Testosterone deficiency in patients with erectile dysfunction: when should a higher cardiovascular risk be considered? J Sex Med (2014) 11 2083-2091

Martinez-Jabaloyas JM, on behalf of the DE-SDT study group

Erectile dysfunction (ED) is common among aging men and is frequently seen in patients with diabetes, hypertension, obesity and a sedentary lifestyle. ED is also known to increase the risk of cardiovascular events and deaths. In contrast, low testosterone (T) levels are also associated with increased cardiovascular risk in men. As ED is one of the most common symptoms associated with low T, this begs the question as to whether the combination of low T and ED will further increase the cardiovascular risk in men. In particular, this paper asks the question of at what low T level is the cardiovascular risk substantially increased in men with ED?

Summary of this paper:
This is a multicenter, cross-sectional observational study conducted in Spain among men aged 18 or more with an average age of 58 years. This study separated men with T levels to those with < 230 ng/dl, between 230-345 ng/dl and those > 345 ng/dl. This study found that obesity and severe ED predicts increased cardiovascular risk more than low T levels alone. In other words, if a patient has T levels that are about 345 ng/dl, the fact that they have obesity and severe ED would be more accurate and reliable markers of predicting increased cardiovascular risk compared to the fact that their T levels are somewhat low. Therefore, it is very important for the physician to actively encourage weight loss, manage high blood pressure and assess for lipid and glucose levels in patients with ED, in addition to treating patients with low T to decrease the cardiovascular risk in these patients.

 

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