
Abstract
Hypogonadism is an endocrine disorder characterized by inadequate serum testosterone production by the Leydig cells of the testis. It is triggered by alterations in the hypothalamic–pituitary–gonadal axis. Erectile dysfunction (ED) is another common disorder in men that involves an alteration in erectile response–organic, relational, or psychological. The incidence of hypogonadism and ED is common in men aged over 40 years. Hypogonadism (including late-onset hypogonadism) and ED may be linked to several environmental factors-induced oxidative stresses. The factors mainly include exposure to pesticides, radiation, air pollution, heavy metals and other endocrine-disrupting chemicals. These environmental risk factors may induce oxidative stress and lead to hormonal dysfunctions. To better understand the subject, the study used many keywords, including “hypogonadism”, “late-onset hypogonadism”, “testosterone”, “erectile dysfunction”, “reactive oxygen species”, “oxidative stress”, and “environmental pollution” in major online databases, such as SCOPUS and PUBMED to extract relevant scientific information. Based on these parameters, this review summarizes a comprehensive insight into the important environmental issues that may have a direct or indirect association with hypogonadism and ED in men. The study concludes that environmental factors-induced oxidative stress may cause infertility in men. The hypothesis and outcomes were reviewed critically, and the mechanistic approaches are applied through oxidant-sensitive pathways. This study also provides reccomendations on future therapeutic interventions and protective measures against such adverse environmental factors-induced hypogonadism and ED.
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11
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Jeong IG, Lim B, Yun SC, Lim JH, Hong JH, Kim CS. Adjuvant Low-dose Statin Use after Radical Prostatectomy: The PRO-STAT Randomized Clinical Trial. Clin Cancer Res 2021; 27:5004-5011. [PMID: 34011557 DOI: 10.1158/1078-0432.ccr-21-0480] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/25/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Statin use is reportedly associated with the risk of prostate cancer, outcomes after treatment, and prostate cancer-specific mortality. We sought to determine the efficacy of adjuvant atorvastatin in prostate cancer after radical prostatectomy. PATIENTS AND METHODS In this randomized, double-blind trial, we assigned patients with pathologic high-risk prostate cancer to receive either low-dose atorvastatin (20 mg/day, n = 183) or placebo (n = 181) for 1 year after radical prostatectomy. The primary endpoint was the 1-year biochemical recurrence rate. The secondary endpoints included the 5-year biochemical recurrence-free survival and changes in lipid, testosterone, and sex hormone binding globulin levels. RESULTS From October 2012 through January 2019, a total of 364 patients underwent randomization. Among 59 total primary end points, 30 (16.4%) and 29 (16.0%) occurred in the atorvastatin and placebo groups, respectively. Atorvastatin did not significantly reduce the primary endpoint of 1-year biochemical recurrence [HR, 0.96; 95% confidence interval (CI), 0.58-1.60]. During a median follow-up of 24 months, 131 patients experienced biochemical recurrence (68 in the atorvastatin group and 63 in the placebo group), representing Kaplan-Meier estimated event rates of 24.0% and 25.4% in the atorvastatin and placebo groups, respectively, at 24 months (HR, 1.00; 95% CI, 0.71-1.41). We observed no significant between-group differences in the testosterone and sex hormone binding globulin levels. CONCLUSIONS Among patients with high-risk pathologic features after radical prostatectomy for prostate cancer, 1-year adjuvant use of atorvastatin was not associated with a lower risk of disease recurrence compared with that for placebo. (ClinicalTrials.gov number, NCT01759836).See related commentary by Murtola and Siltari, p. 4947.
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Affiliation(s)
- In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of South Korea
| | - Bumjin Lim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of South Korea
| | - Sung-Cheol Yun
- Division of Biostatistics, Center for Medical Research and Information, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of South Korea
| | - Ju Hyun Lim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of South Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of South Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of South Korea.
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12
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Leutner M, Matzhold C, Kautzky A, Kaleta M, Thurner S, Klimek P, Kautzky-Willer A. Major Depressive Disorder (MDD) and Antidepressant Medication Are Overrepresented in High-Dose Statin Treatment. Front Med (Lausanne) 2021; 8:608083. [PMID: 33644093 PMCID: PMC7904887 DOI: 10.3389/fmed.2021.608083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/12/2021] [Indexed: 01/24/2023] Open
Abstract
Objective: To examine the dose-dependent relationship of different types of statins with the occurrence of major depressive disorder (MDD) and prescription of antidepressant medication. Methods: This cross-sectional study used medical claims data for the general Austrian population (n = 7,481,168) to identify all statin-treated patients. We analyzed all patients with MDD undergoing statin treatment and calculated the average defined daily dose for six different types of statins. In a sub-analysis conducted independently of inpatient care, we investigated all patients on antidepressant medication (statin-treated patients: n = 98,913; non-statin-treated patients: n = 789,683). Multivariate logistic regression analyses were conducted to calculate the risk of diagnosed MDD and prescription of antidepressant medication in patients treated with different types of statins and dosages compared to non-statin-treated patients. Results: In this study, there was an overrepresentation of MDD in statin-treated patients when compared to non-statin-treated patients (OR: 1.22, 95% CI: 1.20–1.25). However, there was a dose dependent relationship between statins and diagnosis of MDD. Compared to controls, the ORs of MDD were lower for low-dose statin-treated patients (simvastatin>0– < =10 mg:OR: 0.59, 95% CI: 0.54–0.64; atorvastatin>0– < =10 mg:OR:0.65, 95%CI: 0.59–0.70; rosuvastatin>0– < =10 mg:OR: 0.68, 95% CI: 0.53–0.85). In higher statin dosages there was an overrepresentation of MDD (simvastatin>40– < =60 mg:OR: 2.42, 95% CI: 2.18–2.70, >60–80 mg:OR: 5.27, 95% CI: 4.21–6.60; atorvastatin>40– < =60 mg:OR: 2.71, 95% CI: 1.98–3.72, >60– < =80 mg:OR: 3.73, 95% CI: 2.22–6.28; rosuvastatin>20– < =40 mg:OR: 2.09, 95% CI: 1.31–3.34). The results were confirmed in a sex-specific analysis and in a cohort of patients taking antidepressants, prescribed independently of inpatient care. Conclusions: This study shows that it is important to carefully re-investigate the relationship between statins and MDD. High-dose statin treatment was related to an overrepresentation, low-dose statin treatment to an underrepresentation of MDD.
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Affiliation(s)
- Michael Leutner
- Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Caspar Matzhold
- Section for Science of Complex Systems, Center for Medical Statistics, Informatics, and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria.,Complexity Science Hub Vienna, Vienna, Austria
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Michaela Kaleta
- Section for Science of Complex Systems, Center for Medical Statistics, Informatics, and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria.,Complexity Science Hub Vienna, Vienna, Austria
| | - Stefan Thurner
- Section for Science of Complex Systems, Center for Medical Statistics, Informatics, and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria.,Complexity Science Hub Vienna, Vienna, Austria.,Santa Fe Institute, Santa Fe, NM, United States.,Institute for Applied Systems Analysis (IIASA), Laxenburg, Austria
| | - Peter Klimek
- Section for Science of Complex Systems, Center for Medical Statistics, Informatics, and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria.,Complexity Science Hub Vienna, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Gender Institute, Gars am Kamp, Austria
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13
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The Investigative Role of Statins in Ameliorating Lower Urinary Tract Symptoms (LUTS): A Systematic Review. J Clin Med 2021; 10:jcm10030416. [PMID: 33499215 PMCID: PMC7865704 DOI: 10.3390/jcm10030416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/07/2021] [Accepted: 01/18/2021] [Indexed: 01/22/2023] Open
Abstract
Previous data have shown that patients with metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement (BPE) could be refractory to the medical treatment. In this context, the evidence suggests a role for statin use in LUTS/BPE patients. The present systematic review aimed to evaluate the impact of statins on the treatment of men with LUTS/BPE. This review has been registered on PROSPERO (CRD42019120729). A systematic review of English-language literature was performed up to January 2020 in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA statement) criteria. Retrieved studies had to include adults with LUTS connected to BPE treated with statins drugs for metabolic syndrome. After removing duplicates, a total of 381 studies were identified by the literature search and independently screened. Of these articles, 10 fit the inclusion criteria and were further assessed for eligibility. Data from our systematic review suggest that a long-term therapy with statins, at least 6 months, is required to achieve significant impacts on prostate tissue and LUTS. Moreover, besides statins' direct activity, the risk reduction of LUTS might be connected to the improvement of hypercholesterolemia and MetS. The role of statins for the treatment of LUTS/BPE may be beneficial; however, evidence from robust studies is not enough, and more clinical trial are required.
