Archive for the ‘cardiovascular disease’ Category

Erectile Dysfunction and the Other “Bones” That Are Important

September 4, 2016

I would like men to think of erectile dysfunction as a harbinger of other chronic diseases like heart disease, diabetes, kidney failure, high blood pressure, elevated cholesterol levels and also bone disease or osteoporosis.

A recent study from Taiwan 4,460 men aged 40 years and older diagnosed with erectile dysfunction from 1996 to 2010 with 17,480 randomly selected age-matched patients without ED.  The research found that osteoporosis developed in nearly 6% with ED and 3.65% in men without ED.  Men who had ED had a 3 times more likelihood of developing osteoporosis when compared with men who did not have ED.

Osteoporosis is a metabolic bone disease in which the bones become brittle and porous escalating the rate of bone loss and increasing the chance of a fracture of the hips and spine.

The researchers think that the men with ED had a lower level of testosterone which is necessary for bone strength and development.  Another explanation offered by the authors is that chronic, low grade inflammation can damage the lining of the blood vessels and perhaps lead to a decrease in the blood supply to the penis which is necessary for an erection to occur.  The same inflammation can also cause the bones to fail in calcium rebuilding of bone and thus lead to osteoporosis.

Finally, there is the theory that there is alternation of the vitamin D with decreased levels in men with ED.  With less vitamin D there is a risk of alternations in the lining of the blood vessels especially those that supply the penis and lead to ED.  Decrease in vitamin D also alters bone metabolism and may result in osteoporosis.

Bottom Line: Men with ED should be check for the co-morbid conditions such as heart disease, diabetes, high blood pressure, hormone deficiency and also have tests to be certain that men do not have osteoporosis.

Statins, Cholesterol and Erectile Dysfunction

September 4, 2016

Statins are a group of medicines that can help lower the level of cholesterol in the blood.  Having a high level of cholesterol is potentially dangerous, as it can lead to a hardening and narrowing of the arteries (atherosclerosis) and cardiovascular disease (CVD) such as coronary heart disease, chest pain, heart attacks,  strokes, and even erectile dysfunction\impotence.  Cholesterol that narrows the blood vessels can decrease the blood flow to the penis thus making it difficult to achieve and maintain an erection adequate for sexual intimacy.

Before taking statins, every man or woman should give strong consideration to lifestyle changes such as losing weight, exercising regularly, limiting alcohol consumption, and consider smoking cessation.  All of these actions can decrease the cholesterol levels.  All of these lifestyle changes can also improve sexual function.

Bottom Line:  Elevated cholesterol levels are deleterious to your health.  Consider lifestyle changes before starting statins.  Your erections and your partner will thank you!

ED May Be A Warning Sign For Heart Disease

August 7, 2015

The penis is a dangling stress test and may be a predictor of impending heart disease.

Most men would never make the connection between their penis and heart — but it exists. Men should think of their penis as a thermometer for the heart. When the arteries in one part of your body are clogged, you can expect arteries to be filling up with sticky cholesterol-like plaque in other parts of the body as well.

Heart doctors have long understood this concept, routinely ultra-sounding the arteries of the neck (carotids) to provide a barometer for the tiny arteries (coronaries) that supply the heart.

Now, a new study provides evidence that the penis is another crucial barometer of arterial disease. The study, published in the August 2015 issue of the Journal of Sexual Medicine, reveals that men with erectile dysfunction and depression are much more likely to go on to develop heart disease than those without ED.

A team of Italian researchers screened 1687 patients with erectile dysfunction and found that men with ED who were also depressed were much more likely to have a heart attack or angina. ED is clearly an alert to larger emotional and physical problems including heart disease.

Here’s the explanation of the penis-heart connection: The arteries that supply the penis are only able to provide a strong sustained erection when they are working perfectly. So ED is often an indication that something is wrong with your arteries, and since the arteries of the penis are smaller than the arteries of the heart (coronary arteries), they tend to get clogged earlier. ED usually occurs before heart disease occurs. The penis is a likely barometer, a canary in the coal mine, for impending problems in the coronary arteries.

Of course, ED can be caused by many different things, including low testosterone, medication side effects, and depression alone. Not all patients with ED have arterial problems or will go on to have problems with their hearts. But a significant number will. We recommend all men who begin having problems getting erections to see their doctor for a thorough total body examination. And the concept of formally screening men for heart disease on the basis of ED should be investigated further.

