Cardiovascular risk assessment using high-sensitivity C-reactive protein in patients with erectile dysfunction

The Effects of Vibegron Add-on Therapy on Alpha 1-Blocker Therapy for Sexual Function and Overactive Bladder Symptoms in Benign Prostatic Hyperplasia: A Prospective, Open-Label Study

Background: The effect of combining an α1-adrenergic receptor blocker (α1-blocker) and the β3-adrenoceptor agonist vibegron for treating persistent overactive bladder (OAB) symptoms associated with benign prostatic hyperplasia (BPH) on sexual function remains uncertain. Therefore, we aimed to evaluate the effects of vibegron as an add-on to α1-blocker therapy on both OAB and sexual function. Methods: Forty-three patients with BPH in whom OAB symptoms were inadequately controlled by α1-blocker treatment were included in this prospective open-label study. The OAB Symptom Score (OABSS), International Prostate Symptom Score (IPSS), 15-item International Index of Erectile Function (IIEF-15), and Erection Hardness Score (EHS), as well as the residual urine volume and serum-free testosterone (FT) and C-reactive protein (CRP) levels, were evaluated before and 8 weeks after the daily administration of 50 mg vibegron/α1-blocker combination therapy. Results: Vibegron/α1-blocker combination therapy significantly improved the OABSS (from 6.9 ± 2.6 to 5.1 ± 2.9, p < 0.0001) and IIEF intercourse satisfaction domain (from 1.1 ± 2.3 to 1.9 ± 2.6, p = 0.02). No significant differences were observed for the IPSS, EHS, total IIEF-15 score, residual urine volume, and serum FT and CRP levels. Conclusions: The study findings suggest that vibegron/α1-blocker combination therapy improves OAB and sexual satisfaction.

Endothelial Dysfunction, Erectile Deficit and Cardiovascular Disease: An Overview of the Pathogenetic Links

Erectile dysfunction (ED) is a condition with multifactorial pathogenesis, quite common among men, especially those above 60 years old. A vascular etiology is the most common cause. The interaction between chronic inflammation, androgens, and cardiovascular risk factors determines macroscopically invisible alterations such as endothelial dysfunction and subsequent atherosclerosis and flow-limiting stenosis that affects both penile and coronary arteries. Thus, ED and cardiovascular disease (CVD) should be considered two different manifestations of the same systemic disorder, with a shared aetiological factor being endothelial dysfunction. Moreover, the penile arteries have a smaller size compared with coronary arteries; thus, for the same level of arteriopathy, a more significant blood flow reduction will occur in erectile tissue compared with coronary circulation. As a result, ED often precedes CVD by 2–5 years, and its diagnosis offers a time window for cardiovascular risk mitigation. Growing evidence suggests, in fact, that patients presenting with ED should be investigated for CVD even if they have no symptoms. Early detection could facilitate prompt intervention and a reduction in long-term complications. In this review, we provide an overview of the pathogenetic mechanisms behind arteriogenic ED and CVD, focusing on the role of endothelial dysfunction as the common denominator of the two disorders. Developed algorithms that may help identify those patients complaining of ED who should undergo detailed cardiologic assessment and receive intensive treatment for risk factors are also analyzed.

The Inflammation Network in the Pathogenesis of Erectile Dysfunction: Attractive Potential Therapeutic Targets

BACKGROUND

Erectile dysfunction (ED) is an evolving health problem in the aging male population. Chronic low-grade inflammation is a critical component of ED pathogenesis and a probable intermediate stage of endothelial dysfunction, especially in metabolic diseases, with the inclusion of obesity, metabolic syndrome, and diabetes.

OBJECTIVE

This review will present an overview of preclinical and clinical data regarding common inflammatory mechanisms involved in the pathogenesis of ED associated with metabolic diseases and the effect of antiinflammatory drugs on ED.

METHODS

A literature search of existing pre-clinical and clinical studies was performed on databases [Pubmed (MEDLINE), Scopus, and Embase] from January 2000 to October 2019.

RESULTS

Low-grade inflammation is a possible pathological role in endothelial dysfunction as a consequence of ED and other related metabolic diseases. Increased inflammation and endothelial/prothrombotic markers can be associated with the presence and degree of ED. Pharmacological therapy and modification of lifestyle and risk factors may have a significant role in the recovery of erectile response through reduction of inflammatory marker levels.

CONCLUSION

Inflammation is the least common denominator in the pathology of ED and metabolic disorders. The inflammatory process of ED includes a shift in the complex interactions of cytokines, chemokines, and adhesion molecules. These data have established that anti-inflammatory agents could be used as a therapeutic opportunity in the prevention and treatment of ED. Further research on inflammation-related mechanisms underlying ED and the effect of therapeutic strategies aimed at reducing inflammation is required for a better understanding of the pathogenesis and successful management of ED.

What is the best biological parameter to predict erectile dysfunction in men aged >55 years with type 2 diabetes?

To date, there is no evidence regarding the best biological marker to predict erectile dysfunction (ED) in men aged >55 years with type 2 diabetes. This prospective study included data from men aged >55 years with type 2 diabetes. ED was assessed by the International Index of Erectile Function 15-item survey. Total testosterone (TT) levels and bioavailable testosterone were measured; the free testosterone index was calculated. Data from 155 men (aged 64 ± 7 years) were explored. The prevalence of ED and testosterone deficiency was 78.7% and 34.8%, respectively. After univariate analysis, TT and bioavailable testosterone were associated with ED (P = 0.01). After multivariate analysis, and adjustment for age, body mass index, tobacco, alcohol, duration of diabetes, TT, bioavailable testosterone, vitamin D and high-sensitivity C-reactive protein, we found that only high-sensitivity C-reactive protein was significantly predictive of ED. TT could predict ED, but it lacks specificity. We found a potential role of high-sensitivity C-reactive protein as a predictive marker of ED in this targeted population.