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14
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Stamerra CA, Di Giosia P, Ferri C, Giorgini P, Reiner Z, Johnston TP, Sahebkar A. Statin therapy and sex hormones. Eur J Pharmacol 2020; 890:173745. [PMID: 33227286 DOI: 10.1016/j.ejphar.2020.173745] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 12/27/2022]
Abstract
Current guidelines recommend statin therapy for all adult patients with coronary artery disease irrespective of sex. Over recent years, some concerns have been raised concerning the effects of statins on endogenous steroid hormones synthesis. The aim of this review was to summarize the effects of statins on endogenous sex hormones in order to clarify their role and safety in different clinical settings. Results suggest that HMG-CoA inhibitors may slightly impair adrenal and/or gonadal steroid hormone production. In men, statins do not cause any clinically-relevant harmful effects on erectile function and spermatogenesis and, in women, statins have beneficial effects in treatment of polycystic ovary syndrome (PCOS). Additional research is needed to provide specific clinical recommendations concerning this topic.
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Affiliation(s)
- Cosimo Andrea Stamerra
- University of L'Aquila, Department of Life, Health and Environmental Sciences, Building Delta 6 - San Salvatore Hospital, Via Vetoio, Coppito, 67100, L'Aquila, Italy
| | - Paolo Di Giosia
- University of L'Aquila, Department of Life, Health and Environmental Sciences, Building Delta 6 - San Salvatore Hospital, Via Vetoio, Coppito, 67100, L'Aquila, Italy
| | - Claudio Ferri
- University of L'Aquila, Department of Life, Health and Environmental Sciences, Building Delta 6 - San Salvatore Hospital, Via Vetoio, Coppito, 67100, L'Aquila, Italy
| | - Paolo Giorgini
- University of L'Aquila, Department of Life, Health and Environmental Sciences, Building Delta 6 - San Salvatore Hospital, Via Vetoio, Coppito, 67100, L'Aquila, Italy
| | - Zeljko Reiner
- Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Thomas P Johnston
- Division of Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Halal Research Center of IRI, FDA, Tehran, Iran; Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland.
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15
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Ou SC, Lin MC, Lin HJ, Huang CP, Huang ST. Association between erectile dysfunction and fibromyalgia in male patients: A Taiwanese nationwide population-based cohort study. Int J Urol 2020; 27:1102-1108. [PMID: 32901969 DOI: 10.1111/iju.14364] [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: 05/05/2020] [Accepted: 07/30/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the association between erectile dysfunction and fibromyalgia, and to clarify related comorbidities and treatment modalities. METHODS This retrospective cohort study was carried out using 1 million records in the National Health Insurance Research Database. From 2001 to 2012, a total of 53 678 male patients newly diagnosed with fibromyalgia were recruited as the fibromyalgia cohort, and the same number of the non-fibromyalgia cohort was enrolled and matched with propensity score with age, income, comorbidities, and prescribed medications. All records were followed up until the end of 2013. The Cox proportional hazards model was carried out to assess the risk of erectile dysfunction among fibromyalgia patients. RESULTS The incidence rates of erectile dysfunction were 36.86 and 21.15 (per 10 000 person-years) in the fibromyalgia and non-fibromyalgia cohorts, respectively, and a significantly increased risk of erectile dysfunction in fibromyalgia patients was noted (adjusted hazard ratio 1.69, 95% confidence interval 1.55-1.85, P < 0.001). The Cox proportional hazards regression analysis showed increased risk of erectile dysfunction in the fibromyalgia cohort regardless of treatment prescriptions of tramadol, antidepressants, gabapentin and non-steroidal anti-inflammatory drugs. CONCLUSIONS Fibromyalgia was found to be an independent risk factor for the incidence of erectile dysfunction.
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Affiliation(s)
- Shi-Chen Ou
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Hung-Jen Lin
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Chi-Ping Huang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Sheng-Teng Huang
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Cancer Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,Chinese Medicine Research Center, China Medical University, Taichung, Taiwan.,Research Center for Chinese Herbal Medicine, China Medical University, Taichung, Taiwan.,An-Nan Hospital, China Medical University, Tainan, Taiwan
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16
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PRESERVATION OF ERECTILE FUNCTION BY STATINS IN A RAT MODEL OF ERECTILE DYSFUNCTION INDUCED BY HYPERCHOLESTEROLEMIA. JOURNAL OF MEN'S HEALTH 2020. [DOI: 10.15586/jomh.v16i1.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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17
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Leutner M, Matzhold C, Bellach L, Deischinger C, Harreiter J, Thurner S, Klimek P, Kautzky-Willer A. Response to: 'Association between osteoporosis and statin therapy: the story continues' by Burden and Weiler. Ann Rheum Dis 2019; 80:e205. [PMID: 31801740 DOI: 10.1136/annrheumdis-2019-216627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 11/17/2019] [Accepted: 11/20/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Michael Leutner
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
| | - Caspar Matzhold
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Vienna, Austria.,Complexity Science Hub Vienna, Vienna, Austria
| | - Luise Bellach
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
| | - Carola Deischinger
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
| | - Jürgen Harreiter
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
| | - Stefan Thurner
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Vienna, Austria.,Complexity Science Hub Vienna, Vienna, Austria.,Santa Fe Institute, Santa Fe, NM, USA.,IIASA, Laxenburg, Austria
| | - Peter Klimek
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Vienna, Austria.,Complexity Science Hub Vienna, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
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18
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Aykan DA, Seyithanoglu M. The Effects of Administration of Vitamin D, Infliximab, and Leflunomide on Testosterone Concentrations in Rats under Atorvastatin Therapy. Eurasian J Med 2019; 51:224-227. [PMID: 31692672 DOI: 10.5152/eurasianjmed.2019.18481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objective Statins inhibit the 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase enzyme and thus reduce plasma cholesterol levels. Although decreased cholesterol level is the main target of anti-lipidemic drugs, cholesterol has an important role in the synthesis of lipid-based hormones such as testosterone. In this study, the alterations in serum testosterone levels were examined in rats under atorvastatin therapy and their responses to vitamin D, infliximab, and leflunomide supplementation were evaluated. Materials and Methods Wistar rats were treated with atorvastatin (100 mg/kg) for 21 days to induce inhibition of the HMG-CoA reductase enzyme activity. Following statin therapy, rats received vitamin D (0.2 μg/kg/day) orally for 15 days, infliximab (7 mg/kg/day) intraperitoneally in two doses, or leflunomide (10 mg/kg/day) orally in two doses. Subsequently, the alterations in serum testosterone levels were measured by ELISA. Results Atorvastatin led to a decrease in the testosterone level compared to the vehicle group. Administration of vitamin D, infliximab, and leflunomide under HMG-CoA inhibition insignificantly increased the testosterone level compared to the atorvastatin control group. Furthermore, it appears that rats under statin administration respond better to treatment with leflunomide by achieving a greater induction in testosterone levels than with vitamin D or infliximab. Conclusion Our data provide evidence that administration of vitamin D, infliximab, and leflunomide in rats under atorvastatin treatment may ameliorate the serum testosterone levels.
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Affiliation(s)
- Duygun Altintas Aykan
- Department of Pharmacology, Kahramanmaraş Sütçü Imam University School of Medicine, Kahramanmaraş, Turkey
| | - Muhammed Seyithanoglu
- Department of Biochemistry, Kahramanmaraş Sütçü Imam University School of Medicine, Kahramanmaraş, Turkey
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19
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Leutner M, Matzhold C, Bellach L, Deischinger C, Harreiter J, Thurner S, Klimek P, Kautzky-Willer A. Response to: 'Association between osteoporosis and statins therapy' by Lai. Ann Rheum Dis 2019; 80:e181. [PMID: 31653651 DOI: 10.1136/annrheumdis-2019-216494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/20/2019] [Indexed: 01/21/2023]
Affiliation(s)
- Michael Leutner
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
| | - Caspar Matzhold
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Vienna, Austria.,Complexity Science Hub Vienna, Vienna, Austria
| | - Luise Bellach
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
| | - Carola Deischinger
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
| | - Jürgen Harreiter
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
| | - Stefan Thurner
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Vienna, Austria.,Complexity Science Hub Vienna, Vienna, Austria.,Santa Fe Institute, Santa Fe, NM, USA.,IIASA, Laxenburg, Austria
| | - Peter Klimek
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Vienna, Austria.,Complexity Science Hub Vienna, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
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20
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Leutner M, Matzhold C, Bellach L, Deischinger C, Harreiter J, Thurner S, Klimek P, Kautzky-Willer A. Diagnosis of osteoporosis in statin-treated patients is dose-dependent. Ann Rheum Dis 2019; 78:1706-1711. [PMID: 31558481 PMCID: PMC6900255 DOI: 10.1136/annrheumdis-2019-215714] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/27/2019] [Accepted: 09/12/2019] [Indexed: 12/13/2022]
Abstract
Objective Whether HMG-CoA-reductase inhibition, the main mechanism of statins, plays a role in the pathogenesis of osteoporosis, is not entirely known so far. Consequently, this study was set out to investigate the relationship of different kinds and dosages of statins with osteoporosis, hypothesising that the inhibition of the synthesis of cholesterol could influence sex-hormones and therefore the diagnosis of osteoporosis. Methods Medical claims data of all Austrians from 2006 to 2007 was used to identify all patients treated with statins to compute their daily defined dose averages of six different types of statins. We applied multiple logistic regression to analyse the dose-dependent risks of being diagnosed with osteoporosis for each statin individually. Results In the general study population, statin treatment was associated with an overrepresentation of diagnosed osteoporosis compared with controls (OR: 3.62, 95% CI 3.55 to 3.69, p<0.01). There was a highly non-trivial dependence of statin dosage with the ORs of osteoporosis. Osteoporosis was underrepresented in low-dose statin treatment (0–10 mg per day), including lovastatin (OR: 0.39, CI 0.18 to 0.84, p<0.05), pravastatin (OR: 0.68, 95% CI 0.52 to 0.89, p<0.01), simvastatin (OR: 0.70, 95% CI 0.56 to 0.86, p<0.01) and rosuvastatin (OR: 0.69, 95% CI 0.55 to 0.87, p<0.01). However, the exceeding of the 40 mg threshold for simvastatin (OR: 1.64, 95% CI 1.31 to 2.07, p<0.01), and the exceeding of a 20 mg threshold for atorvastatin (OR: 1.78, 95% CI 1.41 to 2.23, p<0.01) and for rosuvastatin (OR: 2.04, 95% CI 1.31 to 3.18, p<0.01) was related to an overrepresentation of osteoporosis. Conclusion Our results show that the diagnosis of osteoporosis in statin-treated patients is dose-dependent. Thus, osteoporosis is underrepresented in low-dose and overrepresented in high-dose statin treatment, demonstrating the importance of future studies’ taking dose-dependency into account when investigating the relationship between statins and osteoporosis.
