Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy.
J Sex Med. 2011 Feb;8(2):504-11. doi: 10.1111/j.1743-6109.2010.02126.x. Epub 2010 Nov 22.
Although several studies have demonstrated that MetS is associated with a two-fold increase in the risk of cardiovascular (CV) diseases, this risk does not appear to be greater than the sum of risks associated with each of its individual components.
To determine the association of men with ED and individual components of MetS and their subsequent relationship to CV risk, and, more specifically whether the sum of the MetS components is greater than the individual components in predicting CV risk.
We longitudinally studied a consecutive series of 1,687 (mean age 52.9±12.8; range 17-88 years) patients attending our clinic for ED and evaluated different clinical and biochemical parameters.
Information on major adverse CV event (MACE) was obtained through the City of Florence Registry Office.
One hundred thirty-nine MACE, 15 of which were fatal, occurred during a mean follow-up of 4.3±2.6 years. Subjects with MetS at baseline showed a higher incidence of MACE (hazard ratio [HR]=1.77), after adjusting for age, however, the association disappeared in an alternative Cox model, adjusting both for age and for individual MetS components (HR=1,525 [0,564-4,123]; P=0.408). The two most predictive MetS components of CV risk were low high-density lipoprotein (HDL) cholesterol and high triglycerides. Exploring possible interactions between individual components of MetS and their effect on CV risk using two alternative approaches indicates that the effect of MetS components on CV risk is additive, but not synergistic. Among subjects with hypertension, after adjusting for age, elevated glycemia, and low HDL cholesterol confer relevant additional risk, while in subjects with high triglycerides, hyperglycemia increased the risk of incident MACE.
With regards to CV risk, the MetS construct seems to add little or nothing to the careful assessment of its components. Thus, there is no reason to recommend the use of MetS as a diagnostic category in patients with ED.
尽管有几项研究表明代谢综合征（MetS）使心血管疾病（CV）风险增加一倍，但这种风险似乎并不大于其各个组成部分所带来的风险总和。
确定患有勃起功能障碍（ED）的男性与 MetS 及其各个组成部分的关联，以及更具体地确定 MetS 组成部分的总和是否大于预测 CV 风险的各个组成部分。
我们对 1687 名（平均年龄 52.9±12.8 岁；范围 17-88 岁）连续就诊于我们诊所的 ED 患者进行了纵向研究，并评估了不同的临床和生化参数。
通过佛罗伦萨市注册处获取主要不良心血管事件（MACE）的信息。
在平均 4.3±2.6 年的随访期间，发生了 139 例 MACE，其中 15 例为致命性。基线时患有 MetS 的患者发生 MACE 的发生率更高（危险比[HR]=1.77），但在替代 Cox 模型中，在校正年龄后，这种关联消失了，该模型还校正了个体 MetS 成分（HR=1.525[0.564-4.123]；P=0.408）。预测 CV 风险的 MetS 两个最具预测性的组成部分是低高密度脂蛋白（HDL）胆固醇和高甘油三酯。使用两种替代方法探索 MetS 组成部分之间的可能相互作用及其对 CV 风险的影响表明，MetS 组成部分对 CV 风险的影响是累加的，而不是协同的。在高血压患者中，在校正年龄、血糖升高和低 HDL 胆固醇后，这些因素会带来相关的额外风险，而在高甘油三酯患者中，高血糖会增加发生 MACE 的风险。
就 CV 风险而言，MetS 结构似乎对其组成部分的仔细评估没有增加或没有任何增加。因此，没有理由推荐在 ED 患者中使用 MetS 作为诊断类别。
