Effects of Statin Treatment on Serum Sex Steroids Levels and Autonomic and Erectile Function

Doğru, Mehmet; Başar, Murat; Şimşek, Ali; Yuvanç, Ercan; Güneri, Mahmut; Ebinç, Haksun; Batı̇slam, Ertan

doi:10.1016/j.urology.2007.11.059

Cited by 20 publications

(17 citation statements)

References 29 publications

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“…In a controlled study of 30 hypercholesterolaemic patients with Type 2 diabetes, 12 months of simvastatin (40 mg/day) reduced total cholesterol and LDL-cholesterol, and increased HR recovery, a marker of parasympathetic potency [86], 1 min following a maximal exercise test [87]. In contrast, in an uncontrolled trial of 74 hypercholesterolaemic men, 12 months of atorvastatin (40 mg/day) reduced total cholesterol and LDL-cholesterol, but did not affect time or frequency domain measures of HRV [88]. Similar neutral results have been observed following 6 weeks of simvastatin (20 mg/day) or simvastatin (20 mg/day) plus omega-3 fatty acid supplementation [89].…”

Section: Human Studiesmentioning

confidence: 97%

Statins and the autonomic nervous system

Millar

Floras

2013

Clinical Science

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Statins (3-hydroxy-3-methylglutaryl-CoA reductase inhibitors) reduce plasma cholesterol and improve endothelium-dependent vasodilation, inflammation and oxidative stress. A 'pleiotropic' property of statins receiving less attention is their effect on the autonomic nervous system. Increased central sympathetic outflow and diminished cardiac vagal tone are disturbances characteristic of a range of cardiovascular conditions for which statins are now prescribed routinely to reduce cardiovascular events: following myocardial infarction, and in hypertension, chronic kidney disease, heart failure and diabetes. The purpose of the present review is to synthesize contemporary evidence that statins can improve autonomic circulatory regulation. In experimental preparations, high-dose lipophilic statins have been shown to reduce adrenergic outflow by attenuating oxidative stress in central brain regions involved in sympathetic and parasympathetic discharge induction and modulation. In patients with hypertension, chronic kidney disease and heart failure, lipophilic statins, such as simvastatin or atorvastatin, have been shown to reduce MNSA (muscle sympathetic nerve activity) by 12-30%. Reports concerning the effect of statin therapy on HRV (heart rate variability) are less consistent. Because of their implications for BP (blood pressure) control, insulin sensitivity, arrhythmogenesis and sudden cardiac death, these autonomic nervous system actions should be considered additional mechanisms by which statins lower cardiovascular risk.

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Section: Human Studiesmentioning

confidence: 97%

Statins and the autonomic nervous system

Millar

Floras

2013

Clinical Science

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“…24 It has been proposed that in patients with hyperlipidemia, treatment with statin has a protective effect on erectile function. 17 In an experimental study, atorvastatin improved diabetes-related ED and restored sildenafil responsiveness. 25 Statin therapy was effective on early return of potency after nervesparing radical retropubic prostatectomy in men without hypercholesterolemia.…”

Section: Introductionmentioning

confidence: 99%

“…17 Patients with ED but without clinical evidence for cardiovascular disease have a peripheral vascular defect in endothelium-dependent and -independent vasodilation. 18 Oxidized low-density lipoprotein (LDL) inhibits vascular smooth muscle relaxation through endothelial cells.…”

Section: Introductionmentioning

confidence: 99%

Atorvastatin improves the response to sildenafil in hypercholesterolemic men with erectile dysfunction not initially responsive to sildenafil

