In this narrative review we have briefly revised the main epidemiological evidences on the relation between erectile dysfunction (ED) and cardiovascular risk factors and diseases. There are consistent epidemiological evidences which link ED and cardiovascular diseases, diabetes or cholesterol levels. Most of studies which have taken into account in the analysis of the relation between ED and hypertension, cardiovascular diseases, smoking and weight (or body mass index) have shown that these factors have an independent role on the risk of ED. Otherwise, ED is a risk factor for subsequent development of cardiovascular diseases. In the routine clinical practice the presence of ED should be considered a "marker" for the development of cardiovascular diseases. The physician should consider to ask each patient regarding the presence of ED in order to focus preventive measures.

Erectile dysfunction is a common complication of diabetes. Clinical practice has no treatment modality specifically designed for the difficult to treat diabetic erectile dysfunction due to the multifactorial and complex pathophysiology of development. PDE type 5 inhibitors are the first-line treatment option. Non-responders should have total and free testosterone checked and testosterone replacement is recommended for hypogonadal patients. For patients who cannot take PDE type 5 inhibitors, or are proven non-responders, the vacuum constriction device continues to serve as a major treatment option. Intracavernosal injection is the most effective medical therapy for diabetic erectile dysfunction despite its high dropout rate. Use of the Medicated Urethral System for Erection to overcome the disadvantages of needle injection is disappointing due to lack of effectiveness. Penile prosthesis will continue to play an important role in diabetic patients with severe erectile dysfunction in coming years.

BACKGROUND: Proper management of patients with Kallmann syndrome (KS) allows them to attain a normal reproductive health. The purpose of this study is to demonstrate the presentation modalities, phenotypes and the modes of inheritance among 32 patients with Kallmann syndrome in Jordan. Recognition of the syndrome allows for prompt proper management and provision of genetic counselling. SUBJECTS: Over a period of five years (1999-2004), the clinical and inheritance profiles of 26 male and 6 female patients with Kallmann syndrome from 12 families were evaluated at the National Center for Diabetes, Endocrinology and Genetics in Jordan. RESULTS: The patients belonged to twelve Jordanian and Palestinian families and their age at presentation ranged from 4 - 46 years. Nine boys aged 4-14 years presented with cryptorchidism and microphallus, all other males presented with delayed puberty, hypogonadism and/or infertility. The main presentation among six female patients was primary amenorrhea. Intrafamilial variability in clinical phenotype was specifically evident for renal abnormalities and sensorineural hearing impairment. Familial KS was diagnosed in 27 patients belonging to five families with the X-linked mode of inheritance and two families with the autosomal recessive mode of inheritance. CONCLUSIONS:(1) the majority of cases in this study represented the X-linked form of KS, which might point to a high prevalence of Kal 1 gene in the population.(2) Genetic counselling helps these families to reach a diagnosis at an early age and to decide about their reproductive options.(3) Children presenting with cryptorchidism and microphallus in our population should be investigated for KS.

BACKGROUND: The prevalence of the metabolic syndrome is rapidly increasing with a considerable ethnic variation within and across populations. This study was conducted to estimate the prevalence of the metabolic syndrome and its individual components using Adult Treatment Panel III (ATP III) criteria among Northern Jordanians. METHODS: Data were analyzed from a cross-sectional study that included a random sample of 1121 northern Jordanians aged 25 years and above. The metabolic syndrome was defined by ATP III criteria. RESULTS: The age-adjusted prevalence of the metabolic syndrome was 36.3%(95% CI 33.6-39.0%)(28.7% among men and 40.9% among women). The prevalence increased significantly with age in men and women. The prevalence of the metabolic syndrome was significantly higher in women than in men in age groups of 40-49 and 60 years and above. Low HDL cholesterol was the most common abnormality in men (62.7%), and abdominal obesity was the most common abnormality in women (69.1%). CONCLUSIONS: Prevalence of the metabolic syndrome in North Jordan is considerably higher than in developed countries and other Arab populations. An integrated approach is needed for the prevention and treatment of the metabolic syndrome.

