Metabolic syndrome and the menopause

The metabolic syndrome consists of a combination of risk factors that include abdominal obesity, atherogenic dyslipidaemia, hypertension and insulin resistance. It increases the risk of cardiovascular disease and type 2 diabetes. The increased risk of cardiovascular disease is higher in women than in men. The first manifestation of metabolic syndrome may occur in pregnancy presenting as gestational diabetes or preeclampsia. Both conditions are associated with increased insulin resistance. Also metabolic syndrome is more common in polycystic ovarian syndrome. It has been suggested that there is a metabolic syndrome resulting from the menopause due to estrogen deficiency, as many of the risk factors are more prevalent in postmenopausal women. Also estrogen replacement improves insulin sensitivity and reduces the risk of diabetes. The key elements in managing the metabolic syndrome are weight reduction, increasing physical activity and diet modification. If blood pressure, lipid and glycaemic control are not achieved through these interventions then pharmacological therapy will be required.     

Epidemiology and risk factors of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction

Benign prostatic hyperplasia (BPH) is very common in aging men and causes lower urinary tract symptoms (LUTS), which decrease health-related quality of life. A number of evidence suggests that other than ageing, modifiable factors, such as increasing prostate volume, obesity, diet, dyslipidemia, hormonal imbalance, hypertension, metabolic syndrome, alcohol, and smoking, also contribute to the development of BPH and/or LUTS. More recently, erectile dysfunction (ED) has been linked to LUTS/BPH as a part of this syndrome, suggesting that patients with BPH or LUTS easily develop ED, and that LUTS/BPH symptoms often coexist with ED. This article focuses on the epidemiology and risk factors of the combined phenotype LUTS/BPH – ED.     

Does Metabolic Syndrome Impair Sexual Functioning in Adults With Overweight and Obesity?

Objectives: Obesity is a growing public health concern worldwide, and results in increased risk of cardiovascular disease, type 2 diabetes, metabolic syndrome, insulin resistance, dyslipidemia, hypertension, and reduced sex hormone production. Previous research suggests that obesity may contribute to sexual dysfunction. This review aims to determine the relationship between obesity and sexual dysfunction, and ascertain the associated cardiometabolic conditions that may contribute to impaired sexual functioning in individuals with obesity. Methods: Literature searches were conducted through PubMed and Embase from 1980 to 2016, to identify original research articles, reviews including systematic reviews and meta-analyses, using the search terms: obese, obesity, overweight, sexual function, sexual dysfunction, metabolic syndrome, CVD, T2D, hormones and weight loss. Results: This review found that individuals with obesity and cardiometabolic comorbidities were more likely to report the greatest degree or sexual dysfunction and/or reduction in sexual quality of life, compared to those without. Conclusions: Current evidence supports an association between sexual dysfunction and factors associated with obesity, such as reduced insulin sensitivity, dyslipidaemia, hypertension, and low oestrogen or testosterone. To establish efficacious treatments, research examining the impact of weight loss on the conditions associated with obesity, such as hypertension, reduced insulin sensitivity, dyslipidaemia, and low sex hormones and sexual functioning in individuals with overweight and obesity should be a priority.     

Men's sexual health and the metabolic syndrome

The aim of this article is to provide an overview of the current literature on the impact of the metabolic syndrome on male sexual health and current developments in the management of sexually dysfunctional men with a metabolic syndrome. The increasing prevalence across the world of the metabolic syndrome-a cluster of cardiovascular disease risk factors-causes the metabolic syndrome to be considered the most important threat to male sexual health of the 21st century. It has been shown to have a negative impact on male sexual function through its relationship with cardiovascular disease risk, its association with hypogonadism, and associated psychosocial factors. Besides established pharmacological and hormonal interventions, lifestyle modification programs are considered important therapeutic tools.     

