Research presented at the European Congress of Endocrinology shows for the first time that men with erectile dysfunction and low testosterone have a higher than normal risk of dying from cardiovascular disease. Further work from the same research group shows that obesity is also associated with an impairment of blood flow to the penis, which in turn is also associated with cardiovascular disease in men with erectile dysfunction.
A group led by Dr Giovanni Corona (University of Florence) carried out two separate studies on a group of men attending a clinic for erectile dysfunction. The first study looked at testosterone levels in patients with erectile dysfunction. They investigated testosterone levels of 1687 patients attending the andrology clinic for erectile dysfunction, and followed them up for an average of 4.3 years. In the follow-up period, 137 of the patients had a major cardiac event, with 15 fatalities. Low testosterone itself was not associated with major cardiac events, but those patients with the lowest testosterone who had a major cardiac event were significantly more likely to die than those with higher levels of testosterone (P<0.001; the risk is increased by a factor of seven, although the numbers affected will be small).
Researcher Dr Giovanni Corona said:
"Our work shows that screening for testosterone deficiency in men with erectile dysfunction may help clinicians identify those at higher risk from cardiovascular events. However, at the moment we can't say whether low testosterone levels are the cause or the consequence of this higher risk.
"This work needs to be confirmed by larger studies. However, this is the first time that low testosterone is associated with higher death rates from heart disease in men with erectile dysfunction. Our work indicates that if you have erectile dysfunction, and if you have a very low testosterone level, then you are up to 7 times more likely to die from a major cardiac event than if you have erectile dysfunction and normal testosterone levels. It may be worth screening the testosterone levels of men who come to clinics with erectile dysfunction, as this may be a way of identifying those who are most at risk from heart disease. At the same time, we need large-scale studies to look at whether testosterone replacement therapy in at-risk men can prevent unnecessary deaths from heart disease."
In a second study (but using the same group of patients as above), the group showed that the degree of obesity, along with erectile dysfunction, were significantly and independently associated with cardiac events. When a separate analysis was performed for classes of obesity, reduced blood flow to the penis was shown to be significantly related with incident of major cardiac events in obese men (i.e. those with a BMI greater than 30 kg/m2; P<0.05). This was not true of leaner men.
Dr Giovanni Corona concluded:
"We found that, in obese men with erectile dysfunction, more than in leaner men with erectile dysfunction, impaired blood flow to the penis is associated with an increased risk of cardiovascular disease. Taking these results together, we can say that, referral for erectile dysfunction should become an opportunity -- for the patient and for the doctor -- to screen for general health. In one sense, the diagnosis of erectile dysfunction offers these patients a unique chance to undergo a medical examination and therefore to improve not only their sexual but, most importantly, their overall health."
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