et al. 2009

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Despite the initial enthusiasm, the significant number of patients in whom sildenafil is contraindicated or ineffective is a major challenge to all urologists. Our aim was to determine the safety and efficacy of adjunctive atorvastatin in restoring normal erectile function in hypercholesterolemic (low-density lipoprotein (LDL) cholesterol 4120 mg per 100 ml) sildenafil nonresponders. The study comprised 131 men with ED not responding to sildenafil citrate. They were randomized either to 40 mg atorvastatin daily (n ¼ 66, group 1) or matching placebo (n ¼ 65, group 2) for 12 weeks while they were taking on-demand 100 mg sildenafil. Erectile function was subjectively assessed using the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire and response to the global efficacy question (GEQ). Serum biochemical and lipid profile (total cholesterol, triglycerides, LDL cholesterol and high-density lipoprotein cholesterol) analyses were performed at baseline and repeated at post-treatment weeks 6 and 12. Compared with the placebo group (59 patients, mean age ± s.d. 61.9 ± 6.1, mean years ED 3.9 ± 1.8), the atorvastatin group (59 patients, mean age±s.d. 63.9±6.9, mean years ED 3.7±1.6) had significantly greater improvements in all IIEF-5 questions (P ¼ 0.01) and GEQ (P ¼ 0.001). Subgroup analyses did reveal trends in the atorvastatin group to indicate that a change in the IIEF-5 score is affected by age, severity of ED and baseline serum levels of LDL. Patients with moderate (r ¼ 0.28, P ¼ 0.01) and severe (r ¼ 0.20, P ¼ 0.01) ED had better positive response rates to adjunctive atorvastatin than patients with mild to moderate ED. None of the patients taking atorvastatin achieved a response of 5 to the IIEF-5 questions and none of the patients regained normal erectile function as defined by the IIEF-5 score 421. Subjects experienced a statistically significant but modest improvement in erectile function. Further investigation is needed to test the usefulness of long-term atorvastatin administration to restore erectile function in sildenafil nonresponders.

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“…Hyperlipidemia is also considered a significant risk factor for ED, being the only active risk factor in up to 42% of patients (Do gru et al, 2008). Saltzman et al (2004) demonstrated that atorvastatin alone could lead to an improvement in erectile function in men with hypercholesterolaemia as the only risk factor for ED.…”

Section: Lipid-lowering Drugsmentioning

confidence: 99%

Erectile dysfunction in heart failure patients: a critical reappraisal

et al. 2013

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SUMMARYHeart failure (HF) is a complex clinical syndrome with a constantly increasing incidence and prevalence in western countries. Total absence of sexual activity is registered in 30% of HF patients. Moreover, HF-induced reduction in exercise tolerance, side effects of HF medications and the coexistence of shared risk factors between HF and sexual dysfunction may further aggravate the sexual health of HF patients. The purpose of this review is to examine the pathophysiological mechanisms behind the association of erectile dysfunction (ED) and HF, the potential therapeutic approaches and the eventual indications for sexual activity in HF patients. Medline and Cochrane Library search was performed from January 1970 through October 2012 to retrieve relevant papers outlining the association between ED and HF. Many evidences have outlined a tight association between ED and HF pathophysiological standpoint. Shared risk factors, common pathogenic traits and epidemiologic association represent some of the links between these conditions. Erectile dysfunction has been recognized as an earlier predictor of cardiovascular events; moreover, HF itself may cause and/ or worsen ED because of its particular feature and co-morbidities. Furthermore, some cardiovascular drugs may contribute to impaired erectile function. In stable patients with stable HF, sexual activity is generally not contraindicated but it should be encouraged, as a form of moderate-intensity physical exertion. An effective treatment of ED in HF patients should be founded on the correction of reversible risk factors, on the choice of cardiovascular drugs with the lowest effect upon patient's erectile function, and on the use of phosphodiesterase-5-inhibitors. Physicians should be aware of the close relation between HF and ED and of the related clinical and therapeutic implications, in order to improve patients quality of life and clinical outcome.

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Effects of Statin Treatment on Serum Sex Steroids Levels and Autonomic and Erectile Function

Cited by 20 publications

References 29 publications

Statins and the autonomic nervous system

Statins and the autonomic nervous system

Atorvastatin improves the response to sildenafil in hypercholesterolemic men with erectile dysfunction not initially responsive to sildenafil

Erectile dysfunction in heart failure patients: a critical reappraisal

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