Insulin resistance and management of the menopause: a clinical hypothesis in practice

Insulin resistance (IR) is associated with a number of metabolic abnormalities including glucose intolerance, dyslipidemia and central obesity (the metabolic syndrome), which predispose to cardiovascular disease, diabetes mellitus and some cancers. The incidence of many of these conditions increases after the menopause, a time when IR also increases. Medical intervention to help alleviate menopausal symptoms, frequently vasomotor in origin, usually involves hormone replacement therapy (HRT), but some women may only experience partial symptom relief. We have hypothesized that this may be due to concurrent IR. Our approach is therefore to manage menopausal symptoms in conjunction with the treatment of any concurrent IR, achieved through a combination of hormone replacement, dietary intervention and, if necessary, an insulin sensitizer. We suggest that this approach may not only improve symptom relief but may also reduce the risk of developing more serious health complaints in the future.     

Assessment of Cardiovascular Risk in Collegiate Football Players and Nonathletes

Abstract

Collegiate American football players may be at risk for cardiovascular disease. Objective: To compare cardiovascular disease risk factors and cardiovascular structure and function parameters of football players, stratified by position, to a group of sedentary, nonathletes. Participants: Twenty-six collegiate football players and 13 nonathletes participated in this study. Methods: Blood pressures, anthropometrics, and blood chemistries were obtained and analyzed using standardized procedures. Resting echocardiography was used to evaluate cardiac morphology and function. Brachial artery flow-mediated dilation was assessed using high-resolution ultrasonography. Results: The prevalence of the metabolic syndrome was significantly higher amongst the linemen compared to the skill-position players (46% versus 0%, p < .05). Mildly abnormal wall thickness was noted in 20% of the football players. No significant differences in vascular function were observed between the groups. Conclusions: The increased prevalence of the metabolic syndrome and its components in the collegiate linemen may increase cardiovascular disease risk.     

Effects of androgens in men with the metabolic syndrome

The metabolic syndrome is well recognized as the association between obesity, elevated blood lipids, hypertension, hepatic steatosis, impaired glucose tolerance/diabetes mellitus type II and increased risk for cardiovascular disease. Recently, several publications have demonstrated that uisceral accumulation of fat seems to be more important than general obesity and that several endocrine disturbances should be included in this syndrome. The first observations concerning the importance of body fat distribution and endocrine disturbances, however, were made in the 1940s and later confirmed by further research. Concerning the endocrine disturbances, we have specifically found that abdominal, i.e. visceral, type of obesity is associated with low levels of sex steroids in both men and women, increased Cortisol activity as well as a blunted growth hormone action. In several hormonal intervention studies, we have also demonstrated favorable effects on visceral obesity, insulin sensitivity, blood lipids and blood pressure. Furthermore, recent results from our research group have indicated that this complex of signs and diseases is associated with psychiatric signs such as mental stress, signs of melancholy and decreased life satisfaction. In order to explain better the possible pathogenesis of these risk factors and diseases, the term ‘the neuroendocrine syndrome’ seems to be more adequate. This article willfocus on important biological mechanisms in hormonal intervention strategies, especially androgen treatment, for patients with this syndrome.     

The incidence of metabolic risk factors in an inpatient psychiatric setting

Our study examines risk factors for metabolic syndrome on admission to an acute psychiatric facility and the incidence of medical referrals at discharge. Data on demographics, risk factors for metabolic syndrome, other health risk factors, medications, related diagnoses, and primary care providers and referrals were collected from 125 psychiatric patient charts. Comparison analysis was done for two groups: those with two or more risk factors for metabolic syndrome and those with less than two risk factors. Differences between groups were statistically significant for age, waist circumference, body mass index, high-density lipoprotein, triglycerides, and fasting glucose levels. Few patients were referred to their primary care provider for follow-up care. This study has clinical implications for improving assessment of psychiatric patients at risk for developing metabolic syndrome, for designing interventions to help patients adopt lifestyle changes to mitigate these risks, and for working toward fuller integration of psychiatric and primary care.     

