Sexual Dysfunction May Be A Tip-off To Heart Disease In Diabetic Men

Sexual dysfunction may be a marker of cardiovascular disease in men with longstanding type 1 diabetes, investigators announced at the 72nd Scientific Sessions of the American Diabetes Association (ADA).
Sara Turek, MPH, and colleagues examined the association of sexual dysfunction with clinical markers of vascular disease in 301 men from the ongoing 50-Year Medalist Study who have had type 1 diabetes for more than 50 years. Turek is a coordinator for the study, which is being conducted at the Joslin Diabetes Center in Boston.
In prior analyses, only about half of the Medalist population has been shown to develop diabetic nephropathy, retinopathy, and neuropathy, which are complications that occur in nearly all type 1 diabetic patients in the general population by about 30 years after their initial diagnosis. The rate of cardiovascular disease in Medalists, however, is similar to that reported in age-matched patients with type 2 diabetes.
Research has also demonstrated that participants in the Medalist Study have usually maintained good long-term glycemic control.
One issue that had not been addressed in the Medalist cohort was sexual dysfunction. "We have noticed that while sexual dysfunction is a common complaint among male Medalists that significantly impairs their quality of life, there is a paucity of data on sexual dysfunction in men with long-duration type 1 diabetes," Turek commented.
Overall, 210 male Medalists, or 69.8%, had sexual dysfunction as determined by an affirmative response to the question: "Have you ever had sexual problems?"
Males reporting a positive response had a hemoglobin (Hb)A1c of 7.1± 0.9% versus 6.8 ±0.8% in the no-dysfunction cohort (P=0.02). Body mass index (BMI) was 26.1 ±3.8 kg/m2 and. 25.8 ±3.6 kg/m2 (P=0.03) in the two groups, respectively, total cholesterol was 159.3 ±32.1 and 150.1 ±30.6 mg/dL(P=0.02), and high-density lipoprotein (HDL) was 55.1 ±16.2 and 62.1 ±17.8 mg/dL (P<0.01).
In addition, a history of cigarette smoking was associated with prevalence of sexual dysfunction (51.7% versus 39.3% in the sexual dysfunction and non-sexual dysfunction groups, respectively, P=0.05).
The researchers also examined clinical inflammatory markers that are commonly associated with cardiovascular risk and disease including C-reactive protein (CRP), interleukin (IL-6), and plasminogen activator inhibitor type 1 (PAI-1). Only IL-6 was significantly associated with patient reports of sexual dysfunction (P=0.03), and the association was independent of BMI, age, and glycemic control.
The findings suggest that sexual dysfunction follows the pattern of macrovascular complications seen in the Medalist group, Turek said. Also, the association with Il-6 may provide a pathway linking sexual dysfunction and macrovascular complications in this cohort.
Sara Turek said:

"The clinical message is that sexual dysfunction might be a more overt sign of cardiovascular issues or future cardiovascular issues than other clinical markers of cardiovascular disease symptoms such as hypertension, high cholesterol, and atherosclerosis. So if a patient presents with a complaint of sexual dysfunction, the physician may want to screen for cardiovascular problems since erectile dysfunction may be a predictor of increased cardiometabolic risk in aging men."