Varant Kupelian

Erectile Dysfunction as a Predictor of the Metabolic Syndrome in Aging Men: Results From the Massachusetts Male Aging Study

PURPOSE The metabolic syndrome, characterized by central obesity, insulin dysregulation, abnormal lipids and borderline hypertension, is a precursor state for cardiovascular disease. We determined whether erectile dysfunction is predictive of the metabolic syndrome. MATERIALS AND METHODS Data were obtained from the Massachusetts Male Aging Study, a population based prospective cohort observed at 3 points during approximately 15 years (T(1)-1987 to 1989, T(2)-1995 to 1997, T(3)-2002 to 2004). The metabolic syndrome was defined by using a modification of the Adult Treatment Panel III guidelines. The association between erectile dysfunction and the metabolic syndrome was assessed using relative risks and 95% confidence intervals estimated using Poisson regression models. RESULTS Analysis was conducted of 928 men without the metabolic syndrome at T(1). There were 293 men with incident metabolic syndrome, of which 56 had erectile dysfunction at baseline. Body mass index and the presence of 1 or 2 conditions constituting the metabolic syndrome definition were the strongest predictors of the metabolic syndrome. The association of erectile dysfunction with the metabolic syndrome (unadjusted RR 1.35, 95% CI 1.01-1.81) was modified by body mass index, with a stronger effect of erectile dysfunction in men with body mass index less than 25 (adjusted RR 2.09, 95% CI 1.09-4.02), and no erectile dysfunction and metabolic syndrome association in men with body mass index 25 or greater (adjusted RR 1.06, 95% CI 0.76-1.50). CONCLUSIONS Erectile dysfunction was predictive of the metabolic syndrome only in men with body mass index less than 25. This finding suggests that erectile dysfunction may provide a warning sign and an opportunity for early intervention in men otherwise considered at lower risk for the metabolic syndrome and subsequent cardiovascular disease.

Association of Lower Urinary Tract Symptoms and the Metabolic Syndrome: Results From the Boston Area Community Health Survey

PURPOSE In this study we investigated the relationship between lower urinary tract symptoms as defined by the American Urological Association symptom index and the metabolic syndrome, and determined the relationship between individual symptoms comprising the American Urological Association symptom index and the metabolic syndrome. MATERIALS AND METHODS The Boston Area Community Health Survey used a 2-stage cluster design to recruit a random sample of 2,301 men 30 to 79 years old. Analyses were conducted on 1,899 men who provided blood samples. Urological symptoms comprising the American Urological Association symptom index were included in the analysis. The metabolic syndrome was defined using a modification of the Adult Treatment Panel III guidelines. The association between lower urinary tract symptoms and the metabolic syndrome was assessed using odds ratios and 95% confidence intervals estimated using logistic regression models. RESULTS Increased odds of the metabolic syndrome were observed in men with mild to severe symptoms (American Urological Association symptom index 2 to 35) compared to those with an American Urological Association symptom index score of 0 or 1 (multivariate OR 1.68, 95% CI 1.21-2.35). A statistically significant association was observed between the metabolic syndrome and a voiding symptom score of 5 or greater (multivariate adjusted OR 1.73, 95% CI 1.06-2.80) but not for a storage symptom score of 4 or greater (multivariate adjusted OR 0.94, 95% CI 0.66-1.33). Increased odds of the metabolic syndrome were observed even with mild symptoms, primarily for incomplete emptying, intermittency and nocturia. These associations were observed primarily in younger men (younger than 60 years) and were null in older men (60 years old or older). CONCLUSIONS The observed association between urological symptoms and the metabolic syndrome provides further evidence of common underlying factors between lower urinary tract symptoms and chronic conditions outside the urinary tract.

