The great opportunity of the andrological patient: cardiovascular and metabolic risk assessment and prevention

Abstract

Andrologists, cardiologists and diabetologists (and general practitioners) have the great opportunity to collaborate and find shared clinical workup for the benefit of a large number of men. Several evidence established a link between erectile dysfunction (ED), cardiovascular disease (CVD), diabetes, and metabolic syndrome. Not only these conditions share many risk factors and pathophysiological mechanisms but also an emerging paradigm indicates that ED is, in fact, an independent marker of cardiovascular disease risk, CV events and CV mortality. However, there is no consensus on the best cardiologic investigation in men with ED with no known CVD and, on the contrary, on what is the clinical and prognostic role of detecting ED during cardiovascular investigation and CVD risk assessment. Only vasculogenic ED, which represents the most common type of organic ED, indeed represents a harbinger of CVD, especially for younger patients, and might be diagnosed by dynamic penile color doppler ultrasonography, which represents a real cardiovascular imaging technique that give evidence on the presence of systemic endothelial dysfunction and atherosclerosis. Furthermore, assessment of glucose and lipid metabolism is warranted as first step workup in all ED patients, and diabetologists should ask their patients for erectile function, address ED patients to andrologists, and consider vasculogenic ED in the context of the cardiovascular and metabolic workup and in the context of diabetic complications. Sexual symptoms (and testosterone levels) should sound as harbinger for cardiovascular and metabolic investigation and cardiologists and diabetologists have the opportunity to have a symptom (erectile dysfunction) and a vascular test (penile color doppler) that help them in better management of patients, their comorbidities and complications.

Basal Hormones and Biochemical Markers as Predictors of Overtraining Syndrome in Male Athletes: The EROS-BASAL Study

“…1,[24][25][26][27] Moreover, impaired glucose transporter type 4 signaling in the myocytes, caused by an increase in some cytokines in the muscle tissue, 26,27 may be an additional mechanism to explain the dysfunctional In terms of hormonal changes, the chronic increase in testosterone levels observed in healthy athletes practicing mixed strength and endurance exercises 25 was assumed to be an additional beneficial conditioning effect that could lead to optimal muscle hypertrophy and function, improved sports performance and overall mood states, 17 increased metabolic rate (even at rest), 17 and enhanced metabolic pathways, as endogenous testosterone may improve glucose, lipid, and amino acid metabolism. 28 Conversely, OTS was associated with reduced testosterone, also previously described, 27 which may lead to impaired muscle recovery, decreased muscle mass, reduced basal metabolic rate, and less fat oxidation. 17 Estradiol has recently been shown to play beneficial roles in males with respect to bone mass, libido, humor, and body composition 29 when accompanied by a simultaneous increase in testosterone.…”

Late‐onset Hypogonadism: Bone health

“…2,3 Normative data obtained by studies on male population are urgently need for both DXA reference values and FRAX risk calculation in order to better tailor the diagnosis and the follow-up of men with osteoporosis. Andrological consultation performed in men with LOH represents an opportunity for male health 173 including bone. 4…”

Penile doppler ultrasound predicts cardiovascular events in men with erectile dysfunction

“…At least four meta‐analyses have confirmed the relationship between arteriogenic ED and CV risk (Dong et al ., ; Yamada et al ., ; Fan et al ., ; Osondu et al ., ). All this evidence suggests that vasculogenic ED can be a harbinger for early CVD (Foresta et al ., ; Uddin et al ., ; Zhao & Zhang, ). A recent study observed that the effect of ED on future coronary risk was strongly affected by patient age.…”