![]() However, studies examining the effect of testosterone replacement therapy on cardiovascular outcomes have shown such highly variable results that the field remains confusing some studies suggesting that testosterone therapy increases cardiovascular events and other studies showing either a neutral or even beneficial effect of testosterone on cardiac outcome. Epidemiologic and observational studies show that low endogenous testosterone levels are associated with higher rates of coronary disease, atherosclerotic aortas, and major cardiac events. Exogenous testosterone was shown to be either neutral or to lower cholesterol levels it has been shown to reduce insulin resistance. There is a heated debate regarding the cardiovascular safety of testosterone replacement therapy. Men with ED should be evaluated for cardiovascular risk factors. ![]() Patients with CAD or risk factors for CAD should be routinely questioned about their sexual health and ED. There has been debate about whether statins can exacerbate ED but one recent study showed that statins were neutral and some have shown that lowering total and LDL cholesterol with statins improved erectile function. One study showed a 1.32 times risk of ED for every mmol/L increase in total cholesterol. Men with heart disease, hypertension, smoking, diabetes, dyslipidemia, inactivity and obesity are at increased risk for ED. The same risk factors for atherosclerotic cardiovascular disease are risk factors for ED and may cause endothelial dysfunction of the blood vessels in the penis even before well-established atherosclerotic plaques inhibit blood flow. Therefore, most cases of erectile dysfunction (ED) are vascular in nature and related to endothelial dysfunction. If blood vessels do not dilate normally in the corpus cavernosum of the penis, then an erection will not occur. Will there ever be a RCT, and would such a study be ethical?Įrectile Dysfunction, Cardiovascular Risk and Testosteroneĭirector, Cardiovascular Research InstituteĪn erection is a vascular event. Special considerations of course are needed in women of reproductive age. Based on current evidence, or lack thereof, I recommend statin therapy for primary prevention of ASCVD in all patients with T1DM of 20 years’ duration, at age 30 and with any additional ASCVD risk factor and at age 20 if the LDL-C >100 mg/dL. When turning to the lipid guidelines of the ACC/AHA, NLA, AACE, Endocrine Society, ADA, Europe and Canada no clear distinction for or against a statin is made between T1DM and T2DM. However, a recent observational study did provide evidence that over a 6-year period of observation lipid altering therapy (97% statin) was associated with 22–44% reduction in the risk of CVD and CVD death among individuals with T1DM without a history of CVD (Diabetes Care 39:996, 2016). Thus, any model that attempts to define risk such as the Steno Risk Engine and the Swedish National Diabetes Register (NDR) need to be based almost entirely on observational data. In the Collaborative Cholesterol Treatment Trialists analysis a borderline benefit of statin was provided in the small number of T1DM patients included (0♷9, 99% CI 0♶2–1♰1 p=0♰1) (Lancet 371:12, 2008) however, there was no clear advantage of statins in a similar number of T1DM subjects who were part of the Heart Protection Study (Lancet 361: 2005, 2003). Yet, therapeutic decision making has been difficult because statin intervention data have almost entirely been observational with few randomized clinical trials (RCT) that have included patients with T1DM. Type 1 diabetes mellitus (T1DM) is well recognized to be associated with a higher incidence and prevalence of atherosclerotic cardiovascular disease (ASCVD). Boettcher Endowed Chair in Atherosclerosisĭivision of Endocrinology Metabolism and DiabetesĬardiology Professor of Physiology and Biophysics KEYNOTE: Statins and Type 1 Diabetes Mellitus: When and How?Ĭharles A.
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