Abstract
According to the World Health Organization (WHO), the estimated life expectancy of men in Russia is 58.9 years, which is 13 years less than that of Russian women. Complications from cardiovascular disease (CVD) account for 37% of the male mortality rate. Of the European countries, Russia seems to hold the lead in the CVD-related death rate among men. This primarily results from both the social and economic situation and from a tardy recognition and correction of risk factors. Currently, about 200 behavioral, biological and environmental risk factors have been identified, but the following six are well recognized as contributing most significantly to the development of CVD: hypertension, hypercholesterolemia, smoking, obesity, alcohol abuse, sedentary lifestyle. Overall, these risk factors all further the progression towards myocardial infarction, as well as towards other non-infectious diseases. Furthermore, these risk factors tend to combine in a single individual. In 1988, G. Reaven, an American endocrinologist, propounded the theory that hypertension, dyslipidemia, and impaired glucose tolerance have a common cause in hyperinsulinemia/insulin resistance, which is a connecting link for all of these disorders.
Recently, papers on the link between the metabolic syndrome (MS), erectile dysfunction (ED) and androgen deficiency have been increasingly published. Thus, low testosterone blood levels, apart from being associated with ED and decreased libido, are also associated with insulin resistance, central obesity, and the impairment of lipid metabolism. Thus, in patients with hypogonadism, compared to individuals with obesity or with normal body weight, a marked, significant, insulin resistance/hyperinsulinemia has been established. However, among men with ED and the MS, in contrast to patients with ED without the MS, their total testosterone levels appear to be four times as low as their free testosterone levels. A step-by-step regression analysis has shown that the metabolic risk factors predominate over other major risk factors of ED progression.
Androgen replacement therapy can be a reasonable first-line treatment for patients with hypogonadism combined with sexual dysfunction and the MS. Clinical studies have demonstrated that long-term testosterone injections improve the metabolic profile, namely by also decreasing triglyceride and LDL cholesterol levels, body weight, waist circumference and glucose metabolism parameters.
Thus, the metabolic risk factors act as a connecting link between the pathogenesis of CVD and androgen deficiency. To prevent complications from these conditions, the development of an interdisciplinary work-up for the comprehensive diagnosis and therapy of the MS, hypogonadism and sexual dysfunction should be considered.
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