Why can patients with erectile dysfunction be considered lucky? The association with testosterone deficiency and metabolic syndrome

Metabolic syndrome (MetS) is a diagnostic category, based on a cluster of risk factors (hyperglycemia/diabetes, abdominal obesity, hypertriglyceridaemia, low HDL cholesterol and hypertension), which identifies subjects at high risk for forthcoming type 2 diabetes mellitus and cardiovascular (CV) diseases. Recently, a close association between MetS, erectile dysfunction (ED) and male hypogonadism has been reported. In patients with MetS, hypogonadism can exacerbate sexual dysfunction and arteriogenic ED because of its typical symptoms, such as decreased sexual desire and mood disturbances. On the other hand, hypogonadism per se has been associated with an increased risk of CV and overall mortality. Obesity and in particular central obesity is nowadays considered the most important determinant of MetS-induced hypogonadism whereas hypertension and diabetes play a major role in ED associated with MetS. This review analyses the current literature regarding the relationship between ED, MetS and hypogonadism emphasising the epidemiological and psychopathological aspects and stressing the concept that ED subjects are ‘lucky’, because ED offers a unique chance to undergo medical examination and therefore to improve not only their sexual but, most importantly, their overall health.     

Cardiovascular Reactivity and Behavioral Health

The purpose of this article is to show that cardiovascular reactivity is an important topic within the field of behavioral health. It has been demonstrated that the cardiovascular system responds differentially to stressors that encourage effortful active coping as opposed to passive coping. However, it is also well established that individuals exposed to the same stressor exhibit marked variability in their cardiovascular responses. Evidence from studies of temporal stability of individual differences to laboratory stressors support the view that cardiovascular reactivity may be considered as a psychophysiological trait. The identification of stable individual-specific patterns of exaggerated cardiovascular reactivity during psychologically challenging tasks appears to be important for understanding the development of essential hypertension. Recurrent episodes of stress-induced sympathetic activation associated with non-adaptive hemodynamic responses (non-adaptive with respect to the immediate metabolic demands), give rise to autoregulatory and structural changes in the resistive vessels. Thus, cardiovascular reactivity may be an important aspect of assessing cardiovascular disease risk. Possible application of reactivity testing in a risk-ascertainment process was discussed.     

Our common future: a rapidly growing and rapidly aging humankind

Abstract

Physical inactivity, diabetes, hypertension, dyslipidemia, smoking and obesity were associated with imbalance in oxidative stress, leading to endothelial dysfunction. Such dysfunction is present in both cardiovascular disease (CVD) and erectile dysfunction (ED). ED is the persistent inability to achieve or sustain an erection sufficient for satisfactory sexual performance and is one of the first manifestations of endothelial damage in men with CVD risk factors. The purpose of this article is to review the results of studies involving physical activity, CVD, endothelial dysfunction and ED in order to verify its applicability for improving the health and quality of life of men with such disorders. There is consistent evidence that endothelial damage is intimately linked to ED, and this manifestation seems to be associated with the appearance CVDs. On the other hand, physical activity has been pointed out as an important clinical strategy in the prevention and treatment of CVDs and ED mainly associated with improvement of endothelial function. However, further experimental and clinical prospective investigations are needed to test the role of physical exercises in the modulation of endothelial function and their implications on erectile function and the appearance of CVDs.     

Androgen deficiency in the adult male

Introduction. The purpose of this study was to investigate the association between severity of lower urinary tract symptoms (LUTS), erectile dysfunction (ED) and metabolic syndrome.

Methods. Our study population included a consecutive series of 190 patients with LUTS (International Prostate Symptom Score-IPSS >7) with or without manifestations of the metabolic syndrome. The diagnoses of diabetes mellitus and hypertension were obtained from the patient's medical history. Data on blood pressure, waist measure, body height and weight were collected and body mass index were calculated. Patients were assessed based on the International Index of Erectile Function (IIEF) for ED and IPSS and IPSS-Quality of Life for LUTS. Blood samples were drawn from fasting patients to determine, fasting blood glucose (FBG), triglycerides, HDL-cholesterol and serum total testosterone levels.

