Posts Tagged ‘heart disease’

Low T-Review of New York Times Editorial, March 28, 2017

March 29, 2017

 

Low testosterone affects millions of American men.  Testosterone prescriptions in the United States nearly doubled in recent years from 1.2 million in 2010 to 2.2 million in 2013. Testosterone replacement is not the panacea to restore a middle aged man’s fountain of youth.  However, testosterone replacement can improve a man’s sex drive or libido, can increase his energy level and does improve bone strength and a protector for osteoporosis in men.

That’s the good news.  The bad news is that a single study comparing testosterone gel to placebo for one year found a “buildup of noncalcified plaque” in the coronary arteries of the men treated with testosterone.  However, other studies have not demonstrated any increase in heart problems in men using testosterone.

Although the positive changes were modest in the testosterone group there was a significant improvement in men’s mood in the group using testosterone gel.  The study also pointed out that older men with low testosterone levels often have other chronic health conditions, like obesity, than can affect hormone levels but these can often be managed by lifestyle changes such as an exercise program and diet.

It is important to mention that the results of the recent study do not support the promise implied by advertisements for testosterone that using it “will make you stronger and fitter,” though many men said they simply “felt better” while on the drug, and some improvements in walking could be seen when findings were analyzed.

Again, I would like to emphasize that testosterone has no place in men using these hormones for bodybuilding purposes.  At the present time use of testosterone is snot approved by the FDA for bodybuilding purposes.

The Bottom Line: Hormone replacement therapy has a role in men who have symptoms of low T and documented low blood levels of testosterone.  All men who receive testosterone need to have close follow up with PSA testing, a digital rectal examination and a blood count to check for overproduction of red blood cells.

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Testosterone Replacement-Relationship With Heart Disease

March 27, 2017

Much has been written about the use of testosterone in men with symptoms of low T and documented low levels of testosterone.  One of the issues is the use of testosterone replacement therapy and its impact on cardiovascular health.

First, there have been documented trials that demonstrated clinically improvements in bone density and low blood count or anemia.  Another recent study demonstrated an impressive reduction in cardiovascular events such as heart attack and stroke in men taking testosterone for low T levels.

A two year study was conducted comparing testosterone replacement therapy using topical gels containing testosterone to placebo that had gel only and no testosterone. At one year after starting the study, there were no heart attacks, strokes, or deaths in either group. At two years there were more heart attacks and strokes in the placebo group (nine events for placebo versus two events for testosterone).  The study concluded that testosterone replacement may be cardioprotective or can protect your heart.

A key additional finding was significant improvement in bone density and strength in men treated with testosterone.

Bottom Line:  These new, exciting results provide even more evidence to support the importance of using testosterone replacement therapy in men with low levels of testosterone and who are symptomatic from their decrease in testosterone levels.

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!

Safety of Testosterone Reported In Two Medical Journals

August 26, 2015

Two recently published studies significantly contribute to current knowledge regarding testosterone therapy and cardiovascular health. Researches from Harvard reported that 3 years of testosterone replacement therapy (TRT) in older men with low or low-normal testosterone does not cause progression of subclinical atherosclerosis o hardening of the arteries. The clinical trial was published in JAMA (2015; 314:570-81).

In addition, an article in the European Heart Journal (Aug. 6, 2015), showed that testosterone replacement therapy significantly reduced risks of death, myocardial infarction, and stroke.

The findings of both studies add to the ongoing evidence of testosterone treatment safety, cardiovascular safety in particular.

Bottom Line: These studies provide substantial confidence regarding the use of testosterone therapy when administered and monitored appropriately in well-selected individuals. These are men who have symptoms of low testosterone and confirmed by a blood test that documents low testosterone.

WHAT’S KEEPING YOU AND YOUR ERECTIONS DOWN?

