This suggests that sexual dysfunction can predict cardiovascular disease in those with type 1 diabetes for 50 or more years, but who are relatively free of microvascular diseases.
The primary and most commonly evaluated risk factors for cardiovascular disease associated with diabetes include dyslipidemia, elevated body mass index (BMI), poor glycemic control, hypertension, insulin resistance and a history of smoking.
The hypothesized cause found in previous studies that examine the relationship between sexual dysfunction and cardiovascular disease is that the vessels feeding the genitals are smaller than those feeding the heart and therefore show clinical symptoms earlier. The physiologic mechanism is endothelial dysfunction resulting from the inhibition of the nitric oxide cascade, thus preventing the dilation of the arteries impairing blood flow imperative for rigidity.
“In general, the vessels involved in erectile dysfunction have a smaller diameter, and tend to be affected by mechanisms of endothelial dysfunction earlier than larger vessels found in the heart, so this could be a predictor of cardiovascular disease,” explained the author Sara Turek, study coordinator for the Medalist program at Joslin.
During the Joslin study, approximately 300 males were examined and completed questionnaires as part of the Medalist Study including a question regarding sexual dysfunction.
Seventy percent of males in the study reported experiencing sexual dysfunction over their lifetime. Factors correlated with the sexual dysfunction were higher levels of A1C, BMI, cholesterol and increased levels of IL6, an inflammatory marker. The more significant results from this study demonstrated that sexual dysfunction is associated with cardiovascular disease without being mediated by other identified risk factors.
“If [sexual dysfunction] is an overt problem that drives a man to go to the doctor, it should clue the doctor to take a look at some possible cardiovascular symptoms before anything major and life threatening arises,” said Turek.
A distinctive aspect of this study was that it was the first time sexual dysfunction was examined in such a large group of men who have lived with type 1 diabetes for an extended amount of time.
“The age of this group is interesting,” said co-author Stephanie Hastings, study coordinator for the medalist program at Joslin. “I think it will become more relevant as people continue live longer.”
Future plans for this study include possibly expanding the study to see if the results are consistent with a larger group of participants and following up with medalist participants in three or so years to see in their results have changed or stayed stable. Lastly, Turek and Hastings are also curious about exploring the connection between sexual dysfunction and cardiovascular disease in women.