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Xu Z, Chu W, Lei X, Chen C. Higher oxidative balance score was associated with decreased risk of erectile dysfunction: a population-based study. Nutr J 2024; 23:54. [PMID: 38760760 PMCID: PMC11102141 DOI: 10.1186/s12937-024-00956-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/02/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Erectile dysfunction (ED) is a prevalent condition that is thought to be significantly impacted by oxidative stress. The oxidative balance score (OBS) has been built to characterize the state of antioxidant/pro-oxidant balance. There is less known regarding the relationship of OBS with ED. METHODS This study conducted cross-sectional analyses on 1860 males who participated in the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2004. OBS was constructed by the 16 dietary components and 4 lifestyle factors. Self-reported ED was defined as men who indicated that they "never" or "sometimes" could achieve or keeping an erection adequate for satisfactory intercourse. Multivariate logistic regression models were applied to examine the association between OBS and the risk of ED. RESULTS Among 1860 participants, the median OBS was 20 (IQR 15-26), and OBS was lower in males with ED vs. those without ED (P = 0.001). The results of our analyses indicated a negative correlation between OBS and ED among male subjects. Specifically, each one-unit increase in the continuous OBS was relate to 3% reduction in the odds of ED after full adjustment. Moreover, when extreme OBS quartiles were compared, the adjusted odds ratio (95% confidence interval) for the 4th OBS category was 0.53 (0.32 to 0.88) after full adjustment (P for trend < 0.05). There was also statistical significance in the relationships between dietary/lifestyle OBS with ED, and the association between lifestyle OBS and ED may be even tighter. For each unit increase in lifestyle OBS, the odds of ED decreased by 11% after full adjustment. CONCLUSION Higher OBS was associated with reduced risk of ED in U.S. males. These findings suggested that adopting an antioxidant-rich diet and engaging in antioxidant-promoting lifestyle behaviors may contribute to a lower incidence of ED. These results provided recommendations for a comprehensive dietary and lifestyle antioxidants for ED patients.
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Affiliation(s)
- Zhixiao Xu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weiwei Chu
- Department of Pulmonary and Critical Care Medicine, The Lu 'an People's Hospital of Anhui Province, The Lu 'an Hospital Affiliated to Anhui Medical University, Lu 'an, China
| | - Xiong Lei
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chengshui Chen
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
- Key Laboratory of Interventional Pulmonology of Zhejiang Province, Wenzhou, China.
- Zhejiang Province Engineering Research Center for Endoscope Instruments and Technology Development, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, China.
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Endothelial Dysfunction, Erectile Deficit and Cardiovascular Disease: An Overview of the Pathogenetic Links. Biomedicines 2022; 10:biomedicines10081848. [PMID: 36009395 PMCID: PMC9405076 DOI: 10.3390/biomedicines10081848] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/22/2022] Open
Abstract
Erectile dysfunction (ED) is a condition with multifactorial pathogenesis, quite common among men, especially those above 60 years old. A vascular etiology is the most common cause. The interaction between chronic inflammation, androgens, and cardiovascular risk factors determines macroscopically invisible alterations such as endothelial dysfunction and subsequent atherosclerosis and flow-limiting stenosis that affects both penile and coronary arteries. Thus, ED and cardiovascular disease (CVD) should be considered two different manifestations of the same systemic disorder, with a shared aetiological factor being endothelial dysfunction. Moreover, the penile arteries have a smaller size compared with coronary arteries; thus, for the same level of arteriopathy, a more significant blood flow reduction will occur in erectile tissue compared with coronary circulation. As a result, ED often precedes CVD by 2–5 years, and its diagnosis offers a time window for cardiovascular risk mitigation. Growing evidence suggests, in fact, that patients presenting with ED should be investigated for CVD even if they have no symptoms. Early detection could facilitate prompt intervention and a reduction in long-term complications. In this review, we provide an overview of the pathogenetic mechanisms behind arteriogenic ED and CVD, focusing on the role of endothelial dysfunction as the common denominator of the two disorders. Developed algorithms that may help identify those patients complaining of ED who should undergo detailed cardiologic assessment and receive intensive treatment for risk factors are also analyzed.
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Pretorius D, Mlambo MG, Couper ID. Perspectives on sexual history taking in routine primary care consultations in North West, South Africa: Disconnect between patients and doctors. Afr J Prim Health Care Fam Med 2022; 14:e1-e10. [PMID: 35792630 PMCID: PMC9257710 DOI: 10.4102/phcfm.v14i1.3286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/18/2022] [Accepted: 03/24/2022] [Indexed: 11/01/2022] Open
Abstract
Background: Sexual history is rarely taken in routine consultations and research reported on common barriers that doctors experience, such as gender, age and cultural differences. This article focuses on how patients and doctors view sexual history taking during a consultation and their perspectives on barriers to and facilitators of sexual history taking.Aim: This study aimed to explore doctors’ and patients’ perspectives on sexual history taking during routine primary care consultations with patients at risk of sexual dysfunction.Setting: The research was conducted in primary care facilities in the Dr Kenneth Kaunda Health District, North West province.Methods: This was part of grounded theory research, involving 151 adult patients living with hypertension and diabetes and 21 doctors they consulted. Following recording of routine consultations, open-ended questions on the demographic questionnaire and brief interactions with patients and doctors were documented and analysed using open inductive coding. The code matrix and relations browsers in MaxQDA software were used.Results: There was a disconnect between patients and doctors regarding their expectations on initiating the discussion on sexual challenges and relational and clinical priorities in the consultation. Patients wanted a doctor who listens. Doctors wanted patients to tell them about sexual dysfunction. Other minor barriers included gender, age and cultural differences and time constraints.Conclusion: A disconnect between patients and doctors caused by the doctors’ perceived clinical priorities and screening expectations inhibited sexual history taking in a routine consultation in primary care.
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Affiliation(s)
- Deidré Pretorius
- Division of Family Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
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Ahmed Memon S, Adil M, Raja Khan F, Ullah S, Rehmat S, Zad Gul N. Association between erectile dysfunction, cardiovascular risk factors, and coronary artery disease: Role of exercise stress testing and International Index of Erectile Function (IIEF-5) questionnaire. IJC HEART & VASCULATURE 2022; 40:101033. [PMID: 35495580 PMCID: PMC9043967 DOI: 10.1016/j.ijcha.2022.101033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/17/2022] [Accepted: 04/11/2022] [Indexed: 12/19/2022]
Abstract
Background The exercise stress test (EST) is a non-invasive investigation to diagnose coronary artery disease. This research aimed to determine the relationship between erectile dysfunction (ED), cardiovascular risk factors, and coronary artery disease (CAD) in men referred for EST. Methods A prospective cohort study enrolling 303 patients from August 2020 through September 2021. All patients filled out the international Index of Erectile Function (IIEF-5) questionnaire. . They underwent an exercise stress test (EST). A two-tailed independent sample t-test, chi-square tests, and binary logistic regression were used for statistical analysis. Results EST was positive in 110 (36.3%) patients, negative in 154 (50.8%), and inconclusive in 39 (12.8%) patients. ED was present in 225 (74.3%) patients and absent in 78 (25.8%) patients. 278 (91.7%) had one or more cardiovascular risk factors. This study reported a significant relationship between diabetes mellitus (DM), hypertension (HTN), and the results of EST and ED. Compared to patients without ED, patients with ED had a positive EST result. Definite CAD was diagnosed in 21% of patients with ED compared to 1.3% in patients without ED. For a one-unit increase in age, the odds of ED increased by about 5%. Similarly, a negative EST is compared to a positive EST. Negative EST reduced the likelihood of ED by 82%. Conclusions This research found a statistically significant connection between CAD, certain cardiovascular risk factors, and ED using the EST and IIEF-5 questionnaires. This research is significant because it may alter the way cardiovascular risk stratification is done.
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Affiliation(s)
| | - Muhammad Adil
- Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan
| | - Fahad Raja Khan
- Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan
| | - Safi Ullah
- Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan
| | - Samra Rehmat
- Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan
| | - Nooh Zad Gul
- Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan
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Heo Y, Kim J, Cha C, Shin K, Roh J, Jo J. Wearable E-Textile and CNT Sensor Wireless Measurement System for Real-Time Penile Erection Monitoring. SENSORS (BASEL, SWITZERLAND) 2021; 22:231. [PMID: 35009773 PMCID: PMC8749841 DOI: 10.3390/s22010231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/16/2021] [Accepted: 12/26/2021] [Indexed: 06/14/2023]
Abstract
Erection measurements are the most important indicator of male urological disease diagnosis, treatment, and results. Rigiscan has been used widely in studies and diagnoses for nocturnal penile tumescence for evaluating erectile dysfunction by measuring the number and timing of erectile dysfunctions during sleep. However, this device has limitations such as the weight and bulk of the device and has been questioned for its role as a standard for ED Erectile Dysfunction (ED) diagnosis. In this study, we propose a real-time wearable monitoring system that can quantitatively measure the length and circumference of the penis using electronic textiles (E-textile) and carbon nanotube (CNT) sensors. The E-textile sensor is used to measure the length, circumference, and gradient with portability, convenience, and comfort. Sensors were created by coating CNTs on latex for flexibility. The CNT-based latex condom-type sensor in our proposed system shows the length, circumference, and curvature measurements with changes in resistance, and the E-textile performance shows a 1.44% error rate and a cavity radius of 110 to 300. The results of this conceptual study are for supplementary sensor development with a combination of new technologies with alternatives or existing methods for measuring erection function.
