Erectile Dysfunction, Metabolic Syndrome, and Cardiovascular Risks

Facts and Controversies

Edward Sanchez; Alexander W. Pastuszak; Mohit Khera

Disclosures

Transl Androl Urol. 2017;6(1):28-36. 

In This Article

Hypogonadism in CVD and ED

Androgens play an important role in both penile and vascular health, with cellular targets located in both endothelial and smooth muscle cells. Within the vasculature, androgens promote endothelial cell survival, inhibit proliferation and intimal migration of vascular smooth muscle cells, and reduce endothelial expression of pro-inflammatory markers. Within the penis, low androgen levels are associated with apoptosis of endothelial and smooth muscle cells as well as with pathologic structural remodeling.[31]

Several studies have suggested a link between low testosterone and CVD. Lee et al. found that testosterone levels were negatively correlated with Framingham risk scores in patients with sexual dysfunction.[32] Cao et al. studied a population of elderly males with CAD and found that compared to controls, these men had significantly lower levels of both total and free testosterone, as well as decreased expression of androgen receptors.[33] Low androgen levels have also been associated with an increased risk of cardiovascular death.[34] Malkin et al. observed that androgen deficiency in men with CAD was associated with increased all-cause and vascular mortality.[35] Corona et al. reported that low testosterone levels are significantly associated with cardiovascular death in patients with ED.[34]

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