Decreased forced expiratory volume in first second is associated with erectile dysfunction in apparently healthy men. A preliminary study.

Although it has been evaluated that even 76% of men with chronic obstructive pulmonary disease suffer from erectile dysfunction, the association has been poorly characterised. The aim of the study was to describe the association between forced expiratory volume in first second and erectile dysfunction in apparently healthy men. All together 331 men aged 45-70 years old were randomly drawn from a cross-sectional population-based study conducted in 2005 in Finland. Decreased forced expiratory volume was defined by performing mini-spirometry and erectile dysfunction by International Index of Erectile Function short form questionnaire. After adjustment for age and depressive symptoms predicted forced expiratory volume (FEV1 < 65%) was associated with 2.66 (95% CI, 1.18-5.99) increased risk of moderate to severe erectile dysfunction (International Index of Erectile Function short form score < 17). Therefore, the authors highlight the importance of erectile and sexual health evaluation and treatment, if necessary, in men with decreased lung function.

Erectile dysfunction cannot be used in primary screening of pre-diabetes.

We hypothesized that erectile dysfunction is associated with impaired fasting glucose and impaired glucose tolerance and could be used in primary screening of pre-diabetes. Although erectile dysfunction is known to be closely associated with diabetes, we demonstrate that it is not associated with pre-diabetes in 926 apparently healthy men.

High-intensity physical activity, stable relationship, and high education level associate with decreasing risk of erectile dysfunction in 1,000 apparently healthy cardiovascular risk subjects.

INTRODUCTION: Erectile dysfunction (ED) is especially common in men with cardiovascular diseases (CVDs). However, the data are scarce concerning populations without manifested CVD. AIM: The aim of this study was to describe factors associated with ED, especially those associated with decreasing risk of ED, in men with cardiovascular risk factors but without CVD, diabetes, or chronic renal disease. METHODS: In 2004 to 2007, a cross-sectional population-based sample of men 45 to 70 years old in two rural towns in Finland was collected. Men with previously diagnosed CVD, diabetes, or kidney disease were not invited to the study. In total 1,000 eligible men with cardiovascular risk factors, i.e., central obesity, high scores in the Finnish Diabetes Risk Score, high blood pressure, antihypertensive medication, or family history of coronary heart disease, myocardial infarction, or stroke, were included in the analysis. Questionnaires, clinical measurements, and laboratory tests were obtained. The prevalence of ED was studied comparing the means, and risk factors were studied using multivariate logistic regression analysis. MAIN OUTCOME MEASURES: The rate of ED was defined by the International Index of Erectile Function short form (IIEF-5) and by two questions (2Q) about the ability to achieve and to maintain an erection. RESULTS: The prevalence of ED was 57% or 68% using IIEF-5 or 2Q, respectively. Age (odds ratio [OR]: up to 9.16; 95% confidence interval [CI], 5.00-16.79; P < 0.001), smoking (OR: 1.41; 95% CI, 1.04-1.91; P = 0.028), depressive symptoms (OR: 4.04 for moderate and severe; 95% CI,1.22-13.45; P = 0.001), high-intensity physical activity (OR: 0.50; 95% CI, 0.29-0.86; P = 0.045), high education (OR: 0.52; 95% CI, 0.33-0.83; P = 0.013), and stable relationship (OR: 0.43; 95% CI, 0.21-0.88; P = 0.046) were associated with ED. CONCLUSIONS: In apparently healthy men with cardiovascular risk factors, decreasing risk of ED is associated with high-intensity physical activity, stable relationship, and high education level.

Estimating glomerular filtration rate in hypertensive subjects: comparison of the chronic kidney disease epidemiology collaboration (CKD-EPI) and modification of diet in renal disease (MDRD) study equations.