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Affiliation(s)
- Yongki Heo
- Department of Medical and Digital Engineering, Hanyang University, Seoul 04763, Korea;
| | - Jinhyung Kim
- Smart Sensor Research Center, Korea Electronics Technology Institute, Seongnam 13509, Korea; (J.K.); (C.C.); (K.S.)
| | - Cheolung Cha
- Smart Sensor Research Center, Korea Electronics Technology Institute, Seongnam 13509, Korea; (J.K.); (C.C.); (K.S.)
| | - Kyusik Shin
- Smart Sensor Research Center, Korea Electronics Technology Institute, Seongnam 13509, Korea; (J.K.); (C.C.); (K.S.)
| | - Jihyoung Roh
- Department of Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation (DGMIF), Daegu 41061, Korea;
| | - Jungki Jo
- Department of Medical and Digital Engineering, Hanyang University, Seoul 04763, Korea;
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Gerbild H, Areskoug Josefsson K, Marie Larsen C, Schantz Laursen B. Communication about physical activity to reduce vascular erectile dysfunction - A qualitative interview study among men in cardiac rehabilitation. Scand J Caring Sci 2021; 36:839-851. [PMID: 34288023 DOI: 10.1111/scs.13021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Physical activity, a core intervention in cardiac rehabilitation, can reduce vascular erectile dysfunction (ED). ED is a common sensitive problem for men with cardiac diseases, decreasing their quality of life. Cardiac health professionals rarely provide information about ED or its relation to physical activity. Developing health professionals' communicative component of the complex intervention 'Physical Activity to reduce Vascular Erectile Dysfunction' (PAVED) is important. Understanding the receiver needs is essential in designing a complex intervention. AIM To elucidate men's perspectives on cardiac health professionals' communication about PAVED. ETHICAL ISSUES An Institutional Data Protection Agency approved the study. METHODS An interpretive data-driven thematic analysis was applied to individual, qualitative semi-structured interviews with 20 Danish men attending cardiac rehabilitation. RESULTS The men wanted health professionals' communicating about ED, as it was perceived as a major problem diminishing masculinity and tabooed by health professionals. Men wanted help for self-help, which may be possible with the aid of competent health professionals' communication about how to prevent, reduce and cope with ED - including information about PAVED. The men wanted health professionals' communication about ED in various contexts: general information in groups, sexual counselling for individuals and couples and written material. STUDY LIMITATIONS Recruitment was done from a Danish municipality's cardiac rehabilitation, and the transferability of the results may be limited to similar contexts. CONCLUSION Erectile dysfunction was experienced as a major biopsychosocial problem for the men and their partners. The men had a need for health professionals' communication about sexuality, ED and information about PAVED as well as about prevention, reduction and management of ED. The men had a need for professional communication about sexual health.
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Affiliation(s)
- Helle Gerbild
- Health Sciences Research Centre, UCL University College, Odense, Denmark.,Center for Sexology Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department for Behavioural Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Kristina Areskoug Josefsson
- Department for Behavioural Sciences, Oslo Metropolitan University, Oslo, Norway.,Faculty of Health Studies, VID Specialized University, Sandnes, Norway.,School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Camilla Marie Larsen
- Health Sciences Research Centre, UCL University College, Odense, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Birgitte Schantz Laursen
- Center for Sexology Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Clinical Nursing Research Unit & Sexological Centre, Aalborg University Hospital, Aalborg, Denmark
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Imprialos K, Koutsampasopoulos K, Manolis A, Doumas M. Erectile Dysfunction as a Cardiovascular Risk Factor: Time to Step Up? Curr Vasc Pharmacol 2021; 19:301-312. [PMID: 32286949 DOI: 10.2174/1570161118666200414102556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Erectile dysfunction (ED) is a major health problem that affects a significant proportion of the general population, and its prevalence is even higher in patients with CV risk factors and/or disease. ED and cardiovascular (CV) disease share several common pathophysiological mechanisms, and thus, the potential role of ED as a predictor of CV events has emerged as a significant research aspect. OBJECTIVE The purpose of this review is to present and critically discuss data assessing the relation between ED and CV disease and the potential predictive value of ED for CV events. METHODS A comprehensive review of the literature has been performed to identify studies evaluating the association between ED and CV disease. RESULTS Several cross-sectional and prospective studies have examined the association between ED and CV disease and found an increased prevalence of ED in patients with CV disease. ED was shown to independently predict future CV events. Importantly, ED was found to precede the development of overt coronary artery disease (CAD) by 3 to 5 years, offering a "time window" to properly manage these patients before the clinical manifestation of CAD. Phosphodiesterase type 5 inhibitors are the first-line treatment option for ED and were shown to be safe in terms of CV events in patients with and without CV disease. CONCLUSION Accumulating evidence supports a strong predictive role of ED for CV events. Early identification of ED could allow for the optimal management of these patients to reduce the risk for a CV event to occur.
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Affiliation(s)
- Konstantinos Imprialos
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Konstantinos Koutsampasopoulos
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | | | - Michael Doumas
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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8
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Roy N, Rosas SE. Erectile dysfunction and coronary artery calcification in incident dialysis patients. J Nephrol 2021; 34:1521-1529. [PMID: 33683674 DOI: 10.1007/s40620-021-00994-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/05/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Erectile dysfunction, which has been associated with mortality in the general population, is common in individuals on hemodialysis. Our aim was to determine the relationship between erectile dysfunction, coronary artery calcification and mortality in incident hemodialysis patients. MATERIALS AND METHODS A prospective cohort of incident adult dialysis patients with no history of coronary artery disease underwent coronary artery calcification measurement by ECG-triggered multi-slice computed tomography (MSCT) scan at baseline and at least 12 months later. Erectile dysfunction was determined using the 15-item validated International Index of Erectile Function (IIEF-15) questionnaire. RESULTS Erectile dysfunction was prevalent in 83% of patients, with 43% classified as severe erectile dysfunction, 22.4% as moderate erectile dysfunction, and 17.2% as mild erectile dysfunction. The median (IQR) coronary artery calcification score was 43.4 (0.25-353.8) for those with erectile dysfunction and 0 (0-0) for those without erectile dysfunction (p = 0.007). More than half (55.6%) of the patients with erectile dysfunction experienced progression of coronary artery calcification compared to 14.3% of patients without erectile dysfunction (p = 0.05). Mortality was 21% during an average follow-up of 5.2 (1.3) years. Twenty-three percent of patients with erectile dysfunction died compared to 10% of people without erectile dysfunction (p = 0.4). Erectile dysfunction was not significantly associated with mortality [HR 1.2 (1.3), p = 0.87]. CONCLUSIONS Erectile dysfunction is common in individuals who start dialysis. It is significantly associated with an increased coronary artery calcification score, however, it is not associated with increased mortality in incident dialysis patients with no history of coronary artery disease.
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Affiliation(s)
- Neil Roy
- Kidney and Hypertension Unit, Joslin Diabetes Center, One Joslin Place, Boston, MA, 02215, USA.,Harvard Medical School, Boston, MA, USA
| | - Sylvia Eleni Rosas
- Kidney and Hypertension Unit, Joslin Diabetes Center, One Joslin Place, Boston, MA, 02215, USA. .,Harvard Medical School, Boston, MA, USA.
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Rislanu A, Auwal H, Musa D, Auwal A. Comparative Effectiveness of Electrical Stimulation and Aerobic Exercise in the Management of Erectile Dysfunction: A Randomized Clinical Trial. Ethiop J Health Sci 2020; 30:961-970. [PMID: 33883841 PMCID: PMC8047238 DOI: 10.4314/ejhs.v30i6.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/09/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Electrical stimulation and aerobic exercise have been indicated to be beneficial in the management of erectile dysfunction individually. However, there is a scarcity of evidence comparing the two treatment approaches. This study investigated the effects of Electrical Stimulation (ES) compared with Eerobic Exercise (AE) in the management of individuals with Erectile Dysfunction (ED). METHODS This study was a single-blind parallel randomized clinical trial. Thirty (30) patients diagnosed with ED (Mean age of 39.17 ± 6.21 years) were recruited and randomized into two groups, A and B with 15 participants in each group. Group A received ES while Group B received AE. International Index of Erectile Function (IIEF-5) was used to assess the sexual functions of the participants at baseline and after 6 weeks of intervention. Within-group and between-group differences were analyzed using dependent and independent t-tests respectively. RESULTS The result indicated a significant difference between groups A and B [20.83 (1.83) Vs 14.33 (2.07), p=0.001] after 6 weeks of intervention. However, the mean effect was significantly higher in the ES group than in the AE group. CONCLUSION The finding of this study indicated that ES is more effective than AE in the management of individuals with ED.Trial Registration: Pan African Clinical Trial Registry (PACTR201906776769795).
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Affiliation(s)
- Adamu Rislanu
- Department of Physiotherapy, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Hassan Auwal
- Department of Medical Rehabilitation (Physiotherapy), Faculty of Allied Health Sciences, College of Medical Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Danazumi Musa
- Department of Physiotherapy, Federal Medical Centre Nguru, Yobe State, Nigeria
| | - Abdulahi Auwal
- Department of Physiotherapy, College of Health Sciences, Faculty of Allied Health Sciences, Bayero University, Kano, Nigeria
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Li DJ, Liao ZC, Zhang XB, Tang YX, Zu XB, Wang L, Yang Y, Peng H, Li XC, Tang ZY, Chen XP. Perception of the association between erectile dysfunction and cardiovascular disease among Chinese physicians: an online survey. J Int Med Res 2020; 48:300060519894187. [PMID: 32208935 PMCID: PMC7370811 DOI: 10.1177/0300060519894187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective There is a close association between erectile dysfunction (ED) and cardiovascular disease (CVD). This study aimed to investigate Chinese physicians’ understanding of this association. Methods A total of 651 physicians, including 245 cardiologists and 406 urologists, participated in our investigation through WeChat. Results Participants with more professional experience, a doctoral/postdoctoral degree, and an intermediate/senior title were significantly more likely to be aware of a close association between ED and CVD. Urologists had a significantly better understanding of the association of severity between both diseases, showed more positive attitudes towards phosphodiesterase type 5 inhibitor application in patients with CVD and systematic treatment, and gave greater consideration to both diseases during follow-up visits than did cardiologists. Men had a significantly better understanding of the associated severity of the two disorders and managed the two diseases together more actively than did women. Department, sex, professional experience, education, and affiliated hospital level significantly affected systematic management of ED and CVD. Conclusion Most physicians from cardiology and urology are aware of the association between ED and CVD, but this awareness may be insufficient. Department, sex, professional experience, education background, and professional title are significant factors associated with perception of this association.
