title: Metabolic syndrome in men with low testosterone levels: relationship with cardiovascular risk factors and comorbidities and with erectile dysfunction.
abstract: BACKGROUND
  Testosterone deficiency and metabolic syndrome (MetS) are strongly associated. Patients consulting for sexual dysfunction may have testosterone deficiency, providing a valuable opportunity to assess MetS. The identification of variables predicting MetS is of great importance.
  
  
  OBJECTIVE
  To identify cardiovascular comorbidities and risk factors, including erectile dysfunction (ED), associated with MetS in men aged≥45 with total testosterone (TT)<8 nmol/L (or <12 nmol/L when calculated free testosterone was <50 pmol/L) and to gain further insight into the relationship between both conditions.
  
  
  METHODS
  Data were collected from a multicenter, cross-sectional, observational study conducted in Spain among men visiting men's health-care offices with a confirmed diagnosis of testosterone deficiency. Subjects with data for MetS assessment were included in this analysis. Other data available were anthropometrics, toxic habits, cardiovascular comorbidities, ED diagnosis, and TT values.
  
  
  METHODS
  The MetS harmonized definition was used. Waist circumference threshold was 94 cm. ED was diagnosed and classified using the International Index of Erectile Function-5 (IIEF-5) questionnaire. Bivariate and multivariate logistic regression analyses were performed to calculate odds ratios (ORs) for MetS.
  
  
  RESULTS
  Mean age was 61.2±8.1 years. Prevalences of ED and MetS were 97.6% and 69%, respectively, both increasing with age. Bivariate analysis showed that moderate or severe ED, obesity, and peripheral vascular disease (PVD) were the variables associated with the greatest odds of MetS (OR=2.672 and 2.514, respectively), followed by alcohol intake (OR=1.911). Tobacco use, ag,e and testosterone deficiency severity had a minimal effect that disappeared on multivariate analysis. Elevated triglycerides and HDL-cholesterol were MetS risk factors associated with a lower TT level.
  
  
  CONCLUSIONS
  The high prevalence of MetS among men with testosterone deficiency highlights the opportunity to assess cardiovascular health in patients consulting for sexual dysfunction. Moderate to severe ED, obesity, PVD, and alcohol intake significantly increase the likelihood of MetS.
authors.affiliation: Department of Urology, Hospital Clinic de Barcelona, Barcelona, Spain; Spanish Men's Health Research Network (REISHO), Barcelona, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: García-Cruz
authors.forename: Asier
authors.initials: A
authors.lastname: Leibar-Tamayo
authors.forename: Javier
authors.initials: J
authors.lastname: Romero
authors.forename: Marta
authors.initials: M
authors.lastname: Piqueras
authors.forename: Pilar
authors.initials: P
authors.lastname: Luque
authors.forename: Oscar
authors.initials: O
authors.lastname: Cardeñosa
authors.forename: Antonio
authors.initials: A
authors.lastname: Alcaraz
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D016009:Chi-Square Distribution; D008076:Cholesterol, HDL / Q000097:blood; D015897:Comorbidity; D003430:Cross-Sectional Studies; D007172:Erectile Dysfunction / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology; D016017:Odds Ratio; D010410:Penile Erection; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D013739:Testosterone / Q000097:blood / Q000172:deficiency*; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL; D014280:Triglycerides; D013739:Testosterone
keywords: Abdominal Obesity; Cardiovascular Diseases; Diabetes Mellitus; Erectile Dysfunction; Hypercholesterolemia; Hypertension; Hypogonadism; Metabolic Syndrome X; Obesity; Sexual Dysfunction; Testosterone