Is Obesity a Further Cardiovascular Risk Factor in Patients with Erectile Dysfunction?

Abstract

Introduction Erectile dysfunction (ED) and, in particular, arteriogenic ED have been proposed as new markers of risk for incident major adverse cardiovascular events (MACE). Reduced penile blood flow is more common in obese people than in leaner ED subjects. Aim To explore the interaction of overweight/obesity and penile blood flow in the prediction of incident MACE. Methods This is an observational prospective cohort study evaluating a consecutive series of 1,687 patients attending our andrological unit for ED. Different clinical, biochemical, and instrumental (penile flow at color Doppler ultrasound: PCDU) parameters were evaluated. Main Outcomes Measures According to body mass index (BMI), subjects were divided into three groups: normal weight (BMI=18.5–24.9 kg/m2), overweight (BMI=25.0–29.9 kg/m2), and obese (BMI ≥ 30.0 kg/m2). Information on MACE was obtained through the City of Florence Registry Office. Results Among patients studied, 39.8% were normal weight, while 44.1% and 16.1% showed BMI 25–29.9 and 30 kg/m2 or higher, respectively. During a mean follow-up of 4.3 ± 2.6 years, 139 MACE, 15 of which were fatal, were observed. Cox regression model, after adjusting for age and Chronic Diseases Score, showed that obesity classes along with the presence of arteriogenic ED (peak systolic velocity at PCDU <25 cm/second) were significantly and independently associated with incident MACE (hazard ratio=1.47 [1.1–1.95], P <0.05 and 2.58 [1.28–5.09], P <0.001, respectively). When a separate analysis was performed for classes of obesity, reduced peak systolic velocity at PCDU (<25 cm/second) was significantly associated with incident MACE in obese (BMI ≥ 30 kg/m2), but not in leaner, subjects. Conclusions In obese subjects, more than in leaner ED subjects, impaired penile blood flow is associated with an increased risk of incident cardiovascular disease. The interaction with concomitant risk factors, such as obesity, should be taken into account when assessing the predictive value of penile blood flow for cardiovascular diseases.

Erectile dysfunction and central obesity: an Italian perspective

“…We now originally report associations between WC and potential CV risk factors in a large series of subjects seeking medical care for ED at our unit (see above). We confirmed that also different WC grades, as previously reported for BMI classes,323 are associated with an increasing severity of hyperglycemia, insulin resistance and the prevalence of diabetes mellitus ( Figure 4a–c ) as well as dyslipidemia ( Figure 4d–f ). Similarly, pulse pressure, mean blood pressure and prevalence of hypertension were all closely related to WC increment ( Figure 5a–c ).…”

“…However, the impact of obesity in ED subjects on the risk of incident CVD has been endorsed only by few studies,386 and the role of central obesity has never been explored. We now originally report associations between WC and potential CV risk factors in a large series of subjects seeking medical care for ED at our unit (see above).…”

“…Overweight and obesity have become an epidemic problem, on the rise not only in Western societies, but also in developing countries. Obesity causes concern because it constitutes a worldwide, major health problem and is a risk factor for major adverse cardiovascular events (MACE), type 2 diabetes mellitus, certain types of cancer, sleep apnea, osteoarthritis and most of all, excess mortality 23. In fact, together with smoking habits, obesity is considered one of the most common preventable, and therefore treatable causes of premature death.…”

Body weight loss reverts obesity-associated hypogonadotropic hypogonadism: a systematic review and meta-analysis

“…Accordingly, a recent large population-based study involving more than 3400 subjects from eight European centers (EMAS study) showed that about half of subjects were overweight or obese with an even higher prevalence in Eastern transitional countries (2). Excess body weight is a crucial risk factor for mortality and morbidity not only for cardiovascular diseases (CVD) but also for type 2 diabetes mellitus (T2DM), cancer, and musculoskeletal disorders; these complications cause nearly 3 million deaths every year worldwide (3,4,5,6,7,8). Despite this evidence, obesity is one of today's most blatantly visible -yet most neglected -public health problems.…”

Neues in der Andrologie

“…Besonders interessant sind auch die Aspekte zwischen erektiler Dysfunktion, Fettsucht und Hypogonadismus, wobei Corona et al [10] gezeigt haben, dass sowohl der "Body Mass Index" (BMI) wie auch der vergrößerte Bauchumfang mit reduzierten Testosteronspiegeln (Hypogonadismus) signifikant korrelieren. Darüber hinaus hat die gleiche Arbeitsgruppe [11] in einer Metaanalyse dargestellt, dass eine Testosterongabe die Symptome des metabolischen Syndroms signifikant verbessert (.…”