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Affiliation(s)
- Dong-Jie Li
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, China.,Department of Geriatric Urology, Xiangya International Medical Center, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Changsha, China
| | - Zhang-Cheng Liao
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiao-Bo Zhang
- Department of Geriatric Urology, Xiangya International Medical Center, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Changsha, China
| | - Yu-Xin Tang
- Department of Urology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xiong-Bing Zu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Long Wang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Yang Yang
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Hua Peng
- Department of Geriatric Urology, Xiangya International Medical Center, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Changsha, China
| | - Xiu-Cheng Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zheng-Yan Tang
- National Clinical Research Center for Geriatric Disorders, Changsha, China.,Department of Urology, Xiangya Hospital, Central South University, Changsha, China.,Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, Changsha, China
| | - Xiao-Ping Chen
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Changsha, China
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11
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Rusiecki L, Zdrojowy R, Gebala J, Rabijewski M, Sobieszczańska M, Smoliński R, Pilecki W, Dziubek W, Janocha A, Womperski M, Kałka D. Sexual health in Polish elderly men with coronary artery disease: importance, expectations, and reality. Asian J Androl 2020; 22:526-531. [PMID: 31929194 PMCID: PMC7523618 DOI: 10.4103/aja.aja_131_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Deterioration in overall health, hormonal disturbances, and erectile dysfunction (ED) contributes to limitations in sexual activity in the elderly, which is further limited by incorrect beliefs about the hazards of sexual activity in cardiac patients. We aimed to analyze the occurrence of ED in elderly men, their perception of the relevance of good sexual function, and their expectations of physicians. A cross-sectional study encompassed 731 patients with coronary artery disease (CAD) subjected to cardiac rehabilitation. Demographic data and data on modifiable risk factors and patient expectations were collected. ED was assessed using the IIEF-5 questionnaire. Relationships among the risk factors for ED, occurrence of ED, and patient expectations, as well as the changes in the indicators between 2012 and 2016, were analyzed. The mean age of men was 70.7 ± 5.1 years. The prevalence of ED was 93.0%. The IIEF-5 score was significantly associated with age, tobacco smoking, exercise tolerance, time to diagnosis of CAD, and treatment with calcium channel blockers and diuretics. Patients declared that sexual activity was overall important (47.9%) or very important (25.6%). Three hundred and sixty (49.3%) patients expected their physician to show interest in their sexual health, but the topic was addressed in only 12.5%. Over the past few years, we have observed an increase in the awareness and importance of sexual health as well as a significant increase in patients' expectations of physicians to show interest in their sexual health. Patients' expectations of discussing and receiving treatment for ED remain an unmet medical need.
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Affiliation(s)
- Lesław Rusiecki
- Cardiosexology Unit, Department of Pathophysiology, Wrocław Medical University, Wrocław 50-368, Poland
| | - Romuald Zdrojowy
- Department and Clinic of Urology, Wroclaw Medical University, Wroclaw 50-556, Poland
| | - Jana Gebala
- Cardiosexology Students' Scientific Club, Wrocław Medical University, Wrocław 50-368, Poland
| | - Michał Rabijewski
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw 01-004, Poland
| | | | - Ryszard Smoliński
- Consultant Sexologist, Clinical Hospital Wrocław Medical University, Wrocław 50-556, Poland
| | - Witold Pilecki
- Cardiosexology Unit, Department of Pathophysiology, Wrocław Medical University, Wrocław 50-368, Poland
| | - Wioletta Dziubek
- Department of Physiotherapy, University School of Physical Education, Wroclaw 51-612, Poland
| | - Anna Janocha
- Department of Physiology, Wroclaw Medical University, Wroclaw 50-368, Poland
| | | | - Dariusz Kałka
- Cardiosexology Unit, Department of Pathophysiology, Wrocław Medical University, Wrocław 50-368, Poland.,Centre for Men's Health, Wroclaw 53-151, Poland
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Effect of Ticagrelor, a Cytochrome P450 3A4 Inhibitor, on the Pharmacokinetics of Tadalafil in Rats. Pharmaceutics 2019; 11:pharmaceutics11070354. [PMID: 31330787 PMCID: PMC6680770 DOI: 10.3390/pharmaceutics11070354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 02/06/2023] Open
Abstract
Tadalafil is a cytochrome P450 (CYP) 3A4 substrate. Because there are few data on drug-drug interactions, it is advisable to take sufficient consideration when co-administering tadalafil with CYP3A4 inducers or inhibitors. This study was conducted to assess the effect of ticagrelor, a CYP3A4 inhibitor, on the pharmacokinetic properties of tadalafil after oral administration to rats. A total of 20 Sprague–Dawley male rats were randomly divided into the non-pretreated group and ticagrelor-pretreated group, and tadalafil was orally administered to each group after pretreatment with or without ticagrelor. Blood samples were collected at predetermined time points after oral administration of tadalafil. As a result, systemic exposure of tadalafil in the ticagrelor-pretreated group was significantly increased compared to the non-pretreated group (1.61-fold), and the clearance of tadalafil in the ticagrelor-pretreated group was significantly reduced than the non-pretreated group (37%). The prediction of the drug profile through the one-compartment model could explain the differences of pharmacokinetic properties of tadalafil in the non-pretreated and ticagrelor-pretreated groups. This study suggests that ticagrelor reduces a CYP3A-mediated tadalafil metabolism and that tadalafil and a combination regimen with tadalafil and ticagrelor requires dose control and specific pharmacotherapy.
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Palm P, Missel M, Zwisler AD, Svendsen JH, Giraldi A, Berg SK. A place of understanding: Patients' lived experiences of participating in a sexual rehabilitation programme after heart disease. Scand J Caring Sci 2019; 34:370-379. [PMID: 31313855 DOI: 10.1111/scs.12738] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 06/12/2019] [Accepted: 06/25/2019] [Indexed: 01/06/2023]
Abstract
AIMS AND OBJECTIVES The aim of this project was to explore the lived experience of participating in a nonpharmacological sexual rehabilitation programme. BACKGROUND In the healthcare system, patients are important stakeholders, and their experience and knowledge are essential to include when evaluating rehabilitation programmes. Patient experiences with participating in sexual rehabilitation for cardiovascular patients have not yet been investigated. METHODS Ten qualitative interviews were conducted with male patients from a randomised controlled trial investigating the effect of a 12-week rehabilitation programme focusing on sexuality. The analysis was inspired by Paul Ricoeur's theory of interpretation. Analysis consisted of three levels: (i) naive reading, (ii) structural analysis and (iii) critical interpretation and discussion. The theoretical framework reflects aspects of behavioural theory of social cognitive theory developed by Albert Bandura and his concept of self-efficacy. RESULTS The findings are presented as themes extracted from the structural analysis and interpreted in the critical interpretation and express the way in which cardiovascular patients experience participating in a sexual rehabilitation programme. Three themes were identified reflecting the intervention to be a special place of understanding, describing the intervention as a supporting atmosphere and finally expressing the intervention as empowering sexuality. CONCLUSIONS Participating in the sexual rehabilitation programme was experienced as efficient, valuable, motivating and safe, but dependent on a professional setting. The intervention developed participants' self-efficacy with regard to their sexual performance and relationship. RELEVANCE TO CLINICAL PRACTICE The findings highlight the importance of a professional setting including certain competencies such as humour and professional skills when handling the after-care of cardiovascular patients with sexual problems.
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Affiliation(s)
- Pernille Palm
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Malene Missel
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ann-Dorthe Zwisler
- The National Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Annamaria Giraldi
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Sexological Clinic, Psychiatric Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Selina Kikkenborg Berg
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Palm P, Zwisler AD, Svendsen JH, Giraldi A, Rasmussen ML, Berg SK. Compromised Sexual Health Among Male Patients With Implantable Cardioverter Defibrillator: A Cross-Sectional Questionnaire Study. Sex Med 2019; 7:169-176. [PMID: 30674447 PMCID: PMC6522935 DOI: 10.1016/j.esxm.2018.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/31/2018] [Accepted: 12/04/2018] [Indexed: 01/03/2023] Open
Abstract
Introduction In cardiac patients with implantable cardioverter defibrillator (ICD), sexual function is sparsely described. Aim To determine the prevalence and distribution of sexual dysfunction, and to describe whether primary or secondary prophylactic ICD indication and antitachycardia pacing (ATP) or shock is associated with sexual function. Methods A cross-sectional survey of men with an implanted ICD was conducted at 2 university hospitals in Denmark. Inclusion criteria were men over the age of 18 with an ICD. Exclusion criterion was no partner. Main Outcome Measure Sexual function was assessed by the International Index of Erectile Function questionnaire and data on implantation indication (primary/secondary prevention) and therapy such as ATP and shock (both appropriate and inappropriate) was obtained from the Danish ICD Register. Results Data from 415 questionnaires were analyzed (response rate 50.2%). Patients had a mean age of 63.9±12.1 years. Erectile dysfunction (ED) was present in 70% of patients, orgasmic dysfunction was present in 57.9% of patients, 82.8% had reduced sexual desire, 85.8% had intercourse satisfaction problems, and 76.9% experienced overall satisfaction problems (non-validated metric except for ED). Patients with an ICD on primary prophylactic indication had more sexual dysfunction and ED compared with patients with an ICD on secondary prophylactic indication. ATP therapy, but not shock, was associated with more ED. Conclusion Sexual dysfunction is common in patients with ICD and is not limited to ED, but also orgasmic function, desire, intercourse, and overall satisfaction are affected. Primary prophylactic ICD indication and ATP, but not shock therapy, is associated with compromised sexual function. Palm P, Zwisler A-D, Svendsen JH. Compromised Sexual Health Among Male Patients With Implantable Cardioverter Defibrillator: A Cross-Sectional Questionnaire Study. Sex Med 2019;7:169–176.