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Affiliation(s)
- Michael Leutner
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
| | - Caspar Matzhold
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Vienna, Austria.,Complexity Science Hub Vienna, Vienna, Austria
| | - Luise Bellach
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
| | - Carola Deischinger
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
| | - Jürgen Harreiter
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
| | - Stefan Thurner
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Vienna, Austria.,Complexity Science Hub Vienna, Vienna, Austria.,Santa Fe Institute, Santa Fe, New Mexico, USA.,IIASA, Laxenburg, Austria
| | - Peter Klimek
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Vienna, Austria.,Complexity Science Hub Vienna, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
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21
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Batteux B, Llopis B, Muller C, Khouri C, Moragny J, Liabeuf S, Masmoudi K, Gras V. The drugs that mostly frequently induce gynecomastia: A national case - noncase study. Therapie 2019; 75:225-238. [PMID: 31471065 DOI: 10.1016/j.therap.2019.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/02/2019] [Accepted: 06/14/2019] [Indexed: 12/18/2022]
Abstract
AIMS Drug-induced gynecomastia accounts for up to 25% of cases of gynecomastia. The objective of the present study was to provide a comprehensive overview of drug-induced gynecomastia on the basis of spontaneously reported adverse drug reactions (ADRs) in the French national pharmacovigilance database (FPVD). METHODS We performed a case - noncase study of drug-induced gynecomastia. Cases corresponded to reports of gynecomastia recorded in the FPVD between 1 January 2008 and 31 December 2015. The noncases corresponded to all other spontaneously reported ADRs recorded in the FPVD during the same period. Data were expressed as the reporting odds ratio (ROR) and its 95% confidence interval. RESULTS Of the 255,354 ADRs recorded in the FPVD between 1 January 2008 and 31 December 2015, 327 (0.31%) of relevant cases of gynecomastia and 106,800 noncases were analyzed. The RORs were statistically significant for 54 active compounds mentioned 429 times in cases of gynecomastia. A single drug was involved in 59% of cases. The most frequently implicated drug classes were antiretrovirals (23.5%), diuretics (15.5%), proton pump inhibitors (11.9%), HMG-CoA reductase inhibitors (9.1%), neuroleptics and related drugs (6.5%), calcium channel blockers (6.3%), and 5-alpha reductase inhibitors (4%). CONCLUSIONS A comprehensive analysis of a national pharmacovigilance database highlighted the main drug classes suspected of inducing gynecomastia. A physiopathological mechanism (a hormone imbalance with elevated estrogen levels) is known or suspected for most of the drugs involved in gynecomastia. However, we noticed a lack of harmonization in the summary of product characteristics for original vs. generic medicines.
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Affiliation(s)
- Benjamin Batteux
- Centre régional de pharmacovigilance, CHU Amiens Sud, avenue René Laënnec, 80054 Amiens cedex 1, France.
| | - Benoît Llopis
- Centre régional de pharmacovigilance, CHU Amiens Sud, avenue René Laënnec, 80054 Amiens cedex 1, France
| | - Charlotte Muller
- Centre régional de pharmacovigilance, hôpital civil, 67091 Strasbourg, France
| | - Charles Khouri
- Centre régional de pharmacovigilance, CHU Grenoble, 38043 Grenoble, France
| | - Julien Moragny
- Centre régional de pharmacovigilance, CHU Amiens Sud, avenue René Laënnec, 80054 Amiens cedex 1, France
| | - Sophie Liabeuf
- Centre régional de pharmacovigilance, CHU Amiens Sud, avenue René Laënnec, 80054 Amiens cedex 1, France
| | - Kamel Masmoudi
- Centre régional de pharmacovigilance, CHU Amiens Sud, avenue René Laënnec, 80054 Amiens cedex 1, France
| | - Valérie Gras
- Centre régional de pharmacovigilance, CHU Amiens Sud, avenue René Laënnec, 80054 Amiens cedex 1, France
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22
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The alteration of RhoA geranylgeranylation and Ras farnesylation breaks the integrity of the blood-testis barrier and results in hypospermatogenesis. Cell Death Dis 2019; 10:450. [PMID: 31171774 PMCID: PMC6554403 DOI: 10.1038/s41419-019-1688-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 05/09/2019] [Accepted: 05/23/2019] [Indexed: 12/14/2022]
Abstract
Non-obstructive azoospermia (NOA) severely affects male infertility, however, the deep mechanisms of this disease are rarely interpreted. In this study, we find that undifferentiated spermatogonial stem cells (SSCs) still exist in the basal compartment of the seminiferous tubules and the blood–testis barrier (BTB) formed by the interaction of neighbor Sertoli cells (SCs) is incomplete in NOA patients with spermatogenic maturation arrest. The adhesions between SCs and germ cells (GCs) are also broken in NOA patients. Meanwhile, the expression level of geranylgeranyl diphosphate synthase (Ggpps), a key enzyme in mevalonate metabolic pathway, is lower in NOA patients than that in obstructive azoospermia (OA) patients. After Ggpps deletion specifically in SCs, the mice are infertile and the phenotype of the SC-Ggpps−/− mice is similar to the NOA patients, where the BTB and the SC–GC adhesions are severely destroyed. Although SSCs are still found in the basal compartment of the seminiferous tubules, fewer mature spermatocyte and spermatid are found in SC-Ggpps−/− mice. Further examination suggests that the defect is mediated by the aberrant protein isoprenylation of RhoA and Ras family after Ggpps deletion. The exciting finding is that when the knockout mice are injected with berberine, the abnormal cell adhesions are ameliorated and spermatogenesis is partially restored. Our data suggest that the reconstruction of disrupted BTB is an effective treatment strategy for NOA patients with spermatogenic maturation arrest and hypospermatogenesis.
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Ho CH, Wu CC, Lee MC, Huang PH, Chen JT, Liu SP, Liao PW. The Association of Serum Testosterone Levels With Recurrence and Mortality After Acute Ischemic Stroke in Males. Am J Mens Health 2019; 13:1557988319847097. [PMID: 31109237 PMCID: PMC6537271 DOI: 10.1177/1557988319847097] [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] [Indexed: 11/20/2022] Open
Abstract
The current study aimed to investigate whether low testosterone predicted the
recurrence and clinical outcomes after acute ischemic stroke (AIS) in males.
From June 2015 through August 2017, the study prospectively enrolled 110 male
AIS patients. All received detailed evaluations at admission and were followed
for at least 1 year. The cumulative incidence, overall survival, length of
hospital stay, and the percentage of previous stroke were compared between
subjects with testosterone <440 ng/dl and >440 ng/dl. The median age was
62 years (range, 35–93 years). The median serum testosterone at admission was
438 [203] ng/dl (range, 44–816 ng/dl); 55 patients (50%) had testosterone
<440 ng/dl and were considered as low testosterone. The median follow-up was
23 months. During the period, 12 recurrences and 10 deaths occurred. The 1-year
and 3-year cumulative recurrence rate were 8.3% and 11.9%, respectively; the
1-year and 3-year overall survival were 96.3% and 84.6%, respectively. The
cumulative recurrence rates were similar between the two testosterone groups
(log-rank test, p = .88). Low testosterone was associated with
poor survival with marginal significance (log-rank test, p =
.079). Men with low testosterone had a higher percentage of previous stroke
(29.1% versus 12.7%, p = .035). The mean lengths of hospital
stay were similar between the two testosterone groups (16.6 ± 15.8 days versus
14.0 ± 10.6, p = .31). Total testosterone at admission fails to
predict stroke recurrence. However, men with low testosterone at admission are
more likely to have previous stroke and may have a higher all-cause mortality
rate after AIS.
