Five-year prospective study on cardiovascular events, in patients with erectile dysfunction and hypotestosterone

Abstract

Objective: Testosterone levels play a role in cardiac and vascular pathology. In the present study we investigated the prognostic significance of this hormone for cardiovascular outcome, in a 5-year follow-up. Materials and methods: Our cohort included 802 adult subjects, from 40 to 80 years. Patients were excluded if they had a past history of peripheral or coronary artery disease, and revascularization. A blood sample was drawn to valuate testosterone level, and we considered normal testosterone levels 300 ng/dl. FMD (flow mediated dilatation) of the brachial artery was assessed by measuring the increase of the brachial artery diameter during reactive hyperemia after transient forearm ischemia. B-mode longitudinal images of the brachial artery were obtained at the level of the antecubital fossa. The FMD was defined as the percentage change in the brachial artery diameter 60 s after releasing the ischemic cuff. Erectile dysfunction (ERD) was assessed by the International Index of Erectile Function-5 (IIEF-5) score questionnaire. We considered composite end points including the following major adverse cardiovascular events (MACEs) Results: Subjects with lower serum testosterone levels (n = 332) had higher prevalence of traditional cardiovascular risk factors, such as hypertension (p = 0.009), diabetes (p = 0.03), dyslipidemia (p < 0.0001), obesity (p = 0.002), and endothelial function score (p < 0.0001). AMI, death after AMI, major stroke and all clinical events were more frequent (p < 0.001) in patients with testosterone levels < 300 ng/dl. Further, by multiple logistic regression analysis we found that only dyslipidemia (p = 0,001), obesity (p = 0,007), testosterone < 300 ng/dl (p < 0,0001) and ED (p < 0,0001) were independent predictors of future events. Conclusions: A therapeutic intervention on testosterone may not only have a positive effect on the cardiovascular system but also an important role in preventing new cardiovascular events.KEY WORDS: Erectile dysfunction; Cardiovascular events; Prevention. gy (1). In particular, in the present study we investigated the prognostic significance of this hormone for cardiovascular outcome, in a 5-year follow-up. We aimed to assess whether baseline testosterone levels may be predictors of future cardiovascular events in a cohort of intermediate cardiovascular risk patients, according to Framingham risk score, and screened for the presence of ED in our Centre of Early Diagnosis of Preclinical and Multifocal Atherosclerosis and for Cardiovascular Prevention. The follow-up period was 5 years. We therefore aimed to test the hypothesis that measuring levels of this hormone, can provide information not only on the progression of atherosclerosis disease and therefore about ED, helping to define the prognosis, but can also be considered predictive of the risk of developing cardiovascular events, independently from common risk factors. MATERIALS AND METHODSOur cohort included 802 adult subjects, males from 40 to 80 years (mean age of the whole population was 57.52 ± 13.85 y...

Chronic Testosterone Deprivation Sensitizes the Middle-Aged Rat Brain to Damaging Effects of Testosterone Replacement

“…Recent studies support benefits of TRT in aged men (>60) including for cardiovascular and cerebrovascular disease [6, 10-12]. Low T, even within the reference range, is associated with an increased risk of ischemic stroke [7, 9, 59-61], and in some studies, TRT reduced risk [11, 12]. Nevertheless, others found that initiation of TRT could increase the risk of major cardiovascular events, including stroke [59, 62].…”

“…Although it is clear that low T levels are associated with cardiovascular disease, including stroke [7][8][9], the health effects of TRT are less clear. Most recent longitudinal studies support the benefits of TRT for cardiovascular and cerebrovascular disease risk [10][11][12].…”

Hypolipidemic and Anti‐Obesity Effects of Hydroalcoholic Extract of Brazilian Red Propolis in a Rodent Model of Dyslipidemia

“…[ 1 ] Dyslipidemia is frequently associated with overweight, obesity, and a broad spectrum of cardio‐metabolic disorders, which pose major public health concerns because they reduce an individual's productive years of life and cause early mortality. [ 2 ] Reduction in serum lipid levels is an important measure to control dyslipidemia and its associated complications, such as acute myocardial infarction and systemic arterial hypertension induced by atherosclerotic disease. [ 3 ] Therefore, several studies have expounded the use of potentially hypolipidemic substances as a therapeutic strategy for treating dyslipidemia and cardiovascular diseases.…”

Sexual dysfunction in dialytic patients. A prospective cross-sectional observational study in two hemodialysis centers

“…Sexual male dysfunction is an extremely common condition that manifests itself with erectile disorder (ED) and premature ejaculation (EP) (1), often present at the same time. In everyday clinical practice, both pathologies require a multidisciplinary approach in the diagnostic phase and in the therapeutic management (2,3) due to their multifactorial genesis, such as psychological factors and endothelial dysfunction. Female sexual dysfunctions are understudied, despite the incidence being alarmingly high: in a 30 years ago study, 76% of women were living with some symptoms of sexual dysfunction (4), while more recent literature suggest that prevalence is around 43% (5).…”