Cardiovascular Disease, Hypogonadism and Erectile Dysfunction: Early Detection, Prevention and the Positive Effects of Long-Term Testosterone Treatment: Prospective Observational, Real-Life Data

Abstract

Purpose: Erectile dysfunction (ED) is associated with testosterone deficiency and is a symptom of functional hypogonadism. A correlation between ED and cardiovascular disease (CVD) has been recognized, and ED has been proposed as an early marker of CVD. However, the relationship between ED and CVD risk in hypogonadism requires clarification and whether testosterone therapy (TTh) can be a beneficial treatment strategy, but long-term data are limited. This study investigates long-term TTh in men with hypogonadism and ED with a history of CVD.

Methods: Seventy-seven patients with a history of CVD and diagnosed with functional hypogonadism and erectile dysfunction (erectile function domain score <21 on the International Index of Erectile Function questionnaire (IIEF questions 1-5)) were enrolled and TTh effects on anthropometric and metabolic parameters investigated for a maximum duration of 12 years. All men received long-acting injections of testosterone undecanoate at 3-monthly intervals. Eight-year data were analysed. Data collection registry started in November 2004 till January 2015.

Results: In hypogonadal men receiving TTh, IIEF increased by 5.4 (p<0.001). Total weight loss was 23.6 ± 0.6 kg after 8 years. HbA1c had declined by an average of 2.0% (P<0.0001). Total cholesterol levels significantly declined following TTh after only 1 year (P<0.0001), and HDL increased from 1.6±0.5 at baseline to 2±0.5 mmol/L following 8 years of TTh (P<0.0001). SBP decreased from 164±14 at baseline to 133±9 mmHg, signifying a reduction of 33±1 mmHg (P<0.0001).

Conclusion: In hypogonadal men with a history of CVD, TTh improves and preserves erectile function over prolonged periods with concurrent sustained improvements in cardiometabolic risk factors. Measuring ED and testosterone status may serve as an important male health indicator predicting subsequent CVD-related events and mortality and TTh may be an effective add-on treatment in secondary prevention of cardiovascular events in hypogonadal men with a history of CVD.

Keywords: cardiovascular disease; erectile function; functional hypogonadism; testosterone therapy.

Figure 1

Flow chart for patient’s selection.

Figure 2

International index of erectile function – erectile function domain (IIEF-EF) in 77 hypogonadal men with a CVD history receiving continuous treatment with testosterone undecanoate. Data are shown as mean. *p<0.0001 vs baseline. #p<0.0001 vs previous year.

Figure 3

Anthropometric parameters in hypogonadal men with a history of cardiovascular disease receiving long-term testosterone therapy.

Figure 4

HbA_1c (%) in hypogonadal men with a history of cardiovascular disease receiving long-term testosterone therapy.

Figure 5

(A) Systolic and (B) diastolic blood pressure (mmHg) in hypogonadal men with a history of cardiovascular disease receiving long-term testosterone therapy. (C) Pulse pressure in hypogonadal men with a history of cardiovascular disease receiving long-term testosterone therapy.

Figure 6

Serum lipids in hypogonadal men with a history of cardiovascular disease receiving long-term testosterone therapy (A) total cholesterol, (B) LDL-cholesterol, (C) triglycerides and (D) HDL-cholesterol. Note: Data are shown as mean. *p<0.0001 vs baseline. #p<0.0001 vs previous year.