Wolfram syndrome is an autosomal recessive disorder with probable locus heterogeneity. Only insulin-dependent diabetes mellitus and progressive optic-nerve atrophy are necessary to make the diagnosis, but associated findings include diabetes insipidus, sensorineural hearing loss, ataxia, peripheral neuropathy, urinary-tract atony, and psychiatric illnesses. We performed clinical and molecular studies on four consanguineous families with 16 affected individuals. We point out a new phenotypic variant with absent diabetes insipidus, presence of peptic ulcer disease and bleeding tendency secondary to a platelet aggregation defect. The same phenotypic variant turned out to be a genotypic variant with linkage to a second Wolfram syndrome locus (WFS2) on chromosome 4q22-24.

OBJECTIVE To estimate the prevalence of overweight and obesity among Jordanian children and adolescents and to determine their association with metabolic abnormalities. METHODS In a national population-based household survey, a systematic sample of households was selected. All members aged ?7 years in the selected households were invited to participate in the study. Of the respondents, 1,034 subjects were 18 years old or younger. Anthropometric and biochemical measurements were obtained. Overweight and obesity were defined according to age and sex specific cut-off points of BMI defined by the International Obesity Task Force criteria proposed by Cole et al. The metabolic abnormalities were defined for subjects, based on their age, according to the definition of Cook et al. and International Diabetes Federation (IDF) criteria. RESULTS The overall prevalence of overweight and obesity among children were 6.0% and 5.5%, respectively. Among adolescents, the overall prevalence rates of overweight and obesity were 13.7% and 10.0%, respectively. After adjusting for gender and age, overweight was significantly associated with increased odds of having high triglycerides (Odds ratio [OR]= 1.7), low HDL-cholesterol (OR = 1.9), and at least one metabolic abnormality (OR = 2.2). Obesity was significantly associated with increased odds of individual metabolic abnormalities and their clustering. CONCLUSIONS A relatively high proportion of Jordanian children and adolescents had overweight or obesity. Overweight and obesity in children and adolescents were associated with increased odds of metabolic abnormalities and their clustering. Programs addressing eating behavior and physical activity of children and adolescents to maintain a healthy weight are needed in Jordan.

Evidence of the association between 25-hydroxyvitamin D (25(OH)D) and metabolic syndrome (MeS) remains uncertain and incongruent. This study aimed to determine the association between 25(OH)D and MeS among Jordanian adults. A complex multistage sampling technique was used to select a national population-based household sample. The present report deals exclusively with adults aged > 18 years who had complete information on all components of MeS (n = 3,234). A structured questionnaire was used to collect all relevant information. Anthropometric, clinical, and laboratory measurements were obtained. MeS was defined according to the International Diabetes Federation (IDF) definition. Of the total, 42.0% had MeS and 31.7% had 25(OH)D < 30 ng/ml. In a stratified analysis, the prevalence of MeS did not differ significantly between subjects with low and normal 25(OH)D levels for men and women in all age groups. In the multivariate analysis, the odds of MeS were not significantly different between subjects with low and normal 25(OH)D levels (OR = 0.85, 95% CI: 0.70, 1.05, P-value = 0.133). The association between 25(OH)D and MeS remained non-significant when 25(OH)D was analyzed as a continuous variable (OR = 1.004, 95% CI; 1.000, 1.008, P = 0.057) and when analyzed based on quartiles. None of the individual components of MeS were significantly associated with 25(OH)D level. This study does not provide evidence to support the association between 25(OH)D level and MeS or its individual components. Prospective studies are necessary to better determine the roles of 25(OH)D levels in the etiology of MeS.

PURPOSE This study explores the prevalence, type, frequency, purpose and pattern of herbal preparation use as complementary and alternative medicine (CAM) in a cohort of patients with diabetes in Jordan. METHOD The study took the form of a cross-sectional survey of patients attending the outpatient departments at The National Centre for Diabetes, Endocrine and Genetics (NCDEG), in Amman. The method was based on semi-structured questionnaire. RESULTS A total of 1000 diabetes patients were interviewed. Of the participants, 16.6%(n=166) reported using herbs. Most of CAM users were in the age group 51-60 years (n=73, 44.0%) and predominantly female (59.6%). 139 of the CAM users (83.7%) had at least obtained a high school degree. The most common herbal product to be used was green tea (20.5%). CONCLUSION This study confirmed that there is an appreciable prