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

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

Iacona R1, Bonomo V, Di Piazza M, Sansone A, Usala M, Novo S, Pavone C.

Author information

1
Chair and Division of Cardiology, University Hospital “Paolo Giaccone”, Palermo. rosanna.iacona@virgilio.it.

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.

KEYWORDS:

Cardiovascular events; Erectile dysfunction; Prevention

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The link between depression and atherosclerosis through the pathways of inflammation and endothelium dysfunction.

Chrysohoou C1, Kollia N2, Tousoulis D3.

Author information

1
First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece. Electronic address: chrysohoou@usa.net.
2
Department of Nutrition & Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
3
First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece.

Abstract

A large body of evidence suggests that depression increases the risk of cardiovascular morbidity and mortality. The elevated risk associated with depression is not limited to clinical major depressive disorder but also extends to sub-syndromal depressive symptoms and constructs with overlapping characteristics, such as vital exhaustion. Multiple pathophysiological pathways are involved in the relationship between depressive symptoms and atherosclerosis and its clinical manifestations and progression. These underlying mechanisms are not yet fully understood and need further clarification. This review examines inflammation and endothelium dysfunction as potential biological factors involved in the relationship between depressive symptoms and atherosclerosis. It has been reported that systemic inflammation and psychological factors interact through complex pathophysiological and behavioral mechanisms and one question that has been raised concerns whether the inflammation drives depression or vice versa, or whether the association is merely coincidental. Although further investigation is needed, including well-designed prospective studies, to address this question thoroughly, it seems that there is a feedback relationship, although the biological pathways of each direction may be distinct.

KEYWORDS:

Cardiovascular disease; Depression; Mechanisms

 

 

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