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Metabolic syndrome and sexual dysfunction
Bilal Chughtai, Richard K. Lee, Alexis E. Te and Steven A. Kaplan
Introduction
Obesity affects at least 400 million adults worldwide [1].
In the USA, 40% of men are expected to be obese by
2020 [2–4]. Obesity is both one of the key findings in
metabolic syndrome (MetS) as well as a main factor
for its progression. The MetS, or syndrome X, consists
of a constellation of abnormalities, including central
obesity, glucose intolerance, dyslipidemia, and hyper-
tension (HTN). MetS has a high prevalence around
the world as high as 35–39% in the US and 9.5% in
Europe [5
].
The definition of MetS is somewhat varied in the litera-
ture (see below). Regardless of the definition, MetS
represents a pathway to global dysfunction and not a
disease state itself. MetS, diabetes mellitus, cardiovas-
cular disease (CVD), obesity, erectile dysfunction, and
hypogonadism were previously seen as independent
entities for the aging male. The ATP III definition is
the one most commonly used today as it incorporates key
concepts of MetS, relies on commonly used laboratory
studies, and is less restrictive than the other classifications
[6]. For the purposes of this review, the ATP III criteria
have also been found to be the best predictors of arter-
iogenic erectile dysfunction and male hypogonadism [7].
These conditions are closely interrelated in their cause
and management thus requires an integrated approach.
Notably, there is a strong association between MetS and
sexual dysfunction. We attempt to define the association
between sexual dysfunction and the MetS.
Definitions of MetS:
(1) International Diabetes Federation (2006)
(a) Central obesity and any two of the following:
(i) Raised triglycerides: >150 mg/dl.
(ii) Reduced HDL cholesterol: <40 mg/dl.
(iii) Raised blood pressure: SBP >130 or DBP
>85 mmHg.
(iv) Raised fasting plasma glucose: >100 mg/dl.
(2) World Health Organization criteria (1999)
(a) Presence of one of diabetes mellitus, impaired
glucose tolerance, impaired fasting glucose or
insulin resistance, and two of the following:
(i) Blood pressure: 140/90 mmHg.
(ii) Dyslipidemia: triglycerides: 1.695 mmol/l
and high-density lipoprotein cholesterol
(HDL-C) 0.9 mmol/l (male), 1.0 mmol/l
(female).
(iii) Central obesity: waist-to-hip ratio >0.90
(male); or BMI >30 kg/m
2
.
(iv) Microalbuminuria: urinary albumin excr-
etion ratio 20 mg/min or albumin: creati-
nine ratio 30 mg/g.
(3) European Group for the Study of Insulin Resistance
(1999)
(a) Insulin resistance defined as the top 25% of
the fasting insulin values among non-
diabetic individuals and two or more of the
following:
(i) Central obesity: waist circumference
94 cm.
James Buchanan Brady Foundation, Department of
Urology, Weill Medical College of Cornell University,
New York, New York, USA
Correspondence to Dr Steven A. Kaplan, MD, James
Buchanan Brady Foundation, Department of Urology,
Weill Medical College of Cornell University, 525 E.
68th St, F9 West, New York, NY 10065, USA
Tel: +1 212 746 4811; fax: +1 212 746 5329;
e-mail: kaplans@med.cornell.edu
Current Opinion in Urology 2011, 21:514–518
Purpose of review
To define the link between metabolic syndrome (MetS) and sexual dysfunction. The
global epidemic of obesity and diabetes has led to a striking increase in the number of
people afflicted with the MetS. The MetS consists of a myriad of abnormalities, including
central obesity, glucose intolerance, dyslipidemia, and hypertension.
Recent findings
Although interest in the MetS initially arose due to its association with cardiovascular
disease, subsequent data emerged pointing to a relationship with male sexual
dysfunction.
Summary
Few randomized studies exist to guide treatment of sexual dysfunction related to MetS;
rather, most studies have been observational in nature. Medical therapy has formed the
mainstay of treatment.
Keywords
erectile dysfunction, metabolic syndrome, sexual dysfunction, syndrome X
Curr Opin Urol 21:514–518
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0963-0643
0963-0643 ß 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI:10.1097/MOU.0b013e32834b8681