title: The role of the urologist in the prevention and early detection of cardiovascular disease.
abstract: In this review we identify whether problems encountered in urology, such as erectile dysfunction, have a bearing on general health, in particular cardiovascular health. Testosterone, traditionally regarded as the hormone subserving male reproductive and sexual functioning, appears to have a much wider role. Recent findings show that testosterone is involved in the metabolic control of glucose and lipids, of strength of bone and muscle, and psychological aspects such as mood and energy. Serum testosterone levels decline with ageing, free testosterone levels more so than total testosterone. At least 10 publications have shown that low testosterone levels are associated with an increased risk of death. The metabolic syndrome is a clustering of risk factors predisposing to diabetes mellitus type 2, atherosclerosis, and cardiovascular morbidity and mortality. There is a direct correlation between plasma testosterone and insulin sensitivity, and low testosterone levels are associated with an increased risk of type 2 diabetes mellitus, dramatically illustrated by androgen deprivation in men with prostate carcinoma. Lower total testosterone and sex hormone-binding globulin levels predict a higher incidence of the metabolic syndrome. Administration of testosterone to hypogonadal men reverses part of the unfavourable risk profile for the development of diabetes and atherosclerosis, thus also improving risk factors for erectile dysfunction. We conclude that urologists diagnosing and treating erectile problems are in a unique position to include general aspects of men's health in their work, and thus contribute to general health and to cardiovascular health in particular.
authors.affiliation: Institute of Urology and Andrology, Segeberger Kliniken, Norderstedt-Hamburg, Germany ; Department of Urology, Gulf Medical University School of Medicine, Ajman, United Arab Emirates ; Dresden International University, Germany.
authors.forename: Aksam A
authors.initials: AA
authors.lastname: Yassin
authors.affiliation: Scientific Affairs Men's Healthcare, Bayer Schering Pharma, Berlin, Germany ; Research Department, Gulf Medical University School of Medicine, Ajman, United Arab Emirates.
authors.forename: Farid
authors.initials: F
authors.lastname: Saad
authors.affiliation: Private Urology Practice, Bremerhaven, Germany.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Haider
authors.affiliation: Department of Internal Medicine, Section of Endocrinology, Free University Medical Center, Amsterdam, The Netherlands.
authors.forename: Louis
authors.initials: L
authors.lastname: Gooren
keywords: BMI, body mass index; CHD, coronary heart disease; CVD, cardiovascular disease; Cardiovascular disease; ED, erectile dysfunction; Erectile dysfunction; MMAS, Massachusetts Male Aging Study; Metabolic syndrome; NO, nitric oxide; PDE5(I), phosphodiesterase-5 (inhibitor); SHBG, sex-hormone binding globulin; Testosterone