August 7, 2015

Millions of American men suffer from ED or erectile dysfunction. For young men having difficulty achieving an erection, here are some common causes:
Stress : Among men in their teens, 20s and 30s, most cases of ED are linked to psychological issues. Anxiety and stress are a major factors especially if these are factors right before sex. Many young men who are inexperienced feel pressure to perform the best sexually and also have concerns about size. This stress can lead to performance anxiety. This buildup of stress can cause an influx of adrenaline or epinephrine which can inhibit an erection.
Too much bike riding : Now, just to be clear, if you’re an avid biker, it doesn’t mean you’re going to develop ED. But if you experience numbness as you ride within the first few miles or after biking marathons you may be causing long-term damage. Below the prostate (and what directly rests on the bicycle seat) are the nerves responsible for bringing blood the penis, which is what happens during an erection. Try getting fitted for a better seat if you’re experiencing this.
Medicines : Cold medications like Sudafed contain pseudoephedrine, which acts as epinephrine in the body and decreases the ability to achieve an erection. It increases your body’s natural fight or flight reaction and makes your body think you’re scared of something. The effects of the drug aren’t permanent.
Partying : Drinking and recreational drug use may also serve as a proponent of ED. Alcohol is a depressant and relaxes you but can cause the inability to perform. Cocaine for example, will lower your testosterone levels.
Cancer treatments : If young men have been diagnosed with testicular cancer or another cancer and are being treated with chemotherapy and radiation may lower testosterone levels which affect blood flow to the penis. Radiation can also directly damage the lining of the blood vessels or cause nerve damage.
Diabetes and high blood pressure are other causes of ED because diabetes impacts the body’s ability to produce nitric oxide. Another major factor is being obese or overweight. Anything that’s bad for your heart is bad for your penis. Blood vessels are tiny in the penis and if they’re clogged the blood won’t flow there. Eating right and exercising makes everything work better.

1. STOP SMOKING

Heart problems aren’t the only issue keeping men down. Erectile dysfunction is commonly caused by stress, medications, partying, cancer treatments, or even bike riding.

Smoking can cause blood vessels to narrow, which can have a detrimental effect on blood flow to sex organs. Similarly, smoking diminishes your stamina, limiting the amount of rigorous activity one can handle – which unfortunately can leave your partner wanting more.
2. WORK IT OUT
Notwithstanding my earlier comments about biking, moderate regular exercise has been shown to help improve blood flow to the sexual organs. Exercises focused on thighs, buttocks and pelvis are especially good for genital circulation. In addition, exercise boosts self-image and confidence. Anything that improves self-esteem will in turn improve libido.
3. LOSE WEIGHT
Study out of Duke, found that up to 30% of obese people seeking help controlling their weight indicate problems with sex drive, desire, performance, or all three. This is because being overweight can reduce blood flow and lower testosterone levels. High cholesterol as well as type 2 diabetes, both associated with being overweight, impact sexual performance. Both can cause penile arteries to shut down when arteries get clogged with fat deposits. Erectile dysfunction leads to decreased sexual desire and libido.
4. GINGKO BILOBA
Herbal remedies like tea or supplements derived from ginkgo biloba can have a positive effect on sexual desire and even orgasm. This age-old remedy is known to improve circulation, yet again enhancing sex.
5. TRY SOME LIBIDO-BOOSTING FOODS
Certain foods, like those high in zinc (think oysters!) can increase sperm production and testosterone- the hormone in men responsible for sex drive. Also, foods high in essential fatty acids like flaxseeds, sardines, and nuts help to increase testosterone production and increase libido.

This article was written by Dr. Samadi a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery, and an expert in robotic prostate surgery in New York City.

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.

Male Health Month

May 21, 2015

June is Male health. Here are 10 health concerns for men:

1. Prostate cancer. Approximately 30,000 men die of prostate cancer each ear. All meds should undergo a baseline prostate specific antigen blood test at age 40. Men with a family history of prostate cancer, African American men, and veterans exposed to agent orange are at high risk. These men should consider getting screening each year beginning at age 40.

2. Benign enlargement of the prostate is also a concern for men after the age of 50. 50% of them between the ages of 50 and 60 will develop enlargement of the prostate which is a benign disease but affects a man’s quality of life.