An ideal study would separate men into two groups; one with erectile dysfunction, and one without. Each group would be followed to see which men went on to develop heart problems and which didn’t. In the meantime, there is every reason to consider ED as a warning sign for heart disease and a window into problems in a man’s total health.
Impotence, aka erectile dysfunction, is not often the easiest topic to discuss but it affects more men than we likely realize. As many as 50 million men in the US and Europe suffer from impotence, or erectile dysfunction. Statistically, this number includes only about 5% of men less than 40 years old and up to 25% of men by the time they reach 65 years of age. By definition, impotence is the inability to get or keep an erection firm enough for sexual intercourse.
Erectile dysfunction is almost always referred to as an older man’s disease, but this just isn’t the case. About 26% of men under the age of 40 are affected by ED according to a study published in the Journal of Sexual Medicine.

Bottom Line: One could guess that impotence at a young age could be the first sign of a potential heart attack later in life. So if you have difficulty with obtaining or maintaining an erection, speak to your doctor and consider getting a comprehensive examination including a thorough heart examination.

Non Medical Solutions for Erectile Dysfunction

February 10, 2015

Men suffering from sexual dysfunction can be successful at reversing their problem, by focusing on lifestyle factors and not just relying on medication.

In a new paper published in the Journal of Sexual Medicine, researchers highlight the incidence of erectile dysfunction and lack of sexual desire among men aged 35-80 years.
Over a five-year period, 31% of the 810 men involved in the study developed some form of erectile dysfunction.

Sexual relations are not only an important part of people’s well-being. From a clinical point of view, the inability of some men to perform sexually can also be linked to a range of other health problems, many of which can be debilitating or potentially fatal.

The major risk factors for this are typically physical conditions such as high blood pressure, diabetes and side effects from commonly used medications. Other risk factors include being overweight or obese, a higher level of alcohol intake, having sleeping difficulties or obstructive sleep apnea, and age.

Many of these risk factors affecting men are modifiable thus offering men an opportunity to do something about their condition. Even when medication to help with erectile function is required, it is likely to be considerably more effective if lifestyle factors are also addressed.

Erectile dysfunction can be a very serious issue because it’s a marker of underlying cardiovascular disease, and it often occurs before heart conditions become apparent. Therefore, men should consider improving their weight and overall nutrition, exercise more, drink less alcohol and have a better night’s sleep, as well as address risk factors such as diabetes, high blood pressure and cholesterol.
This is not only likely to improve their sexual ability, but will be improve their cardiovascular health and reduce the risk of developing diabetes if they don’t already have it.

Bottom Line: Lifestyle changes can significantly improve a man’s overall health as well as his erections. So get moving, watch your diet, and make every effort to control your blood glucose and blood pressure.

Testosterone and Its Impact On the Heart-Here’s the Good News

October 22, 2014

I am frequently queried by my patients about the safety of using testosterone and the risk of developing heart disease or a stroke. I would like to give you the evidence from the medical literature, and then help you make an informed decision if testosterone replacement is right for you.

Men have more than twice the risk of dying from coronary disease than women. It has been assumed that testosterone is deleterious to the male cardiovascular system and contributes to the risk of heart disease. In fact, there is little evidence that testosterone produced in body by the testicles is an adverse risk factor but the role of testosterone status and replacement therapy on male health is controversial.

High doses of anabolic steroids often used by body builders and athletes are undoubtedly associated with cardiac disease but these are doses much higher than what the body normally produces. Testosterone levels within the normal range do not appear to be harmful. Indeed, low rather than high testosterone levels in men are associated with several cardiovascular risk factors including an atherosclerosis or hardening of the arteries, insulin resistance, and obesity.

Let me give you information first from animal studies where the scientists can control the variables. Studies in male animals have shown that castration or induced hypogonadism increases atherosclerosis and testosterone replacement prevents this. In addition, testosterone has beneficial effects in men with cardiac disease. Testosterone is a potent coronary artery vasodilator. Testosterone therapy reduces total cholesterol, fat mass, waist circumference and pro-inflammatory cytokines associated with atherosclerosis, diabetes and the metabolic syndrome. Testosterone also improves functional capacity of the heart and insulin resistance in men with heart failure.

In an ageing male population low serumotal testosterone is common and has a prevalence of 30% in men over the age of 60 years. Testosterone deficiency may cause undesirable effects such as loss of bone and lean body mass, increased adiposity, low energy and impaired physical and sexual function. Until recently, these effects were viewed as the natural physiology of aging; however, four recent major studies have found low testosterone to be associated with increased all-cause mortality after controlling for baseline morbidity and age.