BACKGROUND: The Modification of Diet in Renal Disease (MDRD) Study equation is the most commonly used formula for estimation of glomerular filtration rate (eGFR). Recently, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) developed a new equation to provide a more accurate estimate of GFR among individuals with normal or mildly reduced renal function. AIM: To compare the MDRD and CKD-EPI equations in hypertensive population treated in general practice. METHODS: The MDRD and CKD-EPI equations were applied to a cohort of 994 hypertensive subjects aged 45-70 years without cardiovascular or renal disease or previously known diabetes. RESULTS: The prevalence of CKD stage 3 (eGFR 30-59 mL/min per 1.73 m(2)) was 6.7% (95% CI 5.3-8.5) (67/994) according to the MDRD formula and 3.7% (95% CI 2.6-5.1) (37/994) according to the CKD-EPI formula. Of the 67 subjects classified as having CKD stage 3 according to the MDRD equation, 30 (44.8%) were reclassified as 'no-CKD' by the CKD-EPI equation. These subjects were mostly women 26/30 (87.7%). CONCLUSION: Using the CKD-EPI equation leads to lower prevalence estimates for CKD than the MDRD equation in a hypertensive population treated in general practice.

Ankle-brachial index and health-related quality of life.

BACKGROUND: Data from population studies using ankle-brachial index (ABI) measurement to screen patients for peripheral arterial disease (PAD) demonstrate that most patients with PAD have no symptoms or atypical symptoms besides classical intermittent claudication. We aimed at comparing health-related quality of life and ABI in a cohort of cardiovascular risk persons in a general population. METHODS: SF-36 questionnaire was completed and ABI measured from 915 individuals aged 45-70 years with hypertension, metabolic syndrome, pre-diabetes, newly detected diabetes, body mass index ≥ 30 kg/m(2), or a 10-year risk of cardiovascular disease death of 5% or more according to the Systematic Coronary Risk Evaluation (SCORE) system. None of the subjects had symptoms of intermittent claudication. RESULTS: The prevalence of PAD (defined as ABI ≤ 0.90) and borderline PAD (defined as ABI 0.91-1.00) were 5% (95% CI 4-7%) and 20% (95% CI 18-23%), respectively. Patients with PAD had significantly lower quality of life dimension scores for physical functioning, role-physical, general health, and vitality than subjects with normal ABI. Among those with borderline PAD, quality of life was reduced on the general health perception compared to subjects with normal ABI. CONCLUSION: Health-related quality of life of individuals with asymptomatic or atypical PAD or borderline PAD is worse than that of individuals with normal ABI. The level of ABI is independently related to physical functioning.

The assessment of total cardiovascular risk in hypertensive subjects in primary care.

BACKGROUND: Recently published guidelines emphasize that detection of any subclinical target organ damage in hypertensive subjects should be regarded as a sign of high cardiovascular risk. AIM: To assess the ability of conventional multivariable cardiovascular disease risk prediction tools and high-sensitivity C-reactive protein (hs-CRP) to identify hypertensive subjects with target organ damage. METHODS: Ankle-brachial index (ABI), estimated glomerular filtration rate (eGFR), electrocardiographically determined left ventricular hypertrophy (ECG-LVH), and base-line variables were measured in hypertensive subjects aged 45-70 years without established cardiovascular or renal disease or known diabetes. RESULTS: Of the 495 subjects, 123 (24.8% (95% CI 21.1-28.9)) had ABI <1.00, 81 (16.4% (95% CI 13.2-19.9)) had ECG-LVH, and 41 (8.3% (95% CI 6.0-11.1)) had eGFR <60 mL/min/1.73 m(2). In patients with SCORE <5% or Framingham risk <20%, any sign of target organ damage was found in 46% and 49% of patients, respectively. CONCLUSION: Assessment of ECG-LVH, ABI, and eGFR reclassifies a significant number of hypertensive patients to the high-risk category as compared to SCORE and Framingham risk prediction tools only.

Ankle-brachial index is lower in hypertensive than in normotensive individuals in a cardiovascular risk population.