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Affiliation(s)
- Pernille Palm
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Ann-Dorthe Zwisler
- The National Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Annamaria Giraldi
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Sexological Clinic, Psychiatric Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Marianne Linnet Rasmussen
- Department of Nursing, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark
| | - Selina Kikkenborg Berg
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Palm P, Zwisler ADO, Svendsen JH, Thygesen LC, Giraldi A, Jensen KG, Lindschou J, Winkel P, Gluud C, Steinke E, Berg SK. Sexual rehabilitation for cardiac patients with erectile dysfunction: a randomised clinical trial. Heart 2018; 105:775-782. [DOI: 10.1136/heartjnl-2018-313778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/04/2018] [Accepted: 10/09/2018] [Indexed: 11/03/2022] Open
Abstract
BackgroundSexual dysfunction is common in patients with either ischaemic heart disease (IHD) or implantable cardioverter defibrillator (ICD) and has a negative impact on quality of life. Non-pharmacological treatment options are lacking. The purpose of this trial was to assess the effect of sexual rehabilitation versus usual care for males with erectile dysfunction and either IHD and/or ICD.MethodsParticipants with erectile dysfunction and IHD and/or ICD were randomised to 12 weeks of sexual rehabilitation consisting of physical exercise training, pelvic floor exercise and psychoeducation, or usual care. Primary outcome: sexual function by the International Index of Erectile Function (IIEF). Secondary outcome: sexual function by the Psychosocial Adjustment to Illness Scale. Exploratory outcomes: exercise capacity, pelvic floor strength/endurance, self-reported health and mental health.Results154 participants were included, mean age 61.6 years (SD 6.1). Sexual rehabilitation compared with usual care improved sexual function with a mean difference IIEF score of 6.7 (95% CI 3.1 to 10.4, p<0.0003) at 4 months between groups (unadjusted IIEF mean scores 36.4 vs 31.3) and a mean difference of 6.7, 95% CI 3.2 to 10.1 (p<0.0002) at 6 months between groups (unadjusted mean scores IIEF 37.1 vs 32.2). No effects were seen on the secondary outcome. Sexual rehabilitation improved exercise capacity on cycle ergometer measured by Watt max with a mean difference of 10.3, 95% CI 3.6 to 16.9 (p<0.003) and pelvic floor strength (p<0.01). No differences were seen on self-reported health and mental health.ConclusionSexual rehabilitation compared with usual care improves sexual function and exercise capacity.Trial registrationNCT01796353; Results.
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Wu F, Xiong ZQ, Mao SH, Hu JM, Wang JQ, Jiang HW, Ding Q. Aldosterone induces inflammatory cytokines in penile corpus cavernosum by activating the NF-κB pathway. Asian J Androl 2018; 20:24-29. [PMID: 28382926 PMCID: PMC5753550 DOI: 10.4103/aja.aja_8_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/09/2017] [Accepted: 02/06/2017] [Indexed: 01/14/2023] Open
Abstract
Emerging evidence indicates that aldosterone and mineralocorticoid receptors (MRs) are associated with the pathogenesis of erectile dysfunction. However, the molecular mechanisms remain largely unknown. In this study, freshly isolated penile corpus cavernosum tissue from rats was treated with aldosterone, with or without MRs inhibitors. Nuclear factor (NF)-kappa B (NF-κB) activity was evaluated by real-time quantitative PCR, luciferase assay, and immunoblot. The results demonstrated that mRNA levels of the NF-κB target genes, including inhibitor of NF-κB alpha (IκB-α), NF-κB1, tumor necrosis factor-alpha (TNF-α), and interleukin 6 (IL-6), were higher after aldosterone treatment. Accordingly, phosphorylation of p65/RelA, IκB-α, and inhibitor of NF-κB kinase-β was markedly increased by aldosterone. Furthermore, knockdown of MRs prevented activation of the NF-κB canonical pathway by aldosterone. Consistent with this finding, ectopic overexpression of MRs enhanced the transcriptional activation of NF-κB by aldosterone. More importantly, the MRs antagonist, spironolactone blocked aldosterone-mediated activation of the canonical NF-κB pathway. In conclusion, aldosterone has an inflammatory effect in the corpus cavernosum penis, inducing NF-κB activation via an MRs-dependent pathway, which may be prevented by selective MRs antagonists. These data reveal the possible role of aldosterone in erectile dysfunction as well as its potential as a novel pharmacologic target for treatment.
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Affiliation(s)
- Fei Wu
- Department of Urology, Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zu-Quan Xiong
- Department of Urology, Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Shan-Hua Mao
- Department of Urology, Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Ji-Meng Hu
- Department of Urology, Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jian-Qing Wang
- Department of Urology, Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Hao-Wen Jiang
- Department of Urology, Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Qiang Ding
- Department of Urology, Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China
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Colson M, Cuzin B, Faix A, Grellet L, Huyghes E. Cœur et sexe, quoi de neuf ? SEXOLOGIES 2018. [DOI: 10.1016/j.sexol.2018.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Krzanowski T, Dabkowska L, Wujec M, Kedzierska E. The blue pill (sildenafil) and its descendants: an overview. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2017. [DOI: 10.1515/cipms-2017-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
An increasing number of men around the world suffer from erectile dysfunction (ED). Indeed, according to the sexuality study conducted by Professor Izdebski, 1 out of 10 men in Poland suffers from ED. The problem is found among men of any age, however, 60% of all patients are between 40 and 60 years old, thus in their prime, and who still want to fully enjoy life. Not only do the effects of ED affect a man, but they have influence on his relationship and partner as well. In spite of a growing awareness within society, the problem remains perceived as embarrassing, which leads patients to treat themselves on their own, delaying a visit to their doctors. Meanwhile, in many cases, ED may be the first symptom of more serious diseases, such as diabetes, or result from the sideeffects of applied drugs. A breakthrough in the oral medication treatment of ED was observed when a new phosphodiesterase type 5 inhibitor (PDE-5-inhibitor) - sildenafil citrate (Viagra®) - was introduced. Nowadays, 5 active substances from this group are being applied. The current medical guidelines recommend PDE-5 inhibitors as the firstline therapy for most men with ED, irrespective of the cause and severity of the disease. Recently, sildenafil at the dose of 25 mg came into the market without prescription. This paper presents an overview and update of the PDE-5 inhibitors.
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Affiliation(s)
- Tomasz Krzanowski
- Chair and Department of Organic Chemistry, Medical University of Lublin, Chodzki 4A, 20-093 Lublin , Poland
| | - Lila Dabkowska
- Chair and Department of Pharmacology and Pharmacodynamics, Medical University of Lublin, Chodzki 4A, 20-093 Lublin , Poland
| | - Monika Wujec
- Chair and Department of Organic Chemistry, Medical University of Lublin, Chodzki 4A, 20-093 Lublin , Poland
| | - Ewa Kedzierska
- Chair and Department of Pharmacology and Pharmacodynamics, Medical University of Lublin, Chodzki 4A, 20-093 Lublin , Poland
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Dedov II, Mel'nichenko GA, Shestakova MV, Rozhivanov RV, Terehova AL, Zilov AV, Ladygina DO, Kurbatov DG. Guidelines for the Diagnosis and Treatment of testosterone deficiency (hypogonadism) in male patients with diabetes mellitus. ACTA ACUST UNITED AC 2017. [DOI: 10.14341/omet2017483-92] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hypogonadism in men, defined as a reduction in serum testosterone in combination with characteristic symptoms and/or signs (described in detail later), is common in diabetes mellitus (DM). These recommendations do not cover the whole range of pathologies that cause the development of testosterone deficiency (hypogonadism), but focus on its clinical variants and characteristic for men with diabetes. The recommendations provide data on the prevalence of hypogonadism in diabetes, its etiology. In the section "diagnostics" the features of anamnesis of patients with hypogonadism with diabetes, the necessary methods of physical and laboratory examination are presented in detail. The risk factors and clinical consequences of hypogonadism are separately examined. In the section "choice of treatment methods", there are possible treatment options for such patients using various androgenic therapies, taking into account the needs of the man, maintaining his reproductive function and risk factors. Particular attention is paid to indications, contraindications and risk factors for androgen therapy in men with diabetes, especially in old age. With this in mind, principles for monitoring the treatment are developed. Based on a large number of studies, favorable effects of androgen replacement therapy in men with hypogonadism and diabetes have been demonstrated.
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Kałka D, Karpiński Ł, Gebala J, Rusiecki L, Biełous-Wilk A, Krauz ES, Piłot M, Womperski K, Rusiecka M, Pilecki W. Sexual health of male cardiac patients - present status and expectations of patients with coronary heart disease. Arch Med Sci 2017; 13:302-310. [PMID: 28261282 PMCID: PMC5332461 DOI: 10.5114/aoms.2017.65332] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 04/17/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Due to the pathogenetic association between erectile disorders and cardiovascular diseases, cardiologists consult many patients with erectile dysfunction (ED). The aim of the study was to evaluate sexual function in patients with coronary heart disease (CHD) and the use of sexual knowledge in cardiology practice, both current use and that expected by patients. MATERIAL AND METHODS One thousand one hundred and thirty-six patients (average age: 60.73 ±9.20) underwent a dedicated survey which encompassed demographic data and the presence of modifiable ED risk factors. The presence of ED was assessed using the International Index of Erectile Function (IIEF-5) Questionnaire. RESULTS Sexual problems were discussed by cardiologists with 45 (3.96%) patients. The frequency of initiating the topic was significantly associated with the respondents' education level (p = 0.0031); however, it was not associated with the patients' age, duration of CHD, presence of ED, or modifiable risk factors. Four hundred and sixteen (36.62%) respondents indicated that they expect their cardiologist to take an interest in their ED. Nine hundred and twenty-six (81.51%) patients claimed good sexual function to be important or very important to them. Attitude to sexual function was significantly associated with age (p < 0.0001), duration of CHD (p = 0.0018), education (p = 0.0011), presence of ED (p = 0.0041), diabetes (p = 0.0283) and hyperlipidaemia (p = 0.0014). CONCLUSIONS The low frequency with which cardiologists initiate the topic of ED is in contrast to the expectations of patients with CHD. The majority of these patients regard good sexual maintenance as an important part of their life.