3. Erectile dysfunction. Failure to achieve and maintain an erection can be caused by heart disease, diabetes, certain medications, lifestyle, or other problems. Effective drugs are available for treating this common condition that affects over 30 million American men.

4. Cardiovascular disease. Heart disease and stroke are often associated with high cholesterol and high blood pressure. Both can usually be controlled with diet and exercise, sometimes combined with medication.

5. Testicular cancer. Testicular cancer is the most common form of cancer in men between the ages of 20-35 and in most cases can be cured.

6. Diabetes. Men with diabetes or more likely to suffer from heart disease, stroke, kidney disease, vision problems and erectile dysfunction.

7. Skin cancer. Anyone who spends a lot of time in the sun is at risk for skin cancer.

8. Low testosterone. As men age, their testosterone decreases. This can called Andropause, a condition similar to menopause in women.

9. Colorectal cancer. Cancer of the colon and rectum can usually be treated if caught early.

10. Depression. Men are less likely than women to seek help for depression and are 4 times more likely to commit suicide. Help can take the form of medication, counseling, or a combination of both.

I know in New Orleans we have the attitude that “if ain’t broke don’t fix it”. That may apply to your car but not to your body. Take good care of yourself and see your doctor once a year for fine-tuning your health and wellness.

A Walk A Day, and Not An Apple, Keeps the Doctor Away

February 10, 2015

The baby boomers have arrived in large numbers. They are taking responsibility for their health and are eager to stay well and out of the doctor’s office. This blog will discuss the importance of exercise, even walking, to make you healthy and well. This blog will emphasize exercise and not weight loss as the road to good health and longevity.

A brisk 20 minute walk each day could be enough to reduce your risk of early death. A study of over 334,000 European men and women found that twice as many deaths may be attributable to lack of physical activity compared with the number of deaths attributable to obesity, but that just a modest increase in physical activity could have significant health benefits.
Physical inactivity has been consistently associated with an increased risk of early death, as well as being associated with a greater risk of diseases such as heart disease and cancer. Although it may also contribute to an increased body mass index (BMI) and obesity, the association with early death is independent of an individual’s BMI.
To measure the link between physical inactivity and premature death, and its interaction with obesity, researchers analyzed data from 334,161 men and women across Europe participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study. Over an average of 12 years, the researchers measured height, weight and waist circumference, and used self-assessment to measure levels of physical activity. The results are published today in the American Journal of Clinical Nutrition.

TThe authors estimate that doing exercise equivalent to just a 20 minute brisk walk each day — burning between 90 and 110 kcal (‘calories’) — would take an individual from the inactive to moderately inactive group and reduce their risk of premature death by between 16-30%. The impact was greatest amongst normal weight individuals, but even those with higher BMI or with obesity saw a benefit.
Using the most recent available data on deaths in Europe the researchers estimate that 337,000 of the 9.2 million deaths amongst European men and women were attributable to obesity (classed as a BMI greater than 30): however, double this number of deaths (676,000) could be attributed to physical inactivity.

Bottom Line: So what is the message? This is a simple message: just a small amount of physical activity each day could have substantial health benefits for people who are physically inactive. Although we found that just 20 minutes would make a difference. Physical activity has many proven health benefits and should be an important part of our daily life.

Story Source:

Journal Reference:
1. Ulf Ekelund, Heather A Ward, Teresa Norat, Jian’an Luan, Anne M May, Elisabete Weiderpass, Stephen S Sharp, Kim Overvad, Jane Nautrup Østergaard, Anne Tjønneland, Nina Føns Johnsen, Sylvie Mesrine, Agnès Fournier, Guy Fagherazzi, Antonia Trichopoulou, Pagona Lagiou, Dimitrios Trichopoulos, Kuanrong Li, Rudolf Kaaks, Pietro Ferrari, Idlir Licaj, Mazda Jenab, Manuela Bergmann, Heiner Boeing, Domenico Palli, Sabina Sieri, Salvatore Panico, Rosario Tumino, Paolo Vineis, Petra H Peeters, Evelyn Monnikhof, H Bas Bueno-de-Mesquita, J Ramón Quirós, Antonio Agudo, María-José Sánchez, José María Huerta, Eva Ardanaz, Larraitz Arriola, Bo Hedblad, Elisabet Wirfält, Malin Sund, Mattias Johansson, Timothy J Key, Ruth C Travis, Kay-Tee Khaw, Søren Brage, Nicholas J Wareham, and Elio Riboli. Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: the European Prospective Investigation into Cancer and Nutrition Study (EPIC). Am J Clin Nutr, January 14, 2015 DOI: 10.3945/ajcn.114.100065