Association of Nocturia and Mortality: Results From the Third National Health and Nutrition Examination Survey

PURPOSE Nocturia, a common problem in men and women, has been associated with chronic illnesses such as heart disease and hypertension. Using data from the Third National Health and Nutrition Examination Survey we investigated the association of nocturia with subsequent mortality risk. MATERIALS AND METHODS NHANES III is a national probability survey of the United States between 1988 and 1994. Mortality data were obtained by linkage of NHANES III to the National Death Index. Cox proportional hazards regression models were used to assess the association between nocturia and all cause mortality, controlling for potential confounders in a sample of 15,988 men and women 20 years old or older. RESULTS The prevalence of nocturia, defined as 2 or more voiding episodes nightly, was 15.5% in men and 20.9% in women. Multivariate analyses showed a statistically significant trend of increased mortality risk with increased number of voiding episodes in men and women. The magnitude of the nocturia and mortality association was greater in those younger than 65 years with attenuated associations in the 65 years old or older age group. CONCLUSIONS Nocturia is a strong predictor of mortality, more so in younger men and women than in the elderly, with a dose-response pattern in increased mortality risk with increasing number of voiding episodes nightly. Potential underlying mechanisms of the observed association of nocturia and increased mortality risk include sleep disruption and subsequent development of related comorbid conditions.

Does Erectile Dysfunction Contribute to Cardiovascular Disease Risk Prediction beyond the Framingham Risk Score

OBJECTIVES This study was designed to determine whether erectile dysfunction (ED) predicts cardiovascular disease (CVD) beyond traditional risk factors. BACKGROUND Both ED and CVD share pathophysiological mechanisms and often co-occur. It is unknown whether ED improves the prediction of CVD beyond traditional risk factors. METHODS This was a prospective, population-based study of 1,709 men (of 3,258 eligible) age 40 to 70 years. The ED data were measured by self-report. Subjects were followed for CVD for an average follow-up of 11.7 years. The association between ED and CVD was examined using the Cox proportional hazards regression model. The discriminatory capability of ED was examined using C statistics. The reclassification of CVD risk associated with ED was assessed using a method that quantifies net reclassification improvement. RESULTS Of the prospective population, 1,057 men with complete risk factor data who were free of CVD and diabetes at baseline were included. During follow-up, 261 new cases of CVD occurred. We found ED was associated with CVD incidence controlling for age (hazard ratio [HR]: 1.42, 95% confidence interval [CI]: 1.05 to 1.90), age and traditional CVD risk factors (HR: 1.41, 95% CI: 1.05 to 1.90), as well as age and Framingham risk score (HR: 1.40, 95% CI: 1.04 to 1.88). Despite these significant findings, ED did not significantly improve the prediction of CVD incidence beyond traditional risk factors. CONCLUSIONS Independent of established CVD risk factors, ED is significantly associated with increased CVD incidence. Nonetheless, ED does not improve the prediction of who will and will not develop CVD beyond that offered by traditional risk factors.

Erectile Dysfunction and Mortality

INTRODUCTION Erectile dysfunction (ED) and cardiovascular disease (CVD) share pathophysiological mechanisms and often co-occur. Yet it is not known whether ED provides an early warning for increased CVD or other causes of mortality. AIM We sought to examine the association of ED with all-cause and cause-specific mortality. METHODS Prospective population-based study of 1,709 men (of 3,258 eligible) aged 40-70 years. ED was measured by self-report. Subjects were followed for a mean of 15 years. Hazard ratios (HR) were calculated using the Cox proportional hazards regression model. MAIN OUTCOME MEASURES Mortality due to all causes, CVD, malignant neoplasms, and other causes. RESULTS Of 1,709 men, 1,284 survived to the end of 2004 and had complete ED and age data. Of 403 men who died, 371 had complete data. After adjustment for age, body mass index, alcohol consumption, physical activity, cigarette smoking, self-assessed health, and self-reported heart disease, hypertension, and diabetes, ED was associated with HRs of 1.26 (95% confidence interval [CI] 1.01-1.57) for all-cause mortality, and 1.43 (95% CI 1.00-2.05) for CVD mortality. The HR for CVD mortality associated with ED is of comparable magnitude to HRs of some conventional CVD risk factors. CONCLUSIONS These findings demonstrate that ED is significantly associated with increased all-cause mortality, primarily through its association with CVD mortality.