Results. In severe LUTS patient group, IIEF erectile function domain scores were significantly lower than moderate LUTS patient group (p < 0.05). Multiple logistic regression analysis confirmed that presence of ED was the most predictor of severe LUTS. The prevalence of metabolic syndrome was higher in patients with severe LUTS (26%vs. 46%, p = 0.009). The severe form of the LUTS was significantly correlated with waist circumference >102 cm (p < 0.05), blood pressure ≥130/85 mmHg (p < 0.05) and FBG >110 mg/dl (p < 0.01).

Conclusion. Obesity, high plasma level of FBG and hypertension constitute risk factors for the development of severe LUTS. Metabolic syndrome may play a key role in the pathogenesis in both ED and LUTS. Presence of ED is the most predictor of severe LUTS.     

Metabolic impact of shift work

In developing countries, shift work represents a considerable contingent workforce. Recently, studies have shown that overweight and obesity are more prevalent in shift workers than day workers. In addition, shift work has been associated with a higher propensity for the development of many metabolic disorders, such as insulin resistance, diabetes, dislipidemias and metabolic syndrome. Recent data have pointed that decrease of the sleep time, desynchronization of circadian rhythm and alteration of environmental aspects are the main factors related to such problems. Shortened or disturbed sleep is among the most common health-related effects of shift work. The plausible physiological and biological mechanisms are related to the activation of the autonomic nervous system, inflammation, changes in lipid and glucose metabolism, and related changes in the risk for atherosclerosis, metabolic syndrome, and type II diabetes. The present review will discuss the impact of shift work on obesity and metabolic disorders and how disruption of sleep and circadian misalignment may contribute to these metabolic dysfunctions.     

Gender differences in cardiovascular disease prevention

Risk factors are generally shared between men and women with the major differences being hormonal. Nine modifiable risk factors account for over 90% of the risk of a coronary event in men and women--smoking, hypertension, hyperlipidaemia, diabetes, abdominal obesity, lack of exercise, alcohol excess, reduced intake of fruit and vegetables, and psychosocial issues. Approximately half the decline in deaths from coronary heart disease (CHD), between 1980 and 2000, can be attributed to a reduction in the major risk factors and the other half to the use of evidence-based management. As educational efforts to increase awareness of cardiovascular disease (not cancer) to be the leading cause of death and disability in women are also associated with preventative action, it is important that health-care professionals educate themselves about CHD in women and communicate with women themselves, so that women can come forward for advice and evaluation.     

Treating cardiovascular disease in women

Cardiovascular disease (CVD) is the most common cause of death in women but some of the challenges of management differ from those in men. This article addresses the gender-specific issues of cardiovascular management, with emphasis on ischaemic heart disease and modification of coronary risk factors. Women with ischaemic heart disease present later than men, and are therefore older and more likely to suffer from co-morbidities such as diabetes and hypertension. Proven CVD risk factors in women can be divided into those that are modifiable and those that are non-modifiable. The former include diabetes, dyslipidaemia, hypertension, smoking, obesity, sedentary lifestyle and poor nutrition; the latter include family history of heart disease and older age at presentation. It is this difference in age and general health that explains much of the variability in response to treatment. Pharmacotherapy, percutaneous intervention, surgical revascularization, and cardiac rehabilitation and disease prevention are discussed.     

Work stressors and cardiovascular disease

Over the past 20 years, an extensive body of research evidence has documented that psychosocial work stressors are risk factors for hypertension and cardiovascular disease. These stressors, which appear to be increasing in prevalence, include job strain (the combination of psychological job demands and low job control), imbalance between job efforts and rewards, threat-avoidant vigilant work, and long work hours. This article reviews the evidence linking these stressors with hypertension and CVD, and the physiological and social psychological mechanisms underlying the associations. Also described are methods for measuring work stressors and new, more accurate techniques for measuring blood pressure. Finally, strategies for reducing work stressors and preventing hypertension and CVD are reviewed. These include clinical assessment, worksite health promotion, work organization interventions, legal approaches and work site surveillance.     

