title: Erectile dysfunction, physical activity and metabolic syndrome: differences in markers of atherosclerosis.
abstract: BACKGROUND
  Erectile dysfunction (ED), impaired arterial elasticity, elevated resting heart rate as well as increased levels of oxidized LDL and fibrinogen associate with future cardiovascular events. Physical activity is crucial in the prevention of cardiovascular diseases (CVD), while metabolic syndrome (MetS) comprises an increased risk for CVD events. The aim of this study was to assess whether markers of subclinical atherosclerosis are associated with the presence of ED and MetS, and whether physical activity is protective of ED.
  
  
  METHODS
  57 MetS (51.3 ± 8.0 years) and 48 physically active (PhA) (51.1 ± 8.1 years) subjects participated in the study. ED was assessed by the International Index of Erectile Function (IIEF) questionnaire, arterial elasticity by a radial artery tonometer (HDI/PulseWave™ CR-2000) and circulating oxLDL by a capture ELISA immunoassay. Fibrinogen and lipids were assessed by validated methods. The calculation of mean daily energy expenditure of physical exercise was based on a structured questionnaire.
  
  
  RESULTS
  ED was more often present among MetS compared to PhA subjects, 63.2% and 27.1%, respectively (p < 0.001). Regular physical exercise at the level of > 400 kcal/day was protective of ED (OR 0.12, 95% CI 0.017-0.778, p = 0.027), whereas increased fibrinogen (OR 4.67, 95% CI 1.171-18.627, p = 0.029) and elevated resting heart rate (OR 1.07, 95% CI 1.003-1.138, p = 0.04) were independently associated with the presence of ED. In addition, large arterial elasticity (ml/mmHgx10) was lower among MetS compared to PhA subjects (16.6 ± 4.0 vs. 19.6 ± 4.2, p < 0.001), as well as among ED compared to non-ED subjects (16.7 ± 4.6 vs. 19.0 ± 3.9, p = 0.008). Fibrinogen and resting heart rate were highest and large arterial elasticity lowest among subjects with both MetS and ED.
  
  
  CONCLUSIONS
  Markers of subclinical atherosclerosis associated with the presence of ED and were most evident among subjects with both MetS and ED. Thus, especially MetS patients presenting with ED should be considered at high risk for CVD events. Physical activity, on its part, seems to be protective of ED.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01119404.
authors.affiliation: Department of Emergency Medicine, Kanta-Häme Central Hospital, Hämeenlinna, Finland. hanna.pohjantahti-maaroos@kuh.fi
authors.forename: Hanna
authors.initials: H
authors.lastname: Pohjantähti-Maaroos
authors.forename: Ari
authors.initials: A
authors.lastname: Palomäki
authors.forename: Juha
authors.initials: J
authors.lastname: Hartikainen
mesh_terms: D000328:Adult; D050197:Atherosclerosis / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D007172:Erectile Dysfunction / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014664:Vasodilation / Q000502:physiology
chemical_list: D015415:Biomarkers; D008077:Lipoproteins, LDL; C099252:oxidized low density lipoprotein