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Affiliation(s)
- Chen-Hsun Ho
- 1 Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City.,2 Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Chia-Chang Wu
- 1 Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City.,2 Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Mei-Ching Lee
- 3 Department of Neurology, Cathay General Hospital, Taipei
| | - Pai-Hao Huang
- 3 Department of Neurology, Cathay General Hospital, Taipei
| | - Jen-Tse Chen
- 3 Department of Neurology, Cathay General Hospital, Taipei
| | - Shih-Ping Liu
- 4 Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei
| | - Pin-Wen Liao
- 3 Department of Neurology, Cathay General Hospital, Taipei.,5 Department of Medicine, School of Medicine, Fu Jen Catholic University, New Taipei City
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24
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Elgendy AY, Elgendy IY, Mahmoud AN, Al-Ani M, Moussa M, Mahmoud A, Mojadidi MK, Anderson RD. Statin Use in Men and New Onset of Erectile Dysfunction: A Systematic Review and Meta-Analysis. Am J Med 2018; 131:387-394. [PMID: 29146233 DOI: 10.1016/j.amjmed.2017.10.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 10/20/2017] [Accepted: 10/20/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Erectile dysfunction has been reported as an adverse effect of statin therapy. METHODS We performed a meta-analysis of randomized trials and observational studies that compared statin users versus non-statin users and reported data regarding new onset of erectile dysfunction in men with established cardiovascular disease or cardiovascular disease risk factors. We used DerSimonian-Laird and Peto models to construct the summary estimates risk ratio. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess the overall quality of evidence for new-onset erectile dysfunction. RESULTS Three randomized trials and 3 observational studies were identified, with 69,448 men, of whom 24,661 were statin users. Statin use was not associated with an increased risk of new onset of erectile dysfunction by random effects model or fixed effect model (risk ratio 0.96; 95% confidence interval, 0.84-1.10; P = .58; and odds ratio 0.95; 95% confidence interval, 0.88-1.02; P = .20, respectively). This effect was similar in randomized trials and observational studies (Pinteraction = .86). Randomized trials provided a moderate quality of evidence, and observational studies provided a very low quality of evidence by the GRADE assessment. Random effects meta-regression analyses revealed no difference in treatment effect according to age or diabetes mellitus (P = .83 and P = .74, respectively). CONCLUSIONS Among men with established cardiovascular disease or cardiovascular disease risk factors, statin use does not seem to be associated with a new onset of erectile dysfunction. Adequately powered and high-quality randomized trials are recommended to confirm these findings.
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Affiliation(s)
- Akram Y Elgendy
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville
| | - Ahmed N Mahmoud
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville
| | - Mohammad Al-Ani
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville
| | - Mohamed Moussa
- Department of Medicine, North Florida/South Georgia Veterans Health System, Gainesville
| | - Ahmad Mahmoud
- Department of Medicine, University of Florida, Gainesville
| | - Mohammad K Mojadidi
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville
| | - R David Anderson
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville.
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25
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Atorvastatin decreases steroid production in H295R cells and in major endocrine tissues of male rats. Arch Toxicol 2018; 92:1703-1715. [DOI: 10.1007/s00204-018-2187-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 03/13/2018] [Indexed: 12/13/2022]
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26
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Liu Z, Chen P. A case of erectile dysfunction induced by red yeast rice in lipid-lowering therapy. Phytother Res 2018; 32:953-954. [PMID: 29356231 DOI: 10.1002/ptr.6025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 12/10/2017] [Accepted: 12/13/2017] [Indexed: 11/09/2022]
Abstract
This paper studies a 39-year-old male patient who takes red yeast rice (RYR) for self-therapy in lipid-lowering for 3 weeks. Results show that RYR can decrease most of the blood lipid components but without selectivity. During the treatment, the patient developed erectile dysfunction (ED) and accompanied by a dramatic decrease in sexual desire. The ED symptom gradually disappeared within 5 weeks after stopping RYR intake.
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Affiliation(s)
- Zhigang Liu
- Shanghai University of Sport, Shanghai, 200438, China.,Yuxi Normal University, Yuxi, 653100, China
| | - Peijie Chen
- Shanghai University of Sport, Shanghai, 200438, China
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27
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Badawi JK, Bosch R, Djurhuus JC, Hanna-Mitchell AT. Is testosterone important in LUT function in men and women? ICI-RS 2015. Neurourol Urodyn 2017; 36:859-862. [PMID: 28444714 DOI: 10.1002/nau.23041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 05/02/2016] [Indexed: 12/20/2022]
Abstract
AIM This review article is a collaborative report based upon the Authors' presentations and Group discussion on the role of testosterone (T) in the male and female lower urinary tract (LUT) which took place at the 6th International Consultation on Incontinence Research Society's (ICI-RS) annual meeting, in Bristol, UK (September 8-10, 2015). METHODS It comprises overviews and opinions on both the current state of knowledge of the role of T in LUT function and dysfunction in both sexes. RESULTS Results from animal studies suggest that T treatment may be beneficial for disorders of the LUT in women including urinary incontinence and pelvic organ prolapse. The need for clinical studies to evaluate the effect of T treatment in peri- and post-menopausal women, taking into account the type of applied androgen, the application form, timing and dosage, is especially emphasized. In males, findings on the impact of T on the male external urethral sphincter underscores that there is still much to learn about its role in male LUT physiology. The important topic of the use of T therapy in the treatment of enuresis in the young, both sexes, is also discussed. The importance of understanding the steroidogenic pathways linking T with estradiol is discussed as being of paramount importance in researching the unique actions of T in the LUT. CONCLUSION The overall conclusion is that further research into the role of T in LUT function and dysfunction across genders and age groups (young to old) is extremely important. Neurourol. Urodynam. 36:859-862, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Jasmin Katrin Badawi
- Department of Urology, University Hospital Mannheim, Medical Faculty of the Ruprechts-Karls-University of Heidelberg, Mannheim, Germany
| | - Ruud Bosch
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
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28
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Zhang X, Li J, Zhou X, Guan Q, Zhao J, Gao L, Yu C, Wang Y, Zuo C. SIMVASTATIN DECREASES SEX HORMONE LEVELS IN MALE RATS. Endocr Pract 2016; 23:175-181. [PMID: 27849375 DOI: 10.4158/ep161274.or] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Statins can inhibit therate-limiting enzyme hydroxymethyl glutaric acid-coenzyme A reductase to reduce cholesterol biosynthesis, and they are used frequently in the clinic. Cholesterol is also a precursor for sex hormones. However, it is not clear whether statins can affect sex hormone levels. The aim of this study was to investigate the effect of long-term use of statins on sex hormone levels in vivo. METHODS Forty male Sprague-Dawley rats were randomly divided into four groups. Three simvastatin groups were administered different doses of simvastatin intragastrically daily (4, 8, or 16 mg/kg/day, n = 10). The control group was administered vehicle intragastrically daily (n = 10). The serum lipid spectrum and testosterone, estradiol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) levels were measured before (0 weeks) and after 20 and 40 weeks of simvastatin administration. RESULTS In the control group, there were no statistically significant differences between lipid levels, liver function, or sex hormone levels before and after intragastric administration. Compared with the previous intragastric administration group, there was no obvious change in liver function with different doses of simvastatin. However, serum levels of total cholesterol, low-density-lipoprotein cholesterol, triglycerides, testosterone, estradiol, and progesterone were markedly decreased in a dose- and time-dependent manner. By contrast, the levels of FSH and LH were significantly higher, showing feedback regulation. CONCLUSION Long-term simvastatin intake reduces serum testosterone, estradiol, and progesterone levels in male rats. ABBREVIATIONS HMG-CoA = hydroxymethyl glutaric acid CoA LDL = low-density lipoprotein LDL-C = low-density-lipoprotein cholesterol FSH = follicle-stimulating hormone LH = luteinizing hormone.
