Relationship between erectile dysfunction and silent myocardial ischemia in type 2 diabetic patients with no known macrovascular complications.

INTRODUCTION: Erectile dysfunction (ED) is associated with cardiovascular disease (CVD) because it is highly prevalent among those with cardiovascular risk factors (CVRFs). Moreover, it precedes the development of CVD and is considered a subrogate marker of subclinical CVD. AIM: The aim of this study was to evaluate the presence of ED among patients with type 2 diabetes (DM2) without macroangiopathy, and to assess the association between ED and other CVRFs, chronic diabetes complications, silent myocardial ischemia (SMI), and peripheral arterial disease (PAD). METHODS: One hundred fifty-four male patients with DM2 and without clinical evidence of CVD were included in the study. The presence of ED, PAD, SMI, chronic diabetic complications, and other CVRFs was evaluated in these patients. MAIN OUTCOME MEASURES: PAD; SMI; ED; 24-hour blood pressure Holter; lipid profile; insulin resistance; testosterone; chronic inflammation; nephropathy; retinopathy; neuropathy. RESULTS: Prevalence of ED was 68.2%. Patients with ED were older and characterized by DM2, systolic blood pressure (BP), retinopathy, and insulin treatment of longer duration than patients without ED, even when adjusting for age was performed. Adjusting for duration of diabetic condition revealed significant differences in age and systolic BP. Independent factors for ED were age (57.7±7.5 years, relative risks [RR 1.1], P=0.003) and duration of diabetes (9[3-15] years, RR 1.1, P=0.006). SMI was detected in 13.6% of patients (18.1% in patients with ED vs. 4.1% in patients without ED). Asymptomatic PAD was detected in 13.2% of subjects (14.4% in patients with ED vs. 10.4% in patients without). CONCLUSIONS: ED is highly prevalent in DM2, and is associated with the presence of SMI, higher systolic BP and chronic microvascular diabetic complications.

Testosterone levels in males with type 2 diabetes and their relationship with cardiovascular risk factors and cardiovascular disease.

INTRODUCTION: One of the factors involved in type 2 diabetes in males is a reduction in levels of testosterone, which has been shown to predict resistance to insulin and the development of cardiovascular diseases. AIM: To assess the levels of testosterone in patients with type 2 diabetes and to evaluate their relationship with cardiovascular risk factors, peripheral arterial disease (PAD) and silent myocardial ischemia (SMI). METHODS: Total testosterone and sex hormone binding globulin were measured and free and bioavailable testosterones were calculated using Vermeulen's formula. Levels of total testosterone > or = 12 nmol/L or free testosterone > 225 pmol/L were considered normal. PAD was evaluated using the ankle-brachial index. SMI was assessed using a baseline ECG, Doppler echocardiogram, 24-hour electrocardiogram (ECG) Holter, exercise stress testing (EST), nuclear stress (if EST inconclusive), and if the result was positive, a coronary angiography. MAIN OUTCOME MEASURES: PAD, SMI, testosterone, erectile dysfunction, 24-hour blood pressure Holter, body mass index (BMI), waist circumference, lipid profile, insulin resistance, chronic inflammation, United Kingdom Prospective Diabetes Study cardiovascular risk score, nephropathy, retinopathy, and neuropathy. RESULTS: The study population was composed of 192 diabetic males with a mean age of 56.1 +/- 7.8 years and without a history of vascular disease. Twenty-three percent presented total testosterone below normal and 21.8% presented low free testosterone. BMI, waist circumference, neuropathy, triglycerides, C-reactive protein (CRP), glucose, insulin, and HOMA-IR were found to be significantly incremented with respect to subjects with normal testosterone. There was a negative correlation of HOMA-IR with total testosterone. PAD was detected in 12% and SMI in 10.9% of subjects, and differences were not related to testosterone levels. CONCLUSIONS: We have verified the prevalence of low testosterone levels in male patients with type 2 diabetes and have related them to variations in BMI, waist circumference, neuropathy, triglycerides, CRP, glucose, insulin and HOMA-IR, but not with an increase of SMI or PAD.