title: Is obesity a further cardiovascular risk factor in patients with erectile dysfunction?
abstract: BACKGROUND
  Erectile dysfunction (ED) and, in particular, arteriogenic ED have been proposed as new markers of risk for incident major adverse cardiovascular events (MACE). Reduced penile blood flow is more common in obese people than in leaner ED subjects.
  
  
  OBJECTIVE
  To explore the interaction of overweight/obesity and penile blood flow in the prediction of incident MACE.
  
  
  METHODS
  This is an observational prospective cohort study evaluating a consecutive series of 1,687 patients attending our andrological unit for ED. Different clinical, biochemical, and instrumental (penile flow at color Doppler ultrasound: PCDU) parameters were evaluated.
  
  
  METHODS
  According to body mass index (BMI), subjects were divided into three groups: normal weight (BMI = 18.5-24.9 kg/m(2)), overweight (BMI = 25.0-29.9 kg/m(2)), and obese (BMI >or= 30.0 kg/m(2)). Information on MACE was obtained through the City of Florence Registry Office.
  
  
  RESULTS
  Among patients studied, 39.8% were normal weight, while 44.1% and 16.1% showed BMI 25-29.9 and 30 kg/m(2) or higher, respectively. During a mean follow-up of 4.3 +/- 2.6 years, 139 MACE, 15 of which were fatal, were observed. Cox regression model, after adjusting for age and Chronic Diseases Score, showed that obesity classes along with the presence of arteriogenic ED (peak systolic velocity at PCDU <25 cm/second) were significantly and independently associated with incident MACE (hazard ratio = 1.47 [1.1-1.95], P < 0.05 and 2.58 [1.28-5.09], P < 0.001, respectively). When a separate analysis was performed for classes of obesity, reduced peak systolic velocity at PCDU (<25 cm/second) was significantly associated with incident MACE in obese (BMI >or= 30 kg/m(2)), but not in leaner, subjects.
  
  
  CONCLUSIONS
  In obese subjects, more than in leaner ED subjects, impaired penile blood flow is associated with an increased risk of incident cardiovascular disease. The interaction with concomitant risk factors, such as obesity, should be taken into account when assessing the predictive value of penile blood flow for cardiovascular diseases.
authors.affiliation: Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corona
authors.forename: Matteo
authors.initials: M
authors.lastname: Monami
authors.forename: Valentina
authors.initials: V
authors.lastname: Boddi
authors.forename: Daniela
authors.initials: D
authors.lastname: Balzi
authors.forename: Cecilia
authors.initials: C
authors.lastname: Melani
authors.forename: Nelli
authors.initials: N
authors.lastname: Federico
authors.forename: Daniela
authors.initials: D
authors.lastname: Balzi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Sforza
authors.forename: Carlo M
authors.initials: CM
authors.lastname: Rotella
authors.forename: Gianni
authors.initials: G
authors.lastname: Forti
authors.forename: Edoardo
authors.initials: E
authors.lastname: Mannucci
authors.forename: M
authors.initials: M
authors.lastname: Maggi
mesh_terms: D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality / Q000473:pathology*; D016001:Confidence Intervals; D006305:Health Status Indicators; D006801:Humans; D018783:Impotence, Vasculogenic / Q000000981:diagnostic imaging / Q000473:pathology*; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008019:Life Style; D008297:Male; D009765:Obesity / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D010413:Penis / Q000098:blood supply* / Q000000981:diagnostic imaging; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013739:Testosterone / Q000097:blood*; D014463:Ultrasonography
chemical_list: D013739:Testosterone