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29
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Lim SK, Sim DS, Han JY. The factors associated with sexual recovery in male patients with acute myocardial infarction under phase II cardiac rehabilitation. J Clin Nurs 2016; 25:2827-34. [DOI: 10.1111/jocn.13324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Seung-Kyu Lim
- Department of Rehabilitation Medicine; Presbyterian Medical Center (Jesus Hospital); Jeonju Korea
| | - Doo sun Sim
- Department of Cardiovascular Medicine; Heart Research Center; Chonnam National University Medical School & Hospital; Gwangju City Korea
| | - Jae-Young Han
- Department of Physical & Rehabilitation Medicine; Regional Cardiocerebro Vascular Center; Center for Aging and Geriatrics; Chonnam National University Medical School & Hospital; Gwangju City Korea
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30
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Lin SY, Lin CL, Hsu WH, Lin CC, Chang CT, Kao CH. Association of statin use and the risk of end-stage renal disease: A nationwide Asian population-based case-control study. Eur J Intern Med 2016; 31:68-72. [PMID: 26920930 DOI: 10.1016/j.ejim.2016.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/23/2016] [Accepted: 02/04/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although experimental models have shown that statins could alleviate glomerular damage and decrease urinary protein excretion, the renal effects of statins remain unclear. A case-control study was conducted using data from Taiwan's National Health Insurance system. METHODS An end-stage renal disease (ESRD) group comprising 11,486 patients was established. Each patient was frequency-matched by age, sex, and comorbidities with one person without ESRD from the general population. Logistic regression analysis was performed to estimate the influence of statin use on ESRD risk. RESULTS The overall adjusted odds ratios (ORs) of ESRD among patients who received statins was 1.59 (95% confidence interval=1.50-1.68). The raised ESRD risk of statin remained consolidated regardless of statin type (P<.001), except lovastatin. Further, while stratified by cumulative define daily dose, the risk of ESRD increased with accumulative dosage of statins (P for trend<.001). CONCLUSION This population-based case-control study showed that statin use might be associated with increased ESRD risks. Large-scale randomized clinical trial encompassing statins of different kinds and populations of different comorbidities would be helpful to clarify the potential ESRD risks of statin users.
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Affiliation(s)
- Shih-Yi Lin
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taiwan; Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Wu-Huei Hsu
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taiwan; Division of Pulmonary and Critical Care Medicine, China Medical University Hospital and China Medical University, Taichung, , Taiwan
| | - Cheng-Chieh Lin
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chiz-Tzung Chang
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taiwan; Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
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31
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Harshman LC, Wang X, Nakabayashi M, Xie W, Valenca L, Werner L, Yu Y, Kantoff AM, Sweeney CJ, Mucci LA, Pomerantz M, Lee GSM, Kantoff PW. Statin Use at the Time of Initiation of Androgen Deprivation Therapy and Time to Progression in Patients With Hormone-Sensitive Prostate Cancer. JAMA Oncol 2016; 1:495-504. [PMID: 26181260 DOI: 10.1001/jamaoncol.2015.0829] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Statin use has been associated with improved prostate cancer outcomes. Dehydroepiandrosterone sulfate (DHEAS) is a precursor of testosterone and a substrate for SLCO2B1, an organic anionic transporter. We previously demonstrated that genetic variants of SLCO2B1 correlated with time to progression (TTP) during receipt of androgen deprivation therapy (ADT). Statins also use SLCO2B1 to enter cells, and thus we hypothesized that they may compete with DHEAS uptake by the tumor cells. OBJECTIVE To evaluate whether statin use prolongs TTP during ADT for hormone-sensitive prostate cancer. DESIGN, SETTING, AND PARTICIPANTS In vitro studies were performed using prostate cancer cell lines at an academic, comprehensive cancer center. Statin use was retrospectively analyzed in 926 patients who had received ADT for biochemical or metastatic recurrence or de novo metastatic prostate cancer between January 1996 and November 2013. MAIN OUTCOMES AND MEASURES To determine whether statins interfere with DHEAS uptake, we performed in vitro studies using prostate cancer cell lines. Next, we queried our institutional clinical database to assess for an association between statin use and TTP during ADT using multivariable Cox regression analysis and adjusted for known prognostic factors. RESULTS In vitro, we demonstrated that statins block DHEAS uptake by competitively binding to SLCO2B1. In our ADT cohort of 926 patients, 283 (31%) were taking a statin at ADT initiation. After a median follow-up of 5.8 years, 644 patients (70%) had experienced disease progression while receiving ADT. Median TTP during ADT was 20.3 months (95% CI, 18-24 months). Men taking statins had a longer median TTP during ADT compared with nonusers (27.5 [95% CI, 21.1-37.7] vs 17.4 [95% CI, 14.9-21.1] months; P < .001). The association remained statistically significant after adjusting for predefined prognostic factors (adjusted hazard ratio, 0.83 [95% CI, 0.69-0.99]; P = .04). The positive statin effect was observed for both patients with and without metastases (adjusted hazard ratio, 0.79 [95% CI, 0.58-1.07] for M0 disease and 0.84 [95% CI, 0.67-1.06] for M1 disease; P for interaction = .72). CONCLUSIONS AND RELEVANCE Statin use at the time of ADT initiation was associated with a significantly longer TTP during ADT even after adjustment for known prognostic factors. Our in vitro finding that statins competitively reduce DHEAS uptake, thus effectively decreasing the available intratumoral androgen pool, affords a plausible mechanism to support the clinical observation of prolonged TTP in statin users.
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Affiliation(s)
- Lauren C Harshman
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Xiaodong Wang
- Gelb Center for Translational Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Mari Nakabayashi
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Wanling Xie
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Loana Valenca
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Lillian Werner
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Yongjiang Yu
- Gelb Center for Translational Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts4Department of Urology, Shanghai Jiao Tong University School of Medicine, Xinhua Hospital, Shanghai, China
| | | | - Christopher J Sweeney
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Lorelei A Mucci
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Mark Pomerantz
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Gwo-Shu Mary Lee
- Gelb Center for Translational Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Philip W Kantoff
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts2Gelb Center for Translational Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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32
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Abstract
Despite increased global interest in testosterone deficiency in men and its treatment with testosterone therapy, practical aspects of care remain confusing to many practitioners. Testosterone deficiency can result from testicular dysfunction (primary hypogonadism) or hypothalamic-pituitary dysfunction (secondary hypogonadism), and be congenital or acquired. Sexual and nonsexual symptoms of testosterone deficiency can negatively affect quality of life and cause considerable general health concerns. Investigation of testosterone deficiency should be undertaken in men with symptoms of reduced libido, erectile dysfunction, depression, fatigue, poor concentration, and poor memory. Total and free testosterone are the most frequently used tests and evaluating serum concentrations of luteinizing hormone aids determination of primary versus secondary testosterone deficiency. Multiple formulations of testosterone therapy are available, but symptomatic benefits might not manifest for several weeks to many months; long-acting formulations are convenient and improve compliance. Concerns regarding cardiovascular and prostate cancer risks are not supported by current evidence, monitoring during therapy is mandatory. On balance, testosterone therapy can be considered a safe and effective treatment for testosterone deficiency.
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Affiliation(s)
- Antonio Aversa
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Abraham Morgentaler
- Men's Health Boston, 200 Boylston Street, A309, Chestnut Hill, MA 02647, USA
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33
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Artom N, Pinna G, Musso NR, Orlandini F, Malasoma P, Uccelli M, Artom A, Rabbia F, Pascale C, Lantieri F, Pende A. Prevalence of erectile dysfunction in a cohort of Italian hypertensive subjects. Clin Exp Hypertens 2015; 38:143-9. [PMID: 26418513 DOI: 10.3109/10641963.2015.1060994] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to evaluate the prevalence of erectile dysfunction (ED) in a cohort of Italian hypertensive men and the association with clinical and biochemical data. The study involved 270 consecutive hypertensive subjects aged 40-70 years evaluated in Italian Hypertension Centers of six hospitals from Liguria and Piedmont. ED was assessed through the self-administered questionnaire of the International Index of Erectile Function. Clinical history with ongoing drug treatment, various clinical parameters, biochemical data and evidence about the presence of subclinical target organ damage was collected. Twenty-seven subjects refused to answer the questionnaire (10%). Among the 243 remained subjects, 123 presented ED (50.6%). ED was highly related to age, systolic blood pressure, pulse pressure, smoking status, statin therapy and kidney function. The addition of a thiazide diuretic to an inhibitor of the renin-angiotensin system significantly increased the prevalence of ED. The prevalence of ED increased in relation with the number of hypotensive drug classes taken by the patients. ED was highly prevalent in this cohort of Italian hypertensive subjects and was associated with other cardiovascular risk factors, such as age, smoking status and kidney function. The role of ED as an early marker of cardiovascular disease is discussed.
