title: Testosterone deficiency in patients with erectile dysfunction: when should a higher cardiovascular risk be considered?
abstract: BACKGROUND
  Low testosterone levels (low T) increase the cardiovascular (CV) risk of men with erectile dysfunction (ED). T levels associated with a higher CV risk are unknown.
  
  
  OBJECTIVE
  To determine the prevalence of CV risk factors associated with low T as defined by European Guidelines and their contribution to low T, overall and at different ages.
  
  
  METHODS
  Multicenter, cross-sectional, observational study conducted in Spain among men with ED aged ≥ 18 years visiting Urology/Andrology offices for sexual dysfunction. Anthropometric, clinical, and laboratory data, including total T (TT) values, were collected for 1,278 men.
  
  
  METHODS
  Risk factors were assessed in men with TT ≤ 8, 8-12, and ≥ 12 nmol/L, and two-group comparisons were made. Bivariate and multivariate logistic regression analyses were performed to calculate odds ratios for low T after adjusting for possible confounding factors.
  
  
  RESULTS
  Mean age (standard deviation) was 58.0 (9.2) years. Age and prevalence of CV risk factors was similar in men with TT ≤ 8 nmol/L or 8-12 nmol/L and significantly higher than in men with TT >12 nmol/L. Low T was therefore considered as TT ≤ 12 nmol/L, with a prevalence of 33.3%. Obesity, hypertension, hyperlipidemia, and severe ED were the variables most strongly associated with low T: obesity in middle-aged men; hyperlipidemia, and hypertension in older men. Severe ED was a risk factor in both groups. Hypolipidemic therapy had the greater effect in young men. Multivariate analysis showed that severe ED and obesity were the strongest predictors of low T.
  
  
  CONCLUSIONS
  T levels associated with increased CV risk could go as high as 12 nmol/L in men with ED, with distribution of risk factors showing differences according to age. Obesity and severe ED are the best predictors of low T-related CV risk.
authors.affiliation: Servicio de Urología, Hospital Clínico Universitario, Valencia, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Martínez-Jabaloyas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D003430:Cross-Sectional Studies; D004812:Epidemiologic Methods; D007172:Erectile Dysfunction / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology; D013739:Testosterone / Q000172:deficiency*; D055815:Young Adult
chemical_list: D013739:Testosterone
keywords: Abdominal Obesity; Androgen Deficiency; Cardiovascular Diseases; Diabetes; Erectile Dysfunction; Hypercholesterolemia; Hypertension; Hypogonadism; Metabolic Syndrome; Obesity; Sexual Dysfunction; Testosterone