Testosterone Deficiency in Patients with Erectile Dysfunction: When Should a Higher Cardiovascular Risk Be Considered?

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Introduction.Low testosterone levels (low T) increase the cardiovascular (CV) risk of men with erectile dysfunction (ED). T levels associated with a higher CV risk are unknown.Aim.To determine the prevalence of CV risk factors associated with low T as defined by European Guidelines and their contribution to low T, overall and at different ages.Methods.Multicenter, cross-sectional, observational study conducted in Spain among men with ED aged ≥18 years visiting Urology/Andrology offices for sexual dysfunction. Anthropometric, clinical, and laboratory data, including total T (TT) values, were collected for 1,278 men.Main Outcome Measures.Risk factors were assessed in men with TT ≤8, 8–12, and ≥12 nmol/L, and two-group comparisons were made. Bivariate and multivariate logistic regression analyses were performed to calculate odds ratios for low T after adjusting for possible confounding factors.Results.Mean age (standard deviation) was 58.0 (9.2) years. Age and prevalence of CV risk factors was similar in men with TT ≤8 nmol/L or 8–12 nmol/L and significantly higher than in men with TT >12 nmol/L. Low T was therefore considered as TT ≤12 nmol/L, with a prevalence of 33.3%. Obesity, hypertension, hyperlipidemia, and severe ED were the variables most strongly associated with low T: obesity in middle-aged men; hyperlipidemia, and hypertension in older men. Severe ED was a risk factor in both groups. Hypolipidemic therapy had the greater effect in young men. Multivariate analysis showed that severe ED and obesity were the strongest predictors of low T.Conclusion.T levels associated with increased CV risk could go as high as 12 nmol/L in men with ED, with distribution of risk factors showing differences according to age. Obesity and severe ED are the best predictors of low T-related CV risk. Martínez-Jabaloyas JM. Testosterone deficiency in patients with erectile dysfunction: when should a higher cardiovascular risk be considered? J Sex Med 2014;11:2083–2091.

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