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Affiliation(s)
- Nathan Artom
- a Clinic of Internal Medicine 1, University of Genoa , Genoa , Italy
| | - Giuliano Pinna
- b Division of Internal Medicine , Cottolengo Hospital , Turin , Italy .,c Division of Internal Medicine , Cardinal Massaia Hospital , Asti , Italy
| | - Natale R Musso
- a Clinic of Internal Medicine 1, University of Genoa , Genoa , Italy
| | | | - Paolo Malasoma
- d Division of Internal Medicine , Sant' Andrea Hospital , La Spezia , Italy
| | | | - Alberto Artom
- e Division of Internal Medicine , Santa Corona Hospital , Pietra Ligure , Italy
| | - Franco Rabbia
- f Division of Internal Medicine and Hypertension Unit , University of Turin , Turin , Italy , and
| | - Claudio Pascale
- b Division of Internal Medicine , Cottolengo Hospital , Turin , Italy
| | - Francesca Lantieri
- g Biostatistics Unit, Health Science Department, University of Genoa , Genoa , Italy
| | - Aldo Pende
- a Clinic of Internal Medicine 1, University of Genoa , Genoa , Italy
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34
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de Keyser CE, de Lima FV, de Jong FH, Hofman A, de Rijke YB, Uitterlinden AG, Visser LE, Stricker BH. Use of statins is associated with lower serum total and non-sex hormone-binding globulin-bound testosterone levels in male participants of the Rotterdam Study. Eur J Endocrinol 2015; 173:155-65. [PMID: 26034077 DOI: 10.1530/eje-14-1061] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 05/05/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Statins, or HMG-CoA reductase inhibitors, decrease cholesterol production. Because cholesterol is a precursor of the testosterone biosynthesis pathway, there is some concern that statins might lower serum testosterone levels. The objective of the present study was to investigate the association between the use of statins and serum testosterone levels in men. DESIGN Cross-sectional study within the prospective population-based Rotterdam Study. SUBJECTS AND METHODS We included 4166 men with available data on total testosterone, non-sex hormone-binding globulin (SHBG)-bound testosterone, and medication use. Multivariable linear regression analysis was used to compare the differences in serum testosterone levels (nmol/l) between current, past, and never statin users. We considered dose and duration of use. Analyses were adjusted for age, BMI, cardiovascular disease, diabetes mellitus, hypertension, and estradiol levels. RESULTS We identified 577 current (mean age 64.1 years), 148 past (mean age 64.6 years), and 3441 never (mean age 64.6 years) statin users. Adjusted for all covariables, current statin use of 1-≤ 6 months or >6 months was significantly associated with lower total testosterone levels as compared to non-users (β -1.24, 95% CI -2.17, -0.31, and β -1.14, 95% CI -2.07, -0.20 respectively). Current use of 1-≤ 6 months was also associated with significantly lower non-SHBG-bound testosterone levels (β -0.42, 95% CI -0.82, -0.02). There was a trend toward lower testosterone levels at higher statin doses both for total (P(trend) 2.9 × 10(-5)) and non-SHBG-bound (P(trend) 2.0 × 10(-4)) testosterone. No association between past statin use and testosterone levels was found. CONCLUSION We showed that current use of statins was associated with significantly lower serum total and non-SHBG-bound testosterone levels. The clinical relevance of this association should be further investigated.
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Affiliation(s)
- Catherine E de Keyser
- Department of EpidemiologyErasmus Medical Center, PO Box 2040, 3000CA Rotterdam, The NetherlandsThe Health Care InspectorateThe Hague, The NetherlandsDepartments of Internal MedicineClinical ChemistryErasmus Medical Center, Rotterdam, The NetherlandsHospital PharmacyThe Hague Hospitals - HAGA, The Hague, The Netherlands Department of EpidemiologyErasmus Medical Center, PO Box 2040, 3000CA Rotterdam, The NetherlandsThe Health Care InspectorateThe Hague, The NetherlandsDepartments of Internal MedicineClinical ChemistryErasmus Medical Center, Rotterdam, The NetherlandsHospital PharmacyThe Hague Hospitals - HAGA, The Hague, The Netherlands
| | - Filipe Valerio de Lima
- Department of EpidemiologyErasmus Medical Center, PO Box 2040, 3000CA Rotterdam, The NetherlandsThe Health Care InspectorateThe Hague, The NetherlandsDepartments of Internal MedicineClinical ChemistryErasmus Medical Center, Rotterdam, The NetherlandsHospital PharmacyThe Hague Hospitals - HAGA, The Hague, The Netherlands
| | - Frank H de Jong
- Department of EpidemiologyErasmus Medical Center, PO Box 2040, 3000CA Rotterdam, The NetherlandsThe Health Care InspectorateThe Hague, The NetherlandsDepartments of Internal MedicineClinical ChemistryErasmus Medical Center, Rotterdam, The NetherlandsHospital PharmacyThe Hague Hospitals - HAGA, The Hague, The Netherlands
| | - Albert Hofman
- Department of EpidemiologyErasmus Medical Center, PO Box 2040, 3000CA Rotterdam, The NetherlandsThe Health Care InspectorateThe Hague, The NetherlandsDepartments of Internal MedicineClinical ChemistryErasmus Medical Center, Rotterdam, The NetherlandsHospital PharmacyThe Hague Hospitals - HAGA, The Hague, The Netherlands
| | - Yolanda B de Rijke
- Department of EpidemiologyErasmus Medical Center, PO Box 2040, 3000CA Rotterdam, The NetherlandsThe Health Care InspectorateThe Hague, The NetherlandsDepartments of Internal MedicineClinical ChemistryErasmus Medical Center, Rotterdam, The NetherlandsHospital PharmacyThe Hague Hospitals - HAGA, The Hague, The Netherlands Department of EpidemiologyErasmus Medical Center, PO Box 2040, 3000CA Rotterdam, The NetherlandsThe Health Care InspectorateThe Hague, The NetherlandsDepartments of Internal MedicineClinical ChemistryErasmus Medical Center, Rotterdam, The NetherlandsHospital PharmacyThe Hague Hospitals - HAGA, The Hague, The Netherlands
| | - André G Uitterlinden
- Department of EpidemiologyErasmus Medical Center, PO Box 2040, 3000CA Rotterdam, The NetherlandsThe Health Care InspectorateThe Hague, The NetherlandsDepartments of Internal MedicineClinical ChemistryErasmus Medical Center, Rotterdam, The NetherlandsHospital PharmacyThe Hague Hospitals - HAGA, The Hague, The Netherlands Department of EpidemiologyErasmus Medical Center, PO Box 2040, 3000CA Rotterdam, The NetherlandsThe Health Care InspectorateThe Hague, The NetherlandsDepartments of Internal MedicineClinical ChemistryErasmus Medical Center, Rotterdam, The NetherlandsHospital PharmacyThe Hague Hospitals - HAGA, The Hague, The Netherlands
| | - Loes E Visser
- Department of EpidemiologyErasmus Medical Center, PO Box 2040, 3000CA Rotterdam, The NetherlandsThe Health Care InspectorateThe Hague, The NetherlandsDepartments of Internal MedicineClinical ChemistryErasmus Medical Center, Rotterdam, The NetherlandsHospital PharmacyThe Hague Hospitals - HAGA, The Hague, The Netherlands Department of EpidemiologyErasmus Medical Center, PO Box 2040, 3000CA Rotterdam, The NetherlandsThe Health Care InspectorateThe Hague, The NetherlandsDepartments of Internal MedicineClinical ChemistryErasmus Medical Center, Rotterdam, The NetherlandsHospital PharmacyThe Hague Hospitals - HAGA, The Hague, The Netherlands Department of EpidemiologyErasmus Medical Center, PO Box 2040, 3000CA Rotterdam, The NetherlandsThe Health Care InspectorateThe Hague, The NetherlandsDepartments of Internal MedicineClinical ChemistryErasmus Medical Center, Rotterdam, The NetherlandsHospital PharmacyThe Hague Hospitals - HAGA, The Hague, The Netherlands
| | - Bruno H Stricker
- Department of EpidemiologyErasmus Medical Center, PO Box 2040, 3000CA Rotterdam, The NetherlandsThe Health Care InspectorateThe Hague, The NetherlandsDepartments of Internal MedicineClinical ChemistryErasmus Medical Center, Rotterdam, The NetherlandsHospital PharmacyThe Hague Hospitals - HAGA, The Hague, The Netherlands Department of EpidemiologyErasmus Medical Center, PO Box 2040, 3000CA Rotterdam, The NetherlandsThe Health Care InspectorateThe Hague, The NetherlandsDepartments of Internal MedicineClinical ChemistryErasmus Medical Center, Rotterdam, The NetherlandsHospital PharmacyThe Hague Hospitals - HAGA, The Hague, The Netherlands Department of EpidemiologyErasmus Medical Center, PO Box 2040, 3000CA Rotterdam, The NetherlandsThe Health Care InspectorateThe Hague, The NetherlandsDepartments of Internal MedicineClinical ChemistryErasmus Medical Center, Rotterdam, The NetherlandsHospital PharmacyThe Hague Hospitals - HAGA, The Hague, The Netherlands
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Maseroli E, Corona G, Rastrelli G, Lotti F, Cipriani S, Forti G, Mannucci E, Maggi M. Prevalence of Endocrine and Metabolic Disorders in Subjects with Erectile Dysfunction: A Comparative Study. J Sex Med 2015; 12:956-65. [DOI: 10.1111/jsm.12832] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Menezes A, Artham S, Lavie CJ, Milani RV, O'Keefe J. Erectile Dysfunction and Cardiovascular Disease. Postgrad Med 2015; 123:7-16. [DOI: 10.3810/pgm.2011.05.2279] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Ali SK, Reveles KR, Davis R, Mortensen EM, Frei CR, Mansi I. The Association of Statin Use and Gonado‐Sexual Function in Women: A Retrospective Cohort Analysis. J Sex Med 2015; 12:83-92. [DOI: 10.1111/jsm.12736] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Cai X, Tian Y, Wu T, Cao CX, Bu SY, Wang KJ. The role of statins in erectile dysfunction: a systematic review and meta-analysis. Asian J Androl 2014; 16:461-6. [PMID: 24556747 PMCID: PMC4023379 DOI: 10.4103/1008-682x.123678] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To evaluate the effect of statins for erectile dysfunction (ED), a systematic review of the literature was conducted in the Cochrane Library, Embase and PubMed from the inception of each database to June 2013. Only randomized controlled trials (RCTs) comparing treatment for ED with statins were identified. Placebo RCTs with the International Index of Erectile Function (IIEF) as the outcome measure were eligible for meta-analysis. A total of seven RCTs including two statins with a total of 586 patients strictly met our criteria for systematic review and five of them qualified for the meta-analysis. A meta-analysis using a random effects model showed that statins were associated with a significant increase in IIEF-5 scores (mean difference (MD): 3.27; 95% confidential interval (CI):1.51 to 5.02; P < 0.01) and an overall improvement of lipid profiles including total cholesterol (MD: −1.08; 95% CI: −1.68 to −0.48; P < 0.01), low-density lipoprotein (LDL) cholesterol (MD: −1.43; 95% CI: −2.07 to −0.79; P < 0.01), high-density lipoprotein (HDL) cholesterol (MD: 0.24; 95% CI: 0.13 to 0.35; P < 0.01) and triglycerides (TGs) (MD: −0.55; 95% CI: −0.61 to −0.48; P < 0.01). In summary, our study revealed positive consequences of these lipid-lowering drugs on erectile function, especially for nonresponders to phosphodiesterase type 5 inhibitors (PDE5Is). However, it has been reported that statin therapy may reduce levels of testosterone and aggravate symptoms of ED. Therefore, larger, well-designed RCTs are needed to investigate the double-edged role of statins in the treatment of ED.