Inverse Association of Testosterone and the Metabolic Syndrome in Men Is Consistent across Race and Ethnic Groups

CONTEXT Low sex hormone levels have been associated with the metabolic syndrome (MetS). OBJECTIVES Our objective was to determine whether the association between sex hormone levels and MetS varies by race/ethnicity among men and to investigate the relationship of sex hormones and individual components of MetS. DESIGN We conducted a population-based observational survey. PARTICIPANTS A multistage stratified design was used to recruit a random sample of 2301 racially/ethnically diverse men age 30-79 yr. Blood samples were obtained on 1899 men. Analyses were conducted on 1885 men with complete data on total testosterone (T), free T, and SHBG. INTERVENTIONS There were no interventions. MAIN OUTCOME MEASURE MetS was defined using a modification of the Adult Treatment Panel III guidelines. The association between MetS and sex hormone levels was assessed using odds ratios and 95% confidence intervals estimated using logistic regression models. RESULTS A strong inverse association was observed, in both bivariate and multivariate analyses, between hormone levels and MetS. The odds of MetS increased about two-fold with a 1 sd decrease in hormone levels. The association between sex hormones and MetS was statistically significant across racial/ethnic groups. Although the magnitude of this association was largest among White men, racial/ethnic differences were not statistically significant. The strength of the association of sex hormones with individual components of MetS varied; stronger associations were observed with waist circumference and dyslipidemia and more modest associations with diabetes and elevated blood sugar. CONCLUSIONS A robust, dose-response relationship between sex hormone levels and odds of the metabolic syndrome in men is consistent across racial/ethnic groups.

Testosterone, Sex Hormone–Binding Globulin, and Frailty in Older Men

OBJECTIVES: To determine whether testosterone (T) levels are associated with frailty or its components.

Association of Urological Symptoms and Chronic Illness in Men and Women: Contributions of Symptom Severity and Duration—Results From the BACH Survey

PURPOSE We investigated the association between lower urinary tract symptoms and chronic illness, such as heart disease, diabetes, hypertension and depression, in men and women. In addition, we determined whether a dose-response relationship exists in the association between the severity and duration of urological symptoms and major chronic illnesses. MATERIALS AND METHODS The Boston Area Community Health Survey used a multistage stratified design to recruit a random sample of 5,503 adults who were 30 to 79 years old. Urological symptoms in the American Urological Association symptom index were included in analysis. RESULTS Statistically significant associations that were consistent by gender were observed between depression and all urological symptoms. Nocturia of any degree of severity or duration was associated with heart disease in men and with diabetes in women. In men a dose-response relationship was observed for the association of symptom severity and/or the duration of urinary intermittency and frequency with heart disease, and for the association of urinary urgency with diabetes. In women a history of heart disease was associated with a weak stream and straining, while a history of hypertension was associated with urgency and a weak stream. CONCLUSIONS Results indicate a dose-response relationship in the association of the severity and duration of urological symptoms with major chronic illnesses. An association between urinary symptoms and depression was observed in men and women. In contrast, the association between lower urinary tract symptoms and heart disease, diabetes or hypertension varied by gender, suggesting different mechanisms of association in men and women.

Association of C-reactive Protein and Lower Urinary Tract Symptoms in Men and Women: Results From Boston Area Community Health Survey

OBJECTIVES To determine whether an association exists between C-reactive protein (CRP) levels and lower urinary tract symptoms (LUTS) as assessed by the American Urological Association Symptom Index (AUA-SI) among both men and women, and to determine the association of CRP levels with the individual urologic symptoms comprising the AUA-SI among both men and women. METHODS The Boston Area Community Health survey used a multistage stratified design to recruit a random sample of 5502 adults aged 30-79 years. Blood samples were obtained from 3752 participants. The analyses were conducted on 1898 men and 1854 women with complete data on CRP levels. Overall LUTS was defined as an AUA-SI of >or=8 (moderate to severe LUTS). The urologic symptoms comprising the AUA-SI were included in the analysis as reports of fairly often to almost always vs non/rarely/a few times. RESULTS A statistically significant association was observed between the CRP levels and overall LUTS among both men and women. The pattern of associations between the individual symptoms and CRP levels varied by sex. Nocturia and straining were associated with greater CRP levels among men, and incomplete emptying and weak stream were associated with greater CRP levels among women. CONCLUSIONS The results of this study have demonstrated an association between CRP levels and LUTS in both men and women. The dose-response relationship between increased CRP levels and an increased odds of LUTS supports the hypothesized role of inflammatory processes in the etiology of LUTS.

Association of sex hormones and C‐reactive protein levels in men

Objectives  The age‐associated decline in sex hormone levels in men is paralleled by an increase in cardiovascular disease and associated risk factors including low grade chronic inflammation. The objective of this analysis was to investigate the association between sex hormone levels and C‐reactive protein (CRP) in a population‐based sample of men.