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Affiliation(s)
- Dariusz Kałka
- Cardiosexology Unit, Department of Pathophysiology, Medical University of Wroclaw, Wroclaw, Poland
- Center of Men’s Health, Wroclaw, Poland
| | - Łukasz Karpiński
- Center of Men’s Health, Wroclaw, Poland
- Center of Cardiac Prevention and Rehabilitation CREATOR, Wroclaw, Poland
| | | | - Lesław Rusiecki
- Cardiosexology Unit, Department of Pathophysiology, Medical University of Wroclaw, Wroclaw, Poland
| | - Anna Biełous-Wilk
- Cardiosexology Unit, Department of Pathophysiology, Medical University of Wroclaw, Wroclaw, Poland
| | - Ewa S. Krauz
- Department of Cardiac Rehabilitation, Lower Silesian Heart Diseases Centre “Medinet”, Wroclaw, Poland
| | - Magdalena Piłot
- Department of Cardiac Rehabilitation, Centre of Cardiac Rehabilitation and Cardiac Prevention, Glucholazy, Poland
| | - Krzysztof Womperski
- Department of Cardiac Rehabilitation, Hospital of the Ministry of Interior, Glucholazy, Poland
| | - Małgorzata Rusiecka
- Department of Oncology and Gynaecologic Oncology, Medical University of Wroclaw, Wroclaw, Poland
| | - Witold Pilecki
- Cardiosexology Unit, Department of Pathophysiology, Medical University of Wroclaw, Wroclaw, Poland
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Compostella L, Compostella C, Truong LVS, Russo N, Setzu T, Iliceto S, Bellotto F. History of erectile dysfunction as a predictor of poor physical performance after an acute myocardial infarction. Eur J Prev Cardiol 2017; 24:460-467. [PMID: 28067536 DOI: 10.1177/2047487316686434] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Erectile dysfunction may predict future cardiovascular events and indicate the severity of coronary artery disease in middle-aged men. The aim of this study was to evaluate whether erectile dysfunction (expression of generalized macro- and micro-vascular pathology) could predict reduced effort tolerance in patients after an acute myocardial infarction. Patients and methods One hundred and thirty-nine male patients (60 ± 12 years old), admitted to intensive cardiac rehabilitation 13 days after a complicated acute myocardial infarction, were evaluated for history of erectile dysfunction using the International Index of Erectile Function questionnaire. Their physical performance was assessed by means of two six-minute walk tests (performed two weeks apart) and by a symptom limited cardiopulmonary exercise test (CPET). Results Patients with erectile dysfunction (57% of cases) demonstrated poorer physical performance, significantly correlated to the degree of erectile dysfunction. After cardiac rehabilitation, they walked shorter distances at the final six-minute walk test (490 ± 119 vs. 564 ± 94 m; p < 0.001); at CPET they sustained lower workload (79 ± 28 vs. 109 ± 34 W; p < 0.001) and reached lower oxygen uptake at peak effort (18 ± 5 vs. 21 ± 5 ml/kg per min; p = 0.003) and at anaerobic threshold (13 ± 3 vs.16 ± 4 ml/kg per min; p = 0.001). The positive predictive value of presence of erectile dysfunction was 0.71 for low peak oxygen uptake (<20 ml/kg per min) and 0.69 for reduced effort capacity (W-max <100 W). Conclusions As indicators of generalized underlying vascular pathology, presence and degree of erectile dysfunction may predict the severity of deterioration of effort tolerance in post-acute myocardial infarction patients. In the attempt to reduce the possibly associated long-term risk, an optimization of type, intensity and duration of cardiac rehabilitation should be considered.
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Affiliation(s)
- Leonida Compostella
- 1 Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo (BL), Italy.,2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Caterina Compostella
- 3 Department of Medicine, School of Emergency Medicine, University of Padua, Italy
| | - Li Van Stella Truong
- 1 Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo (BL), Italy
| | - Nicola Russo
- 1 Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo (BL), Italy.,2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Tiziana Setzu
- 1 Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo (BL), Italy
| | - Sabino Iliceto
- 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Fabio Bellotto
- 1 Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo (BL), Italy.,2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
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Borgquist R, Nilsson PM, Gudmundsson P, Winter R, Léosdottír M, Willenheimer R. Coronary flow velocity reserve reduction is comparable in patients with erectile dysfunction and in patients with impaired fasting glucose or well-regulated diabetes mellitus. ACTA ACUST UNITED AC 2016; 14:258-64. [PMID: 17446805 DOI: 10.1097/hjr.0b013e328021072b] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is growing evidence that erectile dysfunction is a sentinel for future coronary artery disease. Recently published studies have shown signs of impaired coronary endothelial function in patients with erectile dysfunction, without clinical cardiovascular disease and diabetes. We evaluated the magnitude of coronary vasodilatory dysfunction in men with erectile dysfunction, as compared with men with impaired glucose metabolism (impaired fasting glucose or diabetes) and healthy controls. METHODS We investigated men aged 68-73 years with erectile dysfunction (n=12), age-matched men with impaired glucose metabolism, who all proved to have erectile dysfunction (n=15), and age-matched male controls (n=12). Erectile dysfunction was evaluated using the International Index of Erectile Function (IIEF)-5 questionnaire. Coronary flow velocity reserve in the left anterior descending artery was examined using Doppler ultrasound and intravenous adenosine provocation. RESULTS Coronary flow velocities at rest did not differ between the three groups, but maximum coronary flow velocity was significantly lower in the erectile dysfunction group (P=0.004) and in the impaired glucose metabolism group (P=0.019), as compared with controls. There was no difference between the erectile dysfunction and impaired glucose metabolism groups. Coronary flow velocity reserve was reduced in the erectile dysfunction group (P=0.026) compared to controls, but was similar compared to the impaired glucose metabolism group. In multivariate analysis including all groups, erectile dysfunction score was the only independent predictor of reduced coronary flow velocity reserve (P=0.020). CONCLUSIONS The magnitude of early coronary endothelial and smooth muscle cell dysfunction in otherwise healthy men with erectile dysfunction was comparable to that of patients with impaired glucose metabolism: a well known risk factor for coronary artery disease.
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Affiliation(s)
- Rasmus Borgquist
- Department of Cardiology, Faculty of Medicine, Lund University, Malmoe University Hospital, Malmö, Sweden.
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Montorsi P, Ravagnani PM, Vlachopoulos C. Clinical significance of erectile dysfunction developing after acute coronary event: exception to the rule or confirmation of the artery size hypothesis? Asian J Androl 2016; 17:21-5. [PMID: 25337840 PMCID: PMC4291870 DOI: 10.4103/1008-682x.139254] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Erectile dysfunction (ED) has been found to frequently precedes the onset of coronary artery disease (CAD), representing an early marker of subclinical vascular disease, included CAD. Its recognition is, therefore, a "window opportunity" to prevent a coronary event by aggressive treatment of cardiovascular risk factors. The artery size hypothesis (ASH) has been proposed as a putative mechanism to explain the relationship between ED and CAD. Since atherosclerosis is a systemic disorder all major vascular beds should be affected to the same extent. However, symptoms at different points in the system rarely become evident at the same time. This is likely the result of smaller vessels (i.e. the penile artery) being able to less well tolerate the same amount of plaque when compared with larger ones (i.e. the coronary artery). If true, ED will develop before CAD. We present a case in which ED developed after a coronary event yet before a coronary recurrence potentially representing a late marker of vascular progression. Reasons for this unusual sequence are discussed as they might still fit the ASH.
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Affiliation(s)
- Piero Montorsi
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy
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Dattatrya KY, Vedpalsingh TH, Gorakhnath WV, Kiran PS. Can Erectile Dysfunction in Young Patients Serve as a Surrogate Marker for Coronary Artery Disease? J Clin Diagn Res 2015; 9:PC01-3. [PMID: 26674799 DOI: 10.7860/jcdr/2015/14207.6709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 08/28/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Early diagnosis and expeditious management of coronary artery disease (CAD) has a rewarding survival benefit. AIM To study whether erectile dysfunction (ED) serves as a surrogate marker for CAD in a young patient. SETTINGS AND DESIGN Males (n=207) between ages 20-60 years with ED were evaluated prospectively for risk factors for CAD. MATERIALS AND METHODS Blood Glucose Levels (BGL) fasting and post meal), lipid profile (LP) and 12 lead electrocardiogram (ECG) was done in all of them. International Index of Erectile Function-5 (IEF-5) was used for the evaluation of ED. Those with abnormal parameters were assessed by cardiologists by echocardiography, stress test and if necessary coronary angiography (Non-Invasive or Invasive). STATISTICAL ANALYSIS All the data were analysed using SPSS. 16 statistical software (SPSS Inc., Chicago, IL, USA). All data are expressed as mean and standard deviation. The Student's t-test was used to compare means between groups, and the chi-square test was used to compare proportions between the groups. P-value <0.05 was considered statistically significant. All confidence intervals (CIs) are two tailed and calculated at the 0.05 level. RESULTS Out of 207, 149 patients had at least one abnormal screening parameter. All underwent cardiology consultation and 2D ECHO and Stress test. Thirty six patients underwent coronary angiography. CAD was found in 22 patients. Of these, 19 patients had severe ED. Nine patients were between 20-40 years of age (13.23%). All 9 young patients had deranged LP; severe ED. Six patients were smokers while nobody was hypertensive. CONCLUSION ED serves as a surrogate marker for CAD in young patients (p=0.001). Presence of risk factors and lab abnormalities in young patients with ED warrants a cardiology referral to detect CAD.
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Affiliation(s)
- Kaje Yogesh Dattatrya
- Registrar, Department of Urology, Seth G.S Medical College & KEM Hospital , Mumbai, Maharashtra, India
| | | | | | - Patwardhan Sujata Kiran
- Head of Department, Department of urology, Seth G.S Medical College & KEM Hospital , Mumbai, Maharashtra, India
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Platek AE, Hrynkiewicz-Szymanska A, Kotkowski M, Szymanski FM, Syska-Suminska J, Puchalski B, Filipiak KJ. Prevalence of Erectile Dysfunction in Atrial Fibrillation Patients: A Cross-Sectional, Epidemiological Study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 39:28-35. [PMID: 26412411 DOI: 10.1111/pace.12753] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 09/07/2015] [Accepted: 09/20/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sexual dysfunctions, especially erectile dysfunction (ED), are a major problem in cardiovascular patients. They are caused by cardiovascular risk factors including low-grade inflammation process, endothelial dysfunction, oxidative stress, and hemodynamic and vascular alterations. The same mechanisms are some of the main causes and/or consequences of atrial fibrillation (AF). To this day, literature provides no cross-sectional data on the prevalence of sexual dysfunction in AF. The study aimed to determine the prevalence of sexual dysfunction in consecutive, young male patients with AF. MATERIAL AND METHODS A cross-sectional survey of adult male patients with a primary diagnosis of AF was conducted at University Cardiology Departments, during the period of July 2013 to July 2014. During the enrollment process, the study participants were either electively hospitalized with a primary diagnosis of AF, or had a scheduled outpatient visit. Sexual dysfunctions were assessed using the International Index of Erectile Function. RESULTS A total of 129 consecutive AF patients (mean age 57.0 ± 11.8 years) were analyzed. Hypertension was present in 60.5%, diabetes in 22.5% of patients, 46.5% had dyslipidemia, 18.6% were current smokers, and 45.7% had a family history of cardiovascular disease. At least one kind of sexual dysfunction was found in 86.8% of patients. ED was present in 57.4% of patients, 44.2% of patients had orgasmic dysfunction, 69.0% had lowered sexual desire, 65.1% had lowered intercourse satisfaction, and 55.8% had lowered overall satisfaction. CONCLUSIONS Sexual dysfunctions are highly prevalent in AF patients and are not only limited to ED, but also include dysfunction of orgasmic function, desire, or general satisfaction. In part, the presence of the sexual dysfunctions is probably caused by classical cardiovascular risk factors highly prevalent in AF patients, but the impact of AF itself cannot be underestimated.