The effect of testosterone on mortality has demonstrated an increased risk of death due to cardiovascular diseases in men with low testosterone. One report found that mortality due to any cause and cardiovascular mortality was increased with a reduction in serum testosterone. Low testosterone status is therefore associated with mortality and vascular mortality, yet no study has specifically examined patients with established cardiovascular disease. This is important because men with manifest coronary artery disease are at a higher risk of cardiovascular mortality and represent a patient population prone to testosterone deficiency. In addition, those men with angina, chronic heart failure or diabetes may derive particular symptomatic benefit from androgen replacement therapy.

This study had two aims: first to assess the impact of testosterone status on life expectancy in men with pre-existing coronary disease, and second to identify the prevalence of biochemical testosterone deficiency in men with coronary disease. Our hypothesis was that low serum testosterone would be associated with an adverse survival.

One excellent study that was peer reviewed showed that the prevalence of testosterone deficiency is common in men with coronary disease and is present in 25% of the men. The data have confirmed that low T is related to all-cause and vascular mortality in a coronary disease population. Therefore, the study also concluded that borderline low levels of T may also have an adverse impact on survival.

This study is entirely consistent with previous studies of low testosterone as a cause of decreased life expectancy.

What is the pathophysiology of low testosterone status and the apparent increased mortality of atherosclerotic disease? Animal data show that testosterone deficiency accelerates atheroma or atherosclerosis and replacement with testosterone prevents this. Human studies have shown an increased progression of atheroma in men with lower testosterone. These data therefore suggest that testosterone deficiency is associated with progressive atherosclerosis and replacement, in animals at least, prevents this progression of the heart disease.

We have demonstrated that testosterone deficiency is associated with premature death in male patients with vascular disease; many of these patients died and will continue to die from cardiovascular disease. There is scientific evidence and several documented trials showing benefit in terms of risk factor modification and symptoms. If androgen deficiency is part of the underlying pathophysiology of atherosclerotic disease in men, then the serum testosterone level could be viewed as a modifiable risk factor as men can increase the T level by testosterone replacement therapy. Physiological testosterone replacement is an inexpensive and well-tolerated therapy but does require careful monitoring.

Bottom Line: Testosterone deficiency is common in middle aged and older men. Low testosterone levels appear to cause men to be at an increased risk of cardiovascular disease and even increased risk of death. Hormone replacement therapy for men who are symptomatic may be protective of heart disease but these men require close follow up consisting of a PSA test, a digital rectal exam, and a blood count to check that there is not an increased production of red blood cells.

Recent Study Does Not Indicate Testosterone Use Doesn’t Increase Heart Risk

July 7, 2014

A few months ago an article appeared in the Journal of the American Medical Association (JAMA) that implicated testosterone as a cause of heart disease and stroke. But critics including several hundred physicians have attacked the study noting that among other things, the study including over 100 women among the 1,132 subjects studied. Over 25 international medical groups have demanded that JAMA retract the article.

A new study now points out that testosterone therapy didn’t increase the risk of heart attack, contrary to the JAMA study, and that it even lowered the risk of heart attack by about 30%.
In the latest study, published online in the Annals of Pharmacotherapy, researchers at the University of Texas Medical Branch used a national Medicare sample and compared the records of 6,355 men who had at least one testosterone injection between 1997 and 2005, with 19,065 non-testosterone users. The testosterone users were no more likely to have a myocardial infarction than the nonusers during the period, according to the study.

The researchers also ranked the subjects based on their predicted risk of heart attack for other reasons. For men in the quarter with the highest risk, the use of testosterone cut that risk by roughly 30%.

The latest study only at men receiving testosterone injections, not those using pills, patches or gels, and couldn’t assess what other medications the men were taking. Men typically lose testosterone as they age, and some conditions can cause a steep drop in levels earlier, leading to osteoporosis which increases the risk of hip and spine fractures, sexual dysfunction, loss of muscle tone, fatigue, diabetes and other health problems. Proponents say restoring normal levels can alleviate those issues.

Bottom Line: Testosterone deficiency or low T affects millions of American men. The diagnosis is easily made with a history of decreased libido, decreased sexual performance, loss of muscle mass and loss of energy or fatigue. The diagnosis is easily made with a simple blood test and can be helped with testosterone replacement therapy. For more information on testosterone deficiency speak to your doctor.