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.

ED or Impotence May Be Sending A Message To Your Heart and Brain

October 22, 2014

Having trouble with your erections? You are not alone as nearly 30 million American men suffer from this problem. That’s the bad news. The good news is that erectile dysfunction or ED may be harbinger of something more ominous that may affect your health and well-being. This blog will discuss the connection between ED and heart disease.

No man wants to be diagnosed with erectile dysfunction (ED), but believe it or not, it could save your life. In many cases, ED is a precursor to cardiovascular disease and when diagnosed properly could reduce the chance of having a heart attack or stroke.

ED is the inability to obtain or sustain an erection. It is extremely common, affecting more than half of men over 60. Given our rising rates of obesity and sedentary lifestyles, there is a good chance that performance in the bedroom is not about emotional issues or the male anatomy itself. It may sound strange but the penis is the barometer of a man’s overall health.

You can imagine how a heart artery gets clogged in a person with high blood pressure, high cholesterol or diabetes. When that coronary artery, which measures around 1\8 inch, gets obstructed that little to no blood flows through it, that man is going to experience chest pain (angina) or a heart attack. The same holds true for the carotid arteries, which measure 1\2 inch and take blood up to the brain. When the carotid artery gets blocked, that man will experience symptoms of a stroke. Now imagine the tiny penile artery, measuring only 1\16 inch. Its smaller diameter makes it ultra-sensitive to blockages, resulting in erectile dysfunction the penile artery becomes blocked.

Our entire vascular system is connected and the same things that harm our big blood vessels to our heart and brain will affect our smallest ones as well. The common cause of all this is what’s called atherosclerosis. As the same systemic process takes place throughout our vascular system, it’s these small arteries in the penis that will feel the effects earlier and manifest the symptoms of ED before other organs such as a man’s heart or brain start to suffer.

A lack of erections or difficulty holding an erection may be one of the earliest signs of impending heart disease or a stroke. When a man experiences ED this should an alarm should for men, their partners and their doctors. It’s important to realize that ED and cardiovascular disease have the same risk factors. These include high blood pressure, diabetes, high cholesterol, smoking and excess weight. Realize, too, that all these risk factors are modifiable, meaning you can actually improve them to reverse or halt the damage that is being done.

The message is: the recognition of ED as a warning sign of silent vascular disease has led to the concept that a man with ED and no cardiac symptoms is a cardiac (or vascular) patient until proven otherwise. Studies show that men presenting with only mild ED have a significant amount of undiagnosed high blood pressure, high blood sugar and high cholesterol, among other things. This is why men with mild ED, particularly if they are younger than 50, need to be screened for cardiovascular risk factors and have those risks treated aggressively. This means a visit to a doctor, having an EKG, and a stress test to see if there any decrease in blood supply to the heart.

We’ve come a long way since the days when ED was something men kept to themselves, too embarrassed to discuss with their friends or doctor. The introduction of pills (Viagra, Cialis, Levitra) to treat ED over 15 years ago opened the door for conversations about the condition.

The good news that lifestyle changes to modify risk factors, such as high blood pressure, elevated cholesterol level, obesity, and diabetes, that will provide the greatest benefit to a man’s overall health, not just his penis.

Bottom Line: ED can be a harbinger of impending heart disease or stroke. Don’t dismiss difficulty getting or holding an erection as this may indicate a future heart attack or stroke. See you doctor or urologist.