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Affiliation(s)
- Anna E Platek
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Anna Hrynkiewicz-Szymanska
- Department of Cardiology, Hypertension and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Kotkowski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Filip M Szymanski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Syska-Suminska
- Department of Cardiology, Hypertension and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Bartosz Puchalski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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Botros SM, Mohamed Hussein A, Elserafy AS. Effect of different beta blockers on penile vascular velocities in hypertensive males. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Lin HH, Ho FM, Chen YF, Tseng CM, Ho CC, Chung WS. Increased risk of erectile dysfunction among patients with sleep disorders: a nationwide population-based cohort study. Int J Clin Pract 2015; 69:846-52. [PMID: 25708176 DOI: 10.1111/ijcp.12629] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIMS Few studies have investigated the relationship between sleep disorders (SD) and erectile dysfunction (ED). Therefore, this study explored whether patients with SD in an Asian population are at an increased risk of developing ED. METHODS This longitudinal nationwide population-based cohort study investigated the incidence and risk of developing ED in 34,548 men newly diagnosed with SD between 2002 and 2008 from the National Health Insurance Research Database. A total of 138,192 controls without SD were randomly recruited from the general population and frequency matched according to age and sex. The follow-up period began from the date of entering the study cohort until the date of an ED event, censoring, or 31 December 2010. We conducted Cox proportional hazard regression analyses to estimate the effects of SD on the risk of ED. RESULTS The SD cohort had a 2.11-fold adjusted hazard ratio (HR) of subsequent ED development compared with the non-SD cohort [95% confidence interval (CI) = 1.89-2.37]. The incidence of ED increased with age for both cohorts and was higher for the patients in the SD cohort. Compared with the participants without SD or comorbidities, the patients without SD with any comorbidity exhibited a 1.79-fold risk of developing ED (95% CI = 1.54-2.09); the highest risk was for those with both SD and any comorbidity (HR = 3.34, 95% CI = 2.82-3.95). Furthermore, SD patients who had a particular number of comorbidities showed the dose-response effect of developing ED. CONCLUSION This nationwide cohort study determined that ED risk evidently increased in SD patients compared with the general population.
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Affiliation(s)
- H-H Lin
- Department of Management Information Systems, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - F-M Ho
- Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Y-F Chen
- Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - C-M Tseng
- Department of Management Information Systems, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - C-C Ho
- Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - W-S Chung
- Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
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Atrial fibrillation is associated with increased risk of erectile dysfunction: A nationwide population-based cohort study. Int J Cardiol 2015; 190:106-10. [DOI: 10.1016/j.ijcard.2015.04.108] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 04/10/2015] [Accepted: 04/14/2015] [Indexed: 01/24/2023]
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Besiroglu H, Otunctemur A, Ozbek E. The Relationship Between Metabolic Syndrome, Its Components, and Erectile Dysfunction: A Systematic Review and a Meta-Analysis of Observational Studies. J Sex Med 2015; 12:1309-18. [DOI: 10.1111/jsm.12885] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pastuszak AW, Hyman DA, Yadav N, Godoy G, Lipshultz LI, Araujo AB, Khera M. Erectile dysfunction as a marker for cardiovascular disease diagnosis and intervention: a cost analysis. J Sex Med 2015; 12:975-84. [PMID: 25728904 DOI: 10.1111/jsm.12848] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) is a risk factor for cardiovascular disease (CVD). We examine the costs of screening men with ED for CVD risk factors and the cost savings of treating these at risk men. AIM This study aims to evaluate the effect of screening men presenting with ED for CVD risk factors and to determine the cost effectiveness of this screening protocol. METHODS The known incidence and prevalence of ED and CVD, the rate of undiagnosed CVD, and the effects of CVD treatment were used to model the change in prevalence of acute CVD events and ED as a function of the number of men with ED and CVD. The cost savings associated with reduction in acute cardiovascular (CV) events and ED prevalence was estimated over 20 years. MAIN OUTCOME MEASURES Acute CVD event rate reduction and associated cost savings were modeled over 20 years. RESULTS The relative risk of ED in men with CVD is 1.47 and the coprevalence of both ED and CVD was estimated at 1,991,520 men. Approximately 44% of men with CVD risk factors are unaware of their risk. If all men presenting with ED were screened for CVD, 5.8 million men with previously unknown CVD risk factors would be identified over 20 years, costing $2.7 billion to screen. Assuming a 20% decrease in CV events as a result of screening and treatment, 1.1 million cardiovascular events would be avoided, saving $21.3 billion over 20 years. Similarly, 1.1 million cases of ED would be treated, saving $9.7 billion. Together, the reduction in acute CVD and ED treatment cost would save $28.5 billion over 20 years. CONCLUSIONS Screening for CVD in men presenting with ED can be a cost-effective intervention for secondary prevention of both CVD and, over the longer term, ED.
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Affiliation(s)
- Alexander W Pastuszak
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
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Rosman L, Cahill JM, McCammon SL, Sears SF. Sexual health concerns in patients with cardiovascular disease. Circulation 2014; 129:e313-6. [PMID: 24493810 DOI: 10.1161/circulationaha.113.004846] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lindsey Rosman
- Departments of Psychology (L.R., S.L.M., S.F.S.) and Cardiovascular Sciences (J.M.C., S.F.S.), East Carolina University, Greenville, NC
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Kostis JB, Dobrzynski JM. The effect of statins on erectile dysfunction: a meta-analysis of randomized trials. J Sex Med 2014; 11:1626-35. [PMID: 24684744 DOI: 10.1111/jsm.12521] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) is common in older men, especially those with comorbidities such as diabetes and atherosclerotic disease, conditions where statins are frequently prescribed. AIM To examine the effect of statin therapy on ED using the five-item version of the International Inventory of Erectile Function (IIEF). METHODS We performed a random-effects meta-analysis of studies identified by a systematic search of MEDLINE, Web of Knowledge, the Cochrane Database, and ClinicalTrials.gov. Examination of the 186 retrieved citations resulted in the selection of 11 randomized trials for inclusion in the meta-analysis. MAIN OUTCOME MEASURES Change in the IIEF score. RESULTS IIEF increased by 3.4 points (95% CI 1.7-5.0, P = 0.0001) with statins compared to control. This effect remained statistically significant after multiple sensitivity analyses, including analysis for publication bias, a cumulative meta-analysis, and 11 repeated analyses with each study omitted sequentially. The increase in IIEF with statins was approximately one-third to one-half of that previously reported with phosphodiesterase-5 inhibitors and larger than the effect of lifestyle modification. Metaregression showed an increase in benefit with decreasing lipophilicity. The average age of participants and the degree of LDL cholesterol lowering did not alter the effect on IIEF. CONCLUSION Statins cause a clinically relevant improvement of erectile function as measured by the five-item version of the IIEF.
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Affiliation(s)
- John B Kostis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Neuropsychiatric adverse events associated with statins: epidemiology, pathophysiology, prevention and management. CNS Drugs 2014; 28:249-72. [PMID: 24435290 DOI: 10.1007/s40263-013-0135-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Statins, or 3-hydroxy-3-methyl-glutaryl coenzyme A reductase inhibitors, such as lovastatin, atorvastatin, simvastatin, pravastatin, fluvastatin, rosuvastatin and pitavastatin, are cholesterol-lowering drugs used in clinical practice to prevent coronary heart disease. These drugs are generally well tolerated and have been rarely associated with severe adverse effects (e.g. rhabdomyolysis). Over the years, case series and data from national registries of spontaneous adverse drug reaction reports have demonstrated the occurrence of neuropsychiatric reactions associated with statin treatment. They include behavioural alterations (severe irritability, homicidal impulses, threats to others, road rage, depression and violence, paranoia, alienation, antisocial behaviour); cognitive and memory impairments; sleep disturbance (frequent awakenings, shorter sleep duration, early morning awakenings, nightmares, sleepwalking, night terrors); and sexual dysfunction (impotence and decreased libido). Studies designed to investigate specific neuropsychiatric endpoints have yielded conflicting results. Several mechanisms, mainly related to inhibition of cholesterol biosynthesis, have been proposed to explain the detrimental effects of statins on the central nervous system. Approaches to prevent and manage such adverse effects may include drug discontinuation and introduction of dietary restrictions; maintenance of statin treatment for some weeks with close patient monitoring; switching to a different statin; dose reduction; use of ω-3 fatty acids or coenzyme Q10 supplements; and treatment with psychotropic drugs. The available information suggests that neuropsychiatric effects associated with statins are rare events that likely occur in sensitive patients. Additional data are required, and further clinical studies are needed.
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Erectile dysfunction in the cardiology practice-a patients' perspective. Am Heart J 2014; 167:178-85. [PMID: 24439978 DOI: 10.1016/j.ahj.2013.10.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 10/28/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Erectile dysfunction (ED) is an independent risk factor for cardiovascular events sharing mutual risk factors with coronary artery disease. Several guidelines for the management of ED in cardiovascular disease have been proposed, recommending cardiologists to routinely inquire about erectile function. However, males' specific needs and wishes regarding sexual health care in cardiology are unknown. We sought to identify male patients' view concerning possible improvements in sexual health care and preferred forms of sexual counseling in the cardiology practice. METHODS This is a cross-sectional multicentered survey study among randomly selected males visiting a cardiologist. RESULTS Of 388 respondents, 296 questionnaires were eligible for analysis. Mean age of respondents was 62.9 years. Overall, 56% (n = 165) had ED, with up to 86% in patients with heart failure. Mean bother experienced due to ED was 5.93 (±2.57) on a 0 to 10 scale. Most respondents indicated to feel comfortable discussing sexual health with the cardiologists (88%). Of men with ED (n = 165), 46% would like to have a conversation with the cardiologist about possibilities to improve sexual function, 55% would be helped if questions could be asked during consultation with a specialized nurse, and 58% would appreciate written information. Of all respondents (n = 296), 28% ever tried a phosphodiesterase inhibitor; 4% received the prescription of the cardiologists. CONCLUSIONS Erectile dysfunction is highly prevalent in patients with a variety of cardiovascular diagnosis and care for sexual function is mandatory. Patients indicated that above consultation with the cardiologist, both consultation with a specialized nurse and written information would be helpful.
