ORLANDO—Men with cardiac disease are more likely than those in the general population to have impaired sexual function and hypogonadism, according to new findings presented at the American Urological Association 2014 annual meeting.
In the prospective CUPPID [Cardiac & Urologic Pathology Prevalence Interplay Determination] trial, Tobias S. Köhler, MD, MPH, of Southern Illinois University in Springfield, and colleagues evaluated erectile dysfunction (ED), ejaculatory dysfunction (EjD), and lower urinary tract symptoms (LUTS) in 200 male cardiac patients. The patients had a mean age of 67 years.
Seventy-one patients 71 (36%) had diabetes and 176 (88%) had hyperlipidemia. Of the 200 patients, 147 (73.5%) had symptomatic hypogonadism as defined by calculated free testosterone (less than 6.5 ng/dL) and positive response to Androgen Deficiency in the Aging Male (ADAM) questionnaire.
The expected rate of hypogonadism in the age-matched general population is 10%-15%, according to previous studies. In addition, 46 (31%) of patients with symptomatic hypogonadism based on CFT values would be considered normal by total testosterone measurements.
Approximately 76% of patients with moderate to severe ED had either failed or not undergone any treatment. Of the men with moderate to severe ED, 47% had never undergone treatment with phosphodiesterase type 5 (PDE5) inhibitors. Among those who did try PDE5 inhibitors, the drugs worked unsuccessfully in 87% of men and successfully in 13%.
Dr. Köhler’s group compared the cardiac patients, by age group, with age-group-matched participants in the National Health and Nutrition Examination Survey. Among individuals aged 40-59, the cardiac patients had a 3.2 times increased risk of ED compared with NHANES patients. Among those aged 60-69 and 70 years and older, cardiac patients had a 40% and 20% increased risk, respectively.
Results showed that the cardiac patients were 6 times more likely than their counterparts in the general (NHANES) population to be hypogonadal.
Each 1 ng/dL decrease in calculated free testosterone predicted a 15% increase in LUTS as measured by International Prostate Symptom Score.
“In summary, cardiology clinic patients likely are negatively affected by one if not several urologic problems,” Dr. Köhler told Renal & Urology News. “This is likely due to overlapping mechanisms of poor blood flow [to the heart and genitourinary organs], metabolic syndrome sequalae, and common risk factors such as obesity, high lipids and smoking history.”