BACKGROUND: Hypertension is an established risk factor for peripheral arterial disease (PAD), but the prevalence of this condition in hypertensive patients without comorbidities is unknown. METHODS: In this study, we assess the prevalence and factors associated with PAD, and the usefulness of ankle-brachial index (ABI) in evaluating cardiovascular risk in hypertensive patients without cardiovascular or renal disease or previously known diabetes mellitus. We measured ABI in 972 nonclaudicant patients with hypertension, newly diagnosed glucose disorders, metabolic syndrome, obesity or a 10-year risk of cardiovascular disease death of 5% or more according to the Systematic Coronary Risk Evaluation System. RESULTS: The prevalence of PAD (defined as ABI < or =0.90) and borderline PAD (defined as ABI 0.91-1.00) in hypertensive patients was 7.3% (39/532) and 23.7% (126/532), respectively. In a multivariate model, hypertension remained an independent factor associated with PAD (adjusted odds ratio 3.20; 95% confidence interval 1.56-6.58). There was no association between PAD and metabolic risk factors. SBP and pulse pressure increased linearly across subgroups of ABI (normal 0.91-1.00 and < or =0.90) in hypertensive patients (P < 0.001). CONCLUSION: Subclinical PAD is common in hypertensive patients even without comorbidities. The measurement of ABI is an efficient method to identify patients with increased cardiovascular risk and worth performing to hypertensive patients, particularly those with pulse pressure above 65 mmHg. Uniform criterions of defining PAD and borderline PAD would aid physicians in clinical decision-making.

Effect of a risk-based multifactorial fall prevention program on the incidence of falls.

OBJECTIVES: To evaluate the effects of a multifactorial fall prevention program on falls and to identify the subgroups that benefit the most. DESIGN: Randomized controlled trial. SETTING: Community-dwelling subjects who had fallen at least once during the previous 12 months. PARTICIPANTS: Five hundred ninety-one subjects randomized into intervention (IG) (n=293) and control (CG) (n=298) groups. INTERVENTION: A multifactorial 12-month fall prevention program. MEASUREMENTS: Incidence of falls. RESULTS: The intervention did not reduce the incidence of falls overall (incidence rate ratio (IRR) for IG vs CG=0.92, 95% confidence interval (CI)=0.72-1.19). In subgroup analyses, significant interactions between subgroups and groups (IG and CG) were found for depressive symptoms (P=.006), number of falls during the previous 12 months (P=.003), and self-perceived risk of falling (P=.045). The incidence of falls decreased in subjects with a higher number of depressive symptoms (IRR=0.50, 95% CI=0.28-0.88), whereas it increased in those with a lower number of depressive symptoms (IRR=1.20, 95% CI=0.92-1.57). The incidence of falls decreased also in those with at least three previous falls (IRR=0.59, 95% CI=0.38-0.91) compared to those with one or two previous falls (IRR=1.28, 95% CI=0.95-1.72). The intervention was also more effective in subjects with high self-perceived risk of falling (IRR=0.77, 95% CI=0.55-1.06) than in those with low self-perceived risk (IRR=1.28, 95% CI=0.88-1.86). CONCLUSION: The program was not effective in reducing falls in the total sample of community-dwelling subjects with a history of falling, but the incidence of falls decreased in participants with a higher number of depressive symptoms and in those with at least three falls.

Waist circumference home measurement--a device to find out patients in cardiovascular risk.

BACKGROUND: New strategies are needed to prevent the global epidemic of diabetes and subsequent rise in cardiovascular diseases. We describe a community-based, two-stage screening strategy using home waist circumference measurement and a risk factor questionnaire as a primary screening tool. METHODS: We mailed a tape for measurement of waist and a risk factor questionnaire to every inhabitant aged 45-70 years living in the rural town of Harjavalta in Finland. Thereafter we performed an oral glucose tolerance test, anthropometric variables and blood pressure of subjects having at least one risk factor for type 2 diabetes or cardiovascular disease. People with previously known diabetes or vascular disease were excluded. RESULTS: Seventy-three percent (2085/2856) of the invited inhabitants participated, and 84% of the respondents had at least one pre-specified risk factor. Waist circumference >or=80 cm in women and >or=94 cm in men (n = 1168), positive metabolic syndrome criteria of the International Diabetes Federation (n = 681) or the Finnish Diabetes Risk Score questionnaire >or=12 points (n = 697) identified 95, 92 and 63% of the new cases of type 2 diabetes and 84, 75 or 62% of pre-diabetes, respectively. CONCLUSION: The International Diabetes Federation criteria for elevated waist circumference are very sensitive but lack specificity in diagnosing glucose disorders. The criteria for metabolic syndrome and the Finnish Diabetes Risk Score questionnaire are more efficient tools for the selection of patients for further risk stratification in general practise.