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Johansen PP, Zwisler AD, Hastrup-Svendsen J, Frederiksen M, Lindschou J, Winkel P, Gluud C, Giraldi A, Steinke E, Jaarsma T, Berg SK. The CopenHeartSF trial--comprehensive sexual rehabilitation programme for male patients with implantable cardioverter defibrillator or ischaemic heart disease and impaired sexual function: protocol of a randomised clinical trial. BMJ Open 2013; 3:e003967. [PMID: 24282249 PMCID: PMC3845056 DOI: 10.1136/bmjopen-2013-003967] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Sexuality is an important part of people's physical and mental health. Patients with heart disease often suffer from sexual dysfunction. Sexual dysfunction has a negative impact on quality of life and well-being in persons with heart disease, and sexual dysfunction is associated with anxiety and depression. Treatment and care possibilities seem to be lacking. Studies indicate that non-pharmacological interventions such as exercise training and psychoeducation possess the potential of reducing sexual dysfunction in patients with heart disease. The CopenHeartSF trial will investigate the effect of a comprehensive sexual rehabilitation programme versus usual care. METHODS AND ANALYSIS CopenHeartSF is an investigator-initiated randomised clinical superiority trial with blinded outcome assessment, with 1:1 central randomisation to sexual rehabilitation plus usual care versus usual care alone. Based on sample size calculations, 154 male patients with impaired sexual function due to implantable cardioverter defibrillator or ischaemic heart disease will be included from two university hospitals in Denmark. All patients receive usual care and patients allocated to the experimental intervention group follow a 12-week sexual rehabilitation programme consisting of an individualised exercise programme and psychoeducative consultation with a specially trained nurse. The primary outcome is sexual function measured by the International Index of Erectile Function. The secondary outcome measure is psychosocial adjustment to illness by the Psychosocial Adjustment to Illness Scale, sexual domain. A number of explorative analyses will also be conducted. ETHICS AND DISSEMINATION CopenHeartSF is approved by the regional ethics committee (no H-4-2012-168) and the Danish Data Protection Agency (no 2007-58-0015) and is performed in accordance with good clinical practice and the Declaration of Helsinki in its latest form. REGISTRATION Clinicaltrials.gov identifier: NCT01796353.
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Affiliation(s)
- Pernille Palm Johansen
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark
- The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ann-Dorthe Zwisler
- The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Jesper Hastrup-Svendsen
- The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health Science, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Frederiksen
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jane Lindschou
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Per Winkel
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Gluud
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Annamaria Giraldi
- Sexological Clinic, Psychiatric Center Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
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Fraga-Silva RA, Montecucco F, Mach F, Santos RAS, Stergiopulos N. Pathophysiological role of the renin-angiotensin system on erectile dysfunction. Eur J Clin Invest 2013; 43:978-85. [PMID: 23909886 DOI: 10.1111/eci.12117] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 05/15/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND The renin-angiotensin system (RAS) has been shown to play an active role within the erectile tissues. The aim of this narrative review is to summarize the literature addressing the pathophysiological role of RAS on erectile function. Additionally, we update evidence on recent findings on the role of the Ang-(1-7) and Mas receptor on the erectile function and its therapeutic potential for treating erectile dysfunction (ED). MATERIALS AND METHODS This narrative review is based on the material searched and obtained via MEDLINE and PubMed up to November 2012. The search terms we used are 'angiotensin, erectile dysfunction, renin, Mas receptor' in combination with 'pathophysiology, fibrosis, pathways'. RESULTS The levels of angiotensin (Ang) II, the main component of this system, are increased in the corpus cavernosum as compared to those found in the systemic circulation. Moreover, emerging evidence indicates that an increased activity of Ang II via AT1 receptor might contribute to the development of ED, whereas the pharmacological blockage of Ang II/AT1 actions has beneficial effects on the erection. On the other hand, the heptapeptide Ang-(1-7), known as a major endogenous counter-regulator of Ang II actions, favours penile erection via the activation of Mas receptor. CONCLUSIONS Ang-(1-7) and Mas receptor pathway might be considered as a promising therapeutic target for the treatment of ED.
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Pournaghash-Tehrani S, Etemadi S. ED and quality of life in CABG patients: an intervention study using PRECEDE-PROCEED educational program. Int J Impot Res 2013; 26:16-9. [DOI: 10.1038/ijir.2013.27] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 03/10/2013] [Accepted: 05/08/2013] [Indexed: 01/23/2023]
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Gandaglia G, Salonia A, Passoni N, Montorsi P, Briganti A, Montorsi F. Erectile dysfunction as a cardiovascular risk factor in patients with diabetes. Endocrine 2013; 43:285-92. [PMID: 22948773 DOI: 10.1007/s12020-012-9780-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 08/22/2012] [Indexed: 01/23/2023]
Abstract
Erectile dysfunction (ED) is a highly prevalent disorder among patients with diabetes mellitus (DM). In most cases, ED is considered a vascular disease and its development is significantly related to the exposure to CVD risk factors. In this context, ED and coronary artery disease (CAD) have been proposed as different manifestations of the same systemic disease; in nondiabetic patients, ED has progressively emerged as an important sentinel marker of the subsequent onset of CVD events. The aim of this review was to evaluate the association between ED and CAD in diabetic patients and to evaluate the role of ED as an independent CVD risk factor in these patients. Three large prospective studies confirmed that ED is a powerful predictor of CAD and cardiac mortality in patients with DM. Overall, diabetic patients with ED had roughly 1.4-fold higher risk of CAD as compared with those without ED. Interestingly, in diabetic patients, CAD is often silent and CAD screening according to the current guidelines can miss up to 40 % patients with occult myocardial perfusion abnormalities. Indeed, patients with ED have higher risk of silent myocardial ischemia compared to those without ED, and when ED is added to the risk factors, it can even improve the sensitivity of screening for asymptomatic CAD. Therefore, ED should be considered an independent CVD risk factor, and it could improve the identification of diabetic patients suitable for screening, leading to an early detection of CAD, and thus potentially enhancing the therapeutic effectiveness.
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Affiliation(s)
- Giorgio Gandaglia
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
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Sai Ravi Shanker A, Phanikrishna B, Bhaktha Vatsala Reddy C. Association between erectile dysfunction and coronary artery disease and its severity. Indian Heart J 2013; 65:180-6. [PMID: 23647898 PMCID: PMC3861235 DOI: 10.1016/j.ihj.2013.02.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 10/07/2012] [Accepted: 02/16/2013] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND/AIMS To investigate the prevalence of erectile dysfunction (ED) in patients with coronary artery disease (CAD), its relationship between the severity of ED and the extent of coronary vessel involvement and to register the mean time interval between them. METHODS 240 patients with CAD divided into three age-matched groups: Group 1 (n = 60), ACS with one-vessel disease (1VD); group 2 (n = 60), ACS with 2,3VD; group 3 (n = 60), CSA. Control group (C, n = 60) was composed of patients with suspected CAD who were found to have entirely normal coronary arteries by angiography. ED as any value <26 according to the Gensini's scores and according to the International Index of Erectile Function (IIEF). RESULTS ED prevalence was 76%. ED prevalence was lower in G1 vs. G3 (22 vs.65%). G2 ED rate [55%, P < 0.0001] IIEF = 24 (17-29) & Gensini's scores-21 (12.5-32) were significantly different from G1 and similar to G3, ED in ACS differs according to the extent of CAD. G3 patients who had ED symptoms prior to CAD symptoms and time interval between ED and CAD symptom onset in CCS according to number of vessels. Onset of sexual dysfunction occurred before CAD onset with a mean time interval of 24 m [12-36]. CONCLUSION Early diagnosis of ED, cardiovascular assessment and aggressive treatment of cardiovascular risk factors might have contributed to prevent the acute events of this patient. Patients should be systematically screened for ED as a part of periodic examination programs. This would lead to early detection of modifiable vascular risk factors, or already existing vascular disease and to prevent ED and vascular disease progression through pharmacological and life style modifications.
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Affiliation(s)
- A Sai Ravi Shanker
- Cardiologist, Department of Cardiology, Narayana Medical College, Chinta Reddy Palem, Nellore 524003, Andhra Pradesh, India.
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Byrne M, Doherty S, Murphy AW, McGee HM, Jaarsma T. The CHARMS Study: cardiac patients’ experiences of sexual problems following cardiac rehabilitation. Eur J Cardiovasc Nurs 2013; 12:558-66. [DOI: 10.1177/1474515113477273] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Molly Byrne
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Sally Doherty
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - Hannah M McGee
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, University of Linköping, Sweden
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Berg SK, Elleman-Jensen L, Zwisler AD, Winkel P, Svendsen JH, Pedersen PU, Moons P. Sexual concerns and practices after ICD implantation: findings of the COPE-ICD rehabilitation trial. Eur J Cardiovasc Nurs 2013; 12:468-74. [DOI: 10.1177/1474515112473528] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - Per Winkel
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Denmark
| | | | | | - Philip Moons
- The Heart Centre, University of Copenhagen, Denmark
- Centre for Health Services and Nursing Research, KU Leuven – University of Leuven, Belgium
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Azadzoi KM, Master TA, Siroky MB. Effect of Chronic Ischemia on Constitutive and Inducible Nitric Oxide Synthase Expression in Erectile Tissue. ACTA ACUST UNITED AC 2013; 25:382-8. [PMID: 15064316 DOI: 10.1002/j.1939-4640.2004.tb02804.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Arterial occlusive disease is one of the leading causes of organic erectile dysfunction (ED). Recent studies have shown that the incidence of cardiovascular disease closely correlates with the prevalence of ED. Also, ED is thought to be an early signal of impending cardiovascular problems. We previously found that the atherosclerosis of iliohypogastric arteries in the rabbit causes ED, down-regulates cavernosal neuronal nitric oxide synthase (nNOS) gene expression, and impairs NO synthesis. The goal of this study was to determine the effect of atherosclerosis-induced ischemia on cavernosal nNOS, endothelial NOS (eNOS), and inducible NOS (iNOS) expression and NO-mediated smooth muscle relaxation in the rabbit. Our study showed that iliac artery blood flow, intracavernosal blood flow, and intracavernosal oxygen tension were unchanged 4 weeks after the induction of arterial atherosclerosis, whereas they were significantly diminished at weeks 8 and 16. Erectile responses to nerve stimulation and cavernosal smooth muscle relaxation were unchanged at week 4 and were significantly diminished at weeks 8 and 16 after the induction of atherosclerosis. Western blotting showed that cavernosal nNOS and eNOS protein levels were unaffected at week 4 but were significantly decreased at weeks 8 and 16 after the induction of atherosclerosis. iNOS protein, however, markedly increased during the course of the induced arterial disease. Immunohistochemical staining showed no change in cavernosal eNOS or nNOS expression at week 4. A dramatic decrease in both was evident at 8 and 16 weeks. iNOS expression progressively increased between 4 and 16 weeks of atherosclerosis. Down-regulation of nNOS and eNOS, along with up-regulation of iNOS, may explain ischemic cavernosal smooth muscle relaxation impairment in the rabbit. Ischemically altered NOS expression may be of great pathophysiologic importance in atherosclerosis-induced ED. These data may provide further insight into the mechanism of arteriogenic ED.