Free testosterone correlated with erectile dysfunction severity among young men with normal total testosterone

Erectile dysfunction (ED) due to androgen deficiency is rare in the young population. We retrospectively evaluated in this study men aged 18-40 years presenting with ED from 2015 to 2017. The International Index of Erectile Function-5 (IIEF-5) and Erection Hardness Grade Scores (EHGS) were used to assess erectile function. Total testosterone (TT), sex hormone-binding globulin (SHBG), lipid profile, and glycometabolic indicators were tested in fasting blood sample. TT and SHBG were detected by electrochemiluminescence immunoassay, and free (FT) and bio-available testosterone (BT) were calculated from a validated formula. Linear regression was used to analyze the data. In total, 140 cases (30.56 ± 4.81 years) with a mean TT levels of 6.15 ± 2.17 ng/ml were enrolled. Decreased levels of FT were associated with lower IIEF-5 scores(β = 0.176, P = 0.048) and EHGS (β = 0.198, P = 0.026) after adjustment for age, body mass index (BMI), smoking, comorbidities, high-sensitive C-reactive protein (hsCRP), uric acid, fructosamine, and quantitative insulin sensitivity check index (QUICKI). TT was only associated with EHGS in the crude model (β = 0.177, P = 0.037) and some single factor adjustment models, whereas BT and SHBG were not related with erectile function in any model. Low FT level, even in the presence of normal TT, is associated with ED severity in young men. FT levels should be screened in ED patient even with normal total testosterone.

Effects of testosterone replacement therapy on metabolic syndrome among Japanese hypogonadal men: A subanalysis of a prospective randomised controlled trial (EARTH study)

We investigated the effects of testosterone replacement therapy (TRT) on metabolic factors among hypogonadal men with a metabolic syndrome. From the study population of the EARTH study, which was a randomised controlled study in Japan, 65 hypogonadal patients with a metabolic syndrome, comprising the TRT group (n = 32) and controls (n = 33), were included in this study analysis. The TRT group was administered 250 mg of testosterone enanthate as an intramuscular injection every 4 weeks for 12 months. Waist circumference, body mass index, body fat volume and blood pressure were measured in all patients at baseline and at 12 months. In addition, blood biochemical data, including total cholesterol, triglyceride (TG), HDL cholesterol, fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) levels, were also evaluated. Changes in these categories from baseline to 12 months were compared between the TRT and control groups, with significant differences observed in waist circumference, body fat percentage, FPG, TG and HbA1c levels. No significant differences were observed in other parameters. TRT for 1 year was associated with improvements in some metabolic factors among Japanese men with hypogonadism and metabolic syndrome.

The correlation between highly sensitive C-reactive protein levels and erectile function among men with late-onset hypogonadism

We investigated the correlation between highly sensitive C-reactive protein (hs-CRP) levels and erectile function, and assessed the clinical role of hs-CRP levels in men with late-onset hypogonadism (LOH) syndrome. For 77 participants, we assessed Sexual Health Inventory for men (SHIM) score, Aging Male Symptoms (AMS) score and International Prostate Symptom Score (IPSS). We also evaluated free testosterone (FT), hs-CRP, total cholesterol, triglyceride levels, high density lipoprotein cholesterol, hemoglobin A1c, body mass index, waist size and blood pressure. We attempted to identify parameters correlated with SHIM score and to determine the factors affecting cardiovascular risk based on hs-CRP levels. A Spearman rank correlation test revealed that age, AMS score, IPSS and hs-CRP levels were significantly correlated with SHIM score. Age-adjusted analysis revealed that hs-CRP and IPSS were the independent factors affecting SHIM score (r= -0.304 and -0.322, respectively). Seventeen patients belonged to the moderate to high risk group for cardiovascular disease, whereas the remaining 60 belonged to the low risk group. Age, FT value and SHIM score showed significant differences between the two groups. A multivariate regression analysis demonstrated that SHIM score was an independent factor affecting cardiovascular risk (OR: 0.796; 95%CI: 0.637-0.995).

Association Between Erectile Function and Biomarkers of Subclinical Atherosclerosis: A Study Based on Middle-Aged Healthy Men from the General Population

INTRODUCTION

Epidemiological studies suggest atherosclerosis as a common risk factor between cardiovascular diseases and erectile dysfunction (ED). We aimed to determine the association between erectile function and the biomarkers of subclinical atherosclerosis in 119 middle-aged healthy men from the general population.

METHODS

Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5). Serum levels of biomarkers of atherosclerosis: Apolipoprotein A, Apolipoprotein B, fibrinogen, and C-reactive protein (CRP) were measured. In addition, demographic data was collected.

RESULTS

The mean (SD) of age was 55 years (± 4.0). The prevalence of ED was 50%. There was a negative significant correlation between IIEF-5 and CRP levels (r = -0.20, p = 0.02), and BMI (r = -0.20, p = 0.03), respectively. No significant correlations between IIEF-5 and serum levels of Apolipoprotein A, Apolipoprotein B, and fibrinogen were found (p > 0.05). A positive significant correlation was found between BMI and fibrinogen (r = 0.20, p = 0.01), CRP (r = 0.30, p = 0.001). In a multivariate logistic regression model with IIEF-5 as the dependent variable, CRP was the only biomarker that predicted ED (odds ratio = 1.350; 95 % CI: 1.044-1.754).

CONCLUSIONS

These results indicate that CRP is a biomarker of subclinical atherosclerosis associated with ED. This association seems to be linked to greater BMI among such men.