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Hormones, Metabolism, Aging, and Men s Health metabolic syndrome, such as blood pressure elevation, hyperlipidemia, obesity, and/or elevated blood sugar take time to extract its metabolic toll on the body Montorsi et al documented that ED symptoms were present several years before manifest coronary disease [405] This was predicted a number of years before when Pritzker performed cardiac stress tests on 50 men with ED, but no history or symptoms of heart disease, and was surprised to nd that 56% of the men failed the stress test because of silent ischemia [406] He postulated that ED might be the early factor that could predict heart disease, and that pursuing this vigorously might enable physicians to practice primary cardiac prevention There is a high percentage of men with cardiovascular risks in clinics that treat ED, and the prevalence of the two most important risk factors, diabetes mellitus and hypertension, is amazingly similar whether the number is 150 in a single clinic [407] or several hundred thousand men from managed care statistics [408] Although opinions have been mixed, there seems to be more data that indicates a certain relationship between T and the metabolic syndrome The TT assay is the one most commonly used in clinical practice and the level is signi cantly affected by SHBG Laaksonen et al followed 702 middle-aged men participating in a population-based cohort study [409] After 11 years 147 men developed the metabolic syndrome and 57 men developed diabetes Men with TT, calculated FT, and SHBG levels in the lower fourth had a several-fold increased risk of developing the metabolic syndrome and diabetes This has been con rmed in a recent analysis of the MMAS data [129] The conclusion was that hypogonadism was an early marker for insulin and glucose metabolism Kalme et al con rmed the known fact that increased insulin downregulates SHBG production, which in turn decreases total T levels [410] They followed 1711 men longitudinally They found that low SHBG and IGF-binding protein-1 were both associated with an increased prevalence of abnormal glucose tolerance and the metabolic syndrome, and that SHBG alone was a better indicator of increased cardiovascular mortality All of these factors, of course, are related to risks of ED Conversely, Muller et al have shown that higher T and SHBG levels in aging. excel ean code 128 Code 128 & GS1 - 128 barcode Excel macros from Azalea Software
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Microsoft Excel EAN 128 / GS1 128 Add-In, EAN 128 / GS1 128 barcode creation and setting on Microsoft Excel 2007 & 2010 worksheet. men are independently associated with a higher insulin sensitivity and a reduced risk of the metabolic syndrome [411] Their ndings were independent of BMI and insulin levels, suggesting that androgens may protect against the development of the metabolic syndrome Few studies have looked at the incidence of the metabolic syndrome in an ED population, by looking at the speci c NCEP/ATPIII criteria themselves Bansal et al evaluated the speci c criteria in 154 consecutive consultations for ED [412] Three of the ve criteria for metabolic syndrome were present in 43% of the men with ED, as compared to a reported 24% in a general and similar population that is predominantly Caucasian It is also interesting that metabolic syndrome correlated positively and moderately with increasing severity of ED Looking at the converse, Esposito et al looked at the prevalence of ED in men with the metabolic syndrome [413] They evaluated 100 men with metabolic syndrome and an age and BMI matched control group They found an increased prevalence of erectile dysfunction of 267% in the group with metabolic syndrome versus 13% in the control group They also showed that the prevalence of ED increased as did the number of components of the metabolic syndrome This is not surprising as the pathophysiologic common denominator for metabolic syndrome, ED, and cardiovascular disease is endothelial dysfunction [414] Shabsigh et al looked at ED as a predictor for the metabolic syndrome in a longitudinal study in an aging male population [415] The longitudinal analysis of the MMAS data has shown that ED is predictive of incident metabolic syndrome, but that this association is modi ed by BMI ED is associated with a two-fold increase in risk of metabolic syndrome in men with BMI <25, but not > 25 excel gs1-128 Create Code 128 barcodes with VBA and macros - BarCodeWiz
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