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Affiliation(s)
| | | | | | | | | | - Kun-Jie Wang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
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Debreceni B, Debreceni L. The role of homocysteine-lowering B-vitamins in the primary prevention of cardiovascular disease. Cardiovasc Ther 2014; 32:130-8. [PMID: 24571382 DOI: 10.1111/1755-5922.12064] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality in the Western world. The effort of research should aim at the primary prevention of CVD. Alongside statin therapy, which is maintained to be an effective method of CVD prevention, there are alternative methods such as vitamin B substitution therapy with folic acid (FA), and vitamins B12 and B6 . B-vitamins may inhibit atherogenesis by decreasing the plasma level of homocysteine (Hcy)-a suspected etiological factor for atherosclerosis-and by other mechanisms, primarily through their antioxidant properties. Although Hcy-lowering vitamin trials have failed to demonstrate beneficial effects of B-vitamins in the prevention of CVD, a meta-analysis and stratification of a number of large vitamin trials have suggested their effectiveness in cardiovascular prevention (CVP) in some aspects. Furthermore, interpretation of the results from these large vitamin trials has been troubled by statin/aspirin therapy, which was applied along with the vitamin substitution, and FA fortification, both of which obscured the separate effects of vitamins in CVP. Recent research results have accentuated a new approach to vitamin therapy for CVP. Studies undertaken with the aim of primary prevention have shown that vitamin B substitution may be effective in the primary prevention of CVD and may also be an option in the secondary prevention of disease if statin therapy is accompanied by serious adverse effects. Further investigations are needed to determine the validity of vitamin substitution therapy before its introduction in the protocol of CVD prevention.
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Affiliation(s)
- Balazs Debreceni
- Department of Biochemistry and Medical Chemistry, Medical School, University of Pecs, Pecs, Hungary
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Davis R, Reveles KR, Ali SK, Mortensen EM, Frei CR, Mansi I. Statins and male sexual health: a retrospective cohort analysis. J Sex Med 2014; 12:158-67. [PMID: 25421152 DOI: 10.1111/jsm.12745] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Conflicting reports exist regarding the role of statins in male gonadal and sexual function. Some studies report a beneficial effect, particularly for erectile dysfunction (ED), through statins' anti-inflammatory and cardiovascular protective properties. Others suggest that statins might be associated with sexual dysfunction through negative effects on hormone levels. AIM This study aims to compare the risk of gonadal or sexual dysfunction in statin users vs. nonusers in a single-payer healthcare system. METHODS This was a retrospective cohort study of all male patients (30-85 years) enrolled in the Tricare San Antonio market. Using 79 baseline characteristics, we created a propensity score-matched cohort of statin users and nonusers. The study duration was divided into a baseline period (October 1, 2003 to September 30, 2005) to describe patient baseline characteristics, and a follow-up period (October 1, 2005 to March 1, 2012) to determine patient outcomes. Statin users were defined as those prescribed a statin for ≥3 months between October 1, 2004 and September 30, 2005. MAIN OUTCOME MEASURES Outcomes were identified as the occurrence of benign prostatic hypertrophy (BPH), ED, infertility, testicular dysfunction, or psychosexual dysfunction during the follow-up period as identified by inpatient or outpatient International Classification of Diseases, 9th Revision, Clinical Modification codes. Logistic regression was used to determine the association of statin use with patient outcomes. RESULTS Of 20,731 patients who met study criteria, we propensity score-matched 3,302 statin users with 3,302 nonusers. Statin use in men was not significantly associated with an increased or decreased risk of BPH (odds ratio [OR] 1.08; 95% confidence interval [CI] 0.97-1.19), ED (OR 1.01; 95% CI 0.90-1.13), infertility (OR 1.22; 95% CI 0.66-2.29), testicular dysfunction (OR 0.91; 95% CI 0.73-1.14), or psychosexual dysfunction (OR 1.03; 95% CI 0.94-1.14). CONCLUSIONS Statin use was not associated with increased risk of being diagnosed with gonadal or sexual dysfunction in men. Further studies using a larger sample may be needed.
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Affiliation(s)
- Richard Davis
- Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
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Martínez‐Jabaloyas JM. Testosterone Deficiency in Patients with Erectile Dysfunction: When Should a Higher Cardiovascular Risk Be Considered? J Sex Med 2014; 11:2083-91. [DOI: 10.1111/jsm.12596] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Corona G, Maseroli E, Maggi M. Injectable testosterone undecanoate for the treatment of hypogonadism. Expert Opin Pharmacother 2014; 15:1903-26. [DOI: 10.1517/14656566.2014.944896] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Abstract
Statins form the pharmacologic cornerstone of the primary and secondary prevention of atherosclerotic cardiovascular disease. In addition to beneficial cardiovascular effects, statins seem to have multiple non-cardiovascular effects. Although early concerns about statin induced hepatotoxicity and cancer have subsided owing to reassuring evidence, two of the most common concerns that clinicians have are myopathy and diabetes. Randomized controlled trials suggest that statins are associated with a modest increase in the risk of myositis but not the risk of myalgia. Severe myopathy (rhabdomyolysis) is rare and often linked to a statin regimen that is no longer recommended (simvastatin 80 mg). Randomized controlled trials and meta-analyses suggest an increase in the risk of diabetes with statins, particularly with higher intensity regimens in people with two or more components of the metabolic syndrome. Other non-cardiovascular effects covered in this review are contrast induced nephropathy, cognition, cataracts, erectile dysfunction, and venous thromboembolism. Currently, systematic reviews and clinical practice guidelines indicate that the cardiovascular benefits of statins generally outweigh non-cardiovascular harms in patients above a certain threshold of cardiovascular risk. Literature is also accumulating on the potential non-cardiovascular benefits of statins, which could lead to novel applications of this class of drug in the future.
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Affiliation(s)
- Chintan S Desai
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD 21287, USA
| | - Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD 21287, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD 21287, USA
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Pons-Rejraji H, Brugnon F, Sion B, Maqdasy S, Gouby G, Pereira B, Marceau G, Gremeau AS, Drevet J, Grizard G, Janny L, Tauveron I. Evaluation of atorvastatin efficacy and toxicity on spermatozoa, accessory glands and gonadal hormones of healthy men: a pilot prospective clinical trial. Reprod Biol Endocrinol 2014; 12:65. [PMID: 25016482 PMCID: PMC4114109 DOI: 10.1186/1477-7827-12-65] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 07/07/2014] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Recommendations for cardiovascular disease prevention advocate lowering both cholesterol and low-density lipoprotein cholesterol systemic levels, notably by statin intake. However, statins are the subject of questions concerning their impact on male fertility. This study aimed to evaluate, by a prospective pilot assay, the efficacy and the toxicity of a decrease of cholesterol blood levels, induced by atorvastatin on semen quality and sexual hormone levels of healthy, normocholesterolaemic and normozoospermic men. METHODS Atorvastatin (10 mg daily) was administrated orally during 5 months to 17 men with normal plasma lipid and standard semen parameters. Spermatozoa parameters, accessory gland markers, semen lipid levels and blood levels of gonadal hormones were assayed before statin intake, during the treatment, and 3 months after its withdrawal. RESULTS Atorvastatin treatment significantly decreased circulating low-density lipoprotein cholesterol (LDL-C) and total cholesterol concentrations by 42% and 24% (p<0.0001) respectively, and reached the efficacy objective of the protocol. During atorvastatin therapy and/or 3 months after its withdrawal numerous semen parameters were significantly modified, such as total number of spermatozoa (-31%, p<0.05), vitality (-9.5%, p<0.05), total motility (+7.5%, p<0.05), morphology (head, neck and midpiece abnormalities, p<0.05), and the kinetics of acrosome reaction (p<0.05). Seminal concentrations of acid phosphatases (p<0.01), α-glucosidase (p<0.05) and L-carnitine (p<0.05) were also decreased during the therapy, indicating an alteration of prostatic and epididymal functions. Moreover, we measured at least one altered semen parameter in 35% of the subjects during atorvastatin treatment, and in 65% of the subjects after withdrawal, which led us to consider that atorvastatin is unsafe in the context of our study. CONCLUSIONS Our results show for the first time that atorvastatin significantly affects the sperm parameters and the seminal fluid composition of healthy men.