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Affiliation(s)
- Kazem M Azadzoi
- Boston University School of Medicine, Boston, Massachusetts, USA.
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Dysfonction érectile et diabète : fréquence et profil clinique à partir de 200 observations. Basic Clin Androl 2012. [DOI: 10.1007/s12610-012-0170-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Résumé
Objectif
la dysfonction érectile (DE) est une des complications les plus fréquentes du diabète mais également une des plus sous-diagnostiquées. Les auteurs rapportent la fréquence et le profil clinique de la DE dans une population de patients diabétiques.
Patients et méthodes
200 patients diabétiques ont été évalués par l’Index international de la fonction érectile 5 (IIEF5) dans sa traduction française.
Résultats
146 patients ont été inclus. Une DE était retrouvée chez 74 patients. Parmi eux, 21,6 % présentaient une forme sévère, 37,8 % une forme modérée et 40,6 % une forme mineure. Les patients présentant une DE étaient significativement plus âgés avec un diabète plus ancien.
Conclusion
la DE est fréquente et souvent sévère au cours du diabète. Le rôle des soignants est majeur pour détecter précocement ces troubles et ainsi mettre en place une prise en charge psychologique et médicamenteuse efficace, du moins lorsque cette dernière est matériellement possible.
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Lippi G, Plebani M, Montagnana M, Cervellin G. Biochemical and genetic markers of erectile dysfunction. Adv Clin Chem 2012; 57:139-62. [PMID: 22870589 DOI: 10.1016/b978-0-12-394384-2.00005-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Erectile dysfunction (ED) is a very common pathology, affecting over 150 million men worldwide. The pathogenesis is typically multifactorial, involving a kaleidoscope of organic, endocrine, and psychogenic factors. In general, ED is divided into organic and psychogenic impotence, but most men with organic etiologies have an associated psychogenic component. Given the high frequency of this pathology, the identification of biochemical and genetic correlates and/or markers is of pivotal interest not only for treating preciously these patients and preventing serious psychological consequences but also for the high risk for occult cardiovascular disease (CVD) that often accompanies or follows this pathology. A variety of cardiovascular risk factors have been associated with both the onset and the severity of ED, including markers of endothelial function, thrombosis, and especially dyslipidemia, so that their measurement should now be considered as an important part of the increased global cardiometabolic risk profile in patients with ED. While nitric oxide (NO), asymmetric dimethylarginine (ADMA), and endothelin (ET) hold some promises as biochemical markers of both CVD and ED, there are several technical and clinical drawbacks that make their measurement overall meaningless in the clinical practice. As regards genetic polymorphisms, controversial results have been provided so far. Although some genetic markers were consistently associated with ED, other studies failed to demonstrate significant associations, highlighting a substantial bias in standardization of methodologies and patient enrolment. Nevertheless, further research in this area should be encouraged, since the first promising evidence that gene therapy might be effective to restore the decline in ED has been provided in the animal model.
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Canguven O, Albayrak S, Selimoglu A, Balaban M, Sasmazel A, Baysal A. The effect of cardiopulmonary bypass in coronary artery bypass surgeries (on-pump versus off-pump) on erectile function and endothelium-derived nitric oxide levels. Int Braz J Urol 2011; 37:733-8. [DOI: 10.1590/s1677-55382011000600008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2011] [Indexed: 11/22/2022] Open
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Ewane KA, Lin HC, Wang R. Should patients with erectile dysfunction be evaluated for cardiovascular disease? Asian J Androl 2011; 14:138-44. [PMID: 22120928 DOI: 10.1038/aja.2011.137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The landmark Massachusetts Male Ageing Study shed new light on the prevalence of erectile dysfunction (ED) and drew attention to ED as a disease of ageing. Over the years, ED has been linked to the development of cardiovascular disease (CVD) in some patients. There is clear evidence that ED and CVD share and have a similar risk factor profile. CVD is one of the most recognizable causes of mortality and early detection coupled with prevention of mortality from CVD has been the prime interest of many researchers. Consequently, there has been a multidisciplinary curiosity regarding the proposal to use ED as a marker for future CVD. In fact, there have been several proposals to use ED as a screening tool for future CVD. We performed a comprehensive search of two main databases-PubMed and Cochrane Library using a combination of keywords such as acute myocardial infarction, coronary artery disease (CAD) and ED. Journal articles from January 2000 to June 2011 were reviewed. We included all articles discussing the relationship between ED and CVD in the English language. All the relevant randomized controlled trials, cohort and retrospective studies, and review articles were included in our overall analysis in an attempt to answer the question whether all patients with ED should be clinically evaluated for CVD. The results showed a link between ED and the development of future CVD in some patients, but ED was not shown to be an independent risk predictor that is any better than the traditional Framingham risk factors. Screening for CVD may, however, be rewarding in younger patients with severe ED and in patients with concurrent CVD risk factors.
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Affiliation(s)
- Kenneth A Ewane
- Division of Urology, University of Texas Medical School at Houston, 77030, USA
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Zuo Z, Jiang J, Jiang R, Chen F, Liu J, Yang H, Cheng Y. Effect of periodontitis on erectile function and its possible mechanism. J Sex Med 2011; 8:2598-605. [PMID: 21699666 DOI: 10.1111/j.1743-6109.2011.02361.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Periodontitis is one of the important risk factors resulting in cardiovascular diseases. Erectile dysfunction (ED) is strongly correlated with cardiovascular diseases. The expression of endothelial nitric oxide synthase (eNOS) in penile tissue has an important role in the mechanism of erection. AIM To investigate the effect of periodontitis on erectile function and the possible mechanism. METHODS After induction of periodontitis in rat, the ratio of maximum intracavernosal pressure/mean arterial pressure (ICPmax /MAP)×100, the expression of eNOS in penile tissue, the level of serum C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α), and the ultrastructural changes of the cavernous tissue were examined and compared between periodontitis rats (group A) and control rats (group B). MAIN OUTCOME MEASURE Periodontitis significantly decrease not only the ICPmax/MAP×100 and the expression of eNOS but also the activity of NOS and the level of cyclic guanosine monophosphate (cGMP) in cavernous tissue of rat. RESULTS After electrostimulation by 3 and 5 voltage, the ratio of ICPmax /MAP×100 in group A was significantly less than that in group B (19.54±6.16 vs. 30.45±3.12; 30.91±5.61 vs. 50.52±9.52, respectively; P<0.05).The level of serum CRP and TNF-α in group A is significantly higher in group B (P<0.05).The quantitative real-time reverse transcription polymerase chain reaction study demonstrated no statistically significant difference in the expression of mRNA of eNOS in cavernous tissue between the two groups (P>0.05). But there was significant decrease in eNOS protein of the cavernous tissue in group A than in group B (P<0.05). Total NOS activity and cGMP level in cavernosal tissue were significantly lower in group A than in group B (P<0.05). There was no significant alternation occurred in the ultrastructures of penile cavernous tissue. CONCLUSIONS The function of penile erection is impaired by periodontitis. The decreased in the expression of eNOS and NOS activity in penile cavernous tissue caused by mild systemic inflammatory status in periodontitis may be one of the important risk factors of ED.
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Affiliation(s)
- Zili Zuo
- Department of Urology, Affiliated Hospital, Luzhou Medical College, Department of Statistics, Luzhou, China
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Abstract
INTRODUCTION A role for cytokines in the pathophysiology of erectile dysfunction (ED) has emerged. Cytokines induce genes that synthesize other peptides in the cytokine family and several mediators, such as prostanoids, leukotrienes, nitric oxide, bradykinin, reactive oxygen species, and platelet-activating factor, all of which can affect vascular function. Consistent with the fact that the cavernosal tissue is a complex extension of the vasculature, risk factors that affect the vasculature have been shown to affect cavernosal function as well. Accordingly, the penile tissue has been recognized as an early sentinel for atherosclerosis that underlies coronary artery disease and cardiovascular diseases (CVD). AIM To review the literature pertaining to the role of tumor necrosis factor-alpha (TNF-α) in ED. METHODS PubMed search for pertinent publications on the role of cytokines, particularly TNF-α, in CVD and ED. MAIN OUTCOME MEASURES Clinical and experimental evidence demonstrates that TNF-α may play a role in ED. RESULTS TNF-α has been shown to play an important role in CVD, mainly due to its direct effects on the vasculature. In addition, high levels of TNF-α were demonstrated in patients with ED. In this review, we present a short description of the physiology of erection and the cytokine network. We focus on vascular actions of TNF-α that support a role for this cytokine as a potential candidate in the pathophysiology of ED, particularly in the context of CVD. A brief overview of its discovery, mechanisms of synthesis, receptors, and its main actions on the systemic and penile vasculature is also presented. CONCLUSIONS Considering that ED results from a systemic arterial defect not only confined to the penile vasculature, implication of TNF-α in the pathophysiology of ED offers a humoral linking between CVD and ED.
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