Testosterone and body functions

Testosterone supplementation can help reduce many of the symptoms associated with androgen deficiency in the aging male by its effects on various parts of the body. Bone mineral density can decrease in the hypogonadal man and this may contribute to the increased fracture rate in the elderly. Testosterone therapy can improve bone mineral density and bone architecture by increasing bone formation and decreasing bone resorption – the possible benefits on fracture rate are unknown. Testosterone also improves body composition by reducing body fat mass and increasing lean body mass, and by increasing epidermal thickness, but its effects on muscle strength are still debated. In patients with diabetes and androgen deficiency, testosterone supplementation appears to reduce blood glucose and this could have important implications for cardiovascular risk reduction in patients with diabetes or the metabolic syndrome. The wide-ranging benefits of testosterone therapy in young and old men are clear and it appears that the route of administration (intramuscular, oral, or transdermal) does not alter this fact, but future work could illustrate even more profound effects of testosterone (e.g., in reducing cardiovascular risk) that could result in its recommended use in a wider range of patients.     

The correlation between highly sensitive C-reactive protein levels and erectile function among men with late-onset hypogonadism

We investigated the correlation between highly sensitive C-reactive protein (hs-CRP) levels and erectile function, and assessed the clinical role of hs-CRP levels in men with late-onset hypogonadism (LOH) syndrome. For 77 participants, we assessed Sexual Health Inventory for men (SHIM) score, Aging Male Symptoms (AMS) score and International Prostate Symptom Score (IPSS). We also evaluated free testosterone (FT), hs-CRP, total cholesterol, triglyceride levels, high density lipoprotein cholesterol, hemoglobin A1c, body mass index, waist size and blood pressure. We attempted to identify parameters correlated with SHIM score and to determine the factors affecting cardiovascular risk based on hs-CRP levels. A Spearman rank correlation test revealed that age, AMS score, IPSS and hs-CRP levels were significantly correlated with SHIM score. Age-adjusted analysis revealed that hs-CRP and IPSS were the independent factors affecting SHIM score (r=??0.304 and ?0.322, respectively). Seventeen patients belonged to the moderate to high risk group for cardiovascular disease, whereas the remaining 60 belonged to the low risk group. Age, FT value and SHIM score showed significant differences between the two groups. A multivariate regression analysis demonstrated that SHIM score was an independent factor affecting cardiovascular risk (OR: 0.796; 95%CI: 0.637–0.995).     

Diabetes, aging and physical activity

Diabetes mellitus (DM) is a metabolic disease affecting the regulation of insulin and glucose causing a disruption in the normal control of counterregulatory hormones and macronutrients, resulting in blood glucose accumulation. Metabolic deregulation leads to the production of noxious substances that have a particular propensity for damaging vascular and nervous structures. Physiological changes observed with aging are correlated with a concomitant increase in DM and its associated complications. Long-term complications, including peripheral and central neuropathies, micro- and macrovascular damage, retinopathy, and nephropathy are the major causes of mortality in diabetics [cardiovascular disease (CVD) being the primary complication causing death in this population]. All-cause mortality is three to four times greater in the DM population; hence, management of DM is of timely importance, particularly with a projected prevalence increase of 134% within the next 25 years among individuals over the age of 65 years. Exercise modalities, including endurance and resistance training, were employed to improve glycemic/metabolic control and to ameliorate the progression of DM-related complications. Several risk factors, including glucose levels, blood pressure, lipid/cholesterol profile, and BMI, are reportedly improved with these modes of exercise. However, not all studies demonstrate an improvement in risk factors, but consistently note improvement in complications and a reduction of DM incidence. There is convincing evidence that exercise, with or without specific improvements to traditional DM-related risk factors, is an effective therapy for the management of DM.The Canadian Centre for Activity and Aging is affiliated with St. Joseph’s Health Care and The University of Western Ontario, London, Ontario, Canada.