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Affiliation(s)
- Hanae Pons-Rejraji
- CHU Clermont Ferrand, Laboratoire de BDR: AMP-CECOS, F-63003 Clermont-Ferrand, France
- GReD, UMR CNRS 6293 INSERM U1103, Clermont Université, 63000 Clermont-Ferrand, France
| | - Florence Brugnon
- CHU Clermont Ferrand, Laboratoire de BDR: AMP-CECOS, F-63003 Clermont-Ferrand, France
- GReD, UMR CNRS 6293 INSERM U1103, Clermont Université, 63000 Clermont-Ferrand, France
| | - Benoit Sion
- Pharmacologie Fondamentale et Clinique de la Douleur, France Inserm, U 1107, Neuro-Dol, Clermont Université, Université d’Auvergne, F-63001 Clermont-Ferrand, France
| | - Salwan Maqdasy
- GReD, UMR CNRS 6293 INSERM U1103, Clermont Université, 63000 Clermont-Ferrand, France
- CHU Clermont-Ferrand, Service d’Endocrinologie-Diabétologie, F-63003 Clermont-Ferrand, France
| | - Gerald Gouby
- CHU de Clermont-Ferrand, Délégation à la Recherche Clinique et à l’Innovation (DRCI), F-63003 Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Biostatistics unit, DRCI, Clermont-Ferrand, France
| | - Geoffroy Marceau
- GReD, UMR CNRS 6293 INSERM U1103, Clermont Université, 63000 Clermont-Ferrand, France
- CHU Clermont-Ferrand, Laboratoire de Biochimie, F-63003 Clermont-Ferrand, France
| | - Anne-Sophie Gremeau
- CHU Clermont Ferrand, Laboratoire de BDR: AMP-CECOS, F-63003 Clermont-Ferrand, France
| | - Joel Drevet
- GReD, UMR CNRS 6293 INSERM U1103, Clermont Université, 63000 Clermont-Ferrand, France
- Pharmacologie Fondamentale et Clinique de la Douleur, France Inserm, U 1107, Neuro-Dol, Clermont Université, Université d’Auvergne, F-63001 Clermont-Ferrand, France
| | - Genevieve Grizard
- CHU Clermont Ferrand, Laboratoire de BDR: AMP-CECOS, F-63003 Clermont-Ferrand, France
| | - Laurent Janny
- CHU Clermont Ferrand, Laboratoire de BDR: AMP-CECOS, F-63003 Clermont-Ferrand, France
- GReD, UMR CNRS 6293 INSERM U1103, Clermont Université, 63000 Clermont-Ferrand, France
| | - Igor Tauveron
- GReD, UMR CNRS 6293 INSERM U1103, Clermont Université, 63000 Clermont-Ferrand, France
- CHU Clermont-Ferrand, Service d’Endocrinologie-Diabétologie, F-63003 Clermont-Ferrand, France
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Cui Y, Zong H, Yan H, Zhang Y. The Effect of Statins on Erectile Dysfunction: A Systematic Review and Meta‐Analysis. J Sex Med 2014; 11:1367-75. [DOI: 10.1111/jsm.12497] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Statin drugs markedly inhibit testosterone production by rat Leydig cells in vitro: Implications for men. Reprod Toxicol 2014; 45:52-8. [DOI: 10.1016/j.reprotox.2013.12.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 12/02/2013] [Accepted: 12/28/2013] [Indexed: 11/21/2022]
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Kostis JB, Dobrzynski JM. The effect of statins on erectile dysfunction: a meta-analysis of randomized trials. J Sex Med 2014; 11:1626-35. [PMID: 24684744 DOI: 10.1111/jsm.12521] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) is common in older men, especially those with comorbidities such as diabetes and atherosclerotic disease, conditions where statins are frequently prescribed. AIM To examine the effect of statin therapy on ED using the five-item version of the International Inventory of Erectile Function (IIEF). METHODS We performed a random-effects meta-analysis of studies identified by a systematic search of MEDLINE, Web of Knowledge, the Cochrane Database, and ClinicalTrials.gov. Examination of the 186 retrieved citations resulted in the selection of 11 randomized trials for inclusion in the meta-analysis. MAIN OUTCOME MEASURES Change in the IIEF score. RESULTS IIEF increased by 3.4 points (95% CI 1.7-5.0, P = 0.0001) with statins compared to control. This effect remained statistically significant after multiple sensitivity analyses, including analysis for publication bias, a cumulative meta-analysis, and 11 repeated analyses with each study omitted sequentially. The increase in IIEF with statins was approximately one-third to one-half of that previously reported with phosphodiesterase-5 inhibitors and larger than the effect of lifestyle modification. Metaregression showed an increase in benefit with decreasing lipophilicity. The average age of participants and the degree of LDL cholesterol lowering did not alter the effect on IIEF. CONCLUSION Statins cause a clinically relevant improvement of erectile function as measured by the five-item version of the IIEF.
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Affiliation(s)
- John B Kostis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Neuropsychiatric adverse events associated with statins: epidemiology, pathophysiology, prevention and management. CNS Drugs 2014; 28:249-72. [PMID: 24435290 DOI: 10.1007/s40263-013-0135-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Statins, or 3-hydroxy-3-methyl-glutaryl coenzyme A reductase inhibitors, such as lovastatin, atorvastatin, simvastatin, pravastatin, fluvastatin, rosuvastatin and pitavastatin, are cholesterol-lowering drugs used in clinical practice to prevent coronary heart disease. These drugs are generally well tolerated and have been rarely associated with severe adverse effects (e.g. rhabdomyolysis). Over the years, case series and data from national registries of spontaneous adverse drug reaction reports have demonstrated the occurrence of neuropsychiatric reactions associated with statin treatment. They include behavioural alterations (severe irritability, homicidal impulses, threats to others, road rage, depression and violence, paranoia, alienation, antisocial behaviour); cognitive and memory impairments; sleep disturbance (frequent awakenings, shorter sleep duration, early morning awakenings, nightmares, sleepwalking, night terrors); and sexual dysfunction (impotence and decreased libido). Studies designed to investigate specific neuropsychiatric endpoints have yielded conflicting results. Several mechanisms, mainly related to inhibition of cholesterol biosynthesis, have been proposed to explain the detrimental effects of statins on the central nervous system. Approaches to prevent and manage such adverse effects may include drug discontinuation and introduction of dietary restrictions; maintenance of statin treatment for some weeks with close patient monitoring; switching to a different statin; dose reduction; use of ω-3 fatty acids or coenzyme Q10 supplements; and treatment with psychotropic drugs. The available information suggests that neuropsychiatric effects associated with statins are rare events that likely occur in sensitive patients. Additional data are required, and further clinical studies are needed.
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Gray KM, Derosa A. Subcutaneous pellet testosterone replacement therapy: the "first steps" in treating men with spinal cord injuries. J Osteopath Med 2013; 113:921-5. [PMID: 24285035 DOI: 10.7556/jaoa.2013.071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The authors describe the case of a 36-year-old man who presented with hormone level concerns 6 months after a rock climbing accident that resulted in paraplegia. Hypogonadism was diagnosed, and the patient received subcutaneous pellet testosterone replacement therapy. Within 6 months, the patient had substantial improvement in muscle function and was able to take several steps with the assistance of crutches or a walker. This case highlights the potential improvement in quality of life and overall prognosis resulting from the subcutaneous pellet form of testosterone when used as part of the overall treatment plan in such patients. Considering the overwhelming preponderance of hypogonadism in men with spinal cord injuries, the standard of care for such patients should include screening, laboratory hormone evaluation, and prompt treatment for testosterone deficiency.
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Evidence for a Positive Association Between Serum Carnitine and Free Testosterone Levels in Uremic Men with Hemodialysis. Rejuvenation Res 2013; 16:200-5. [DOI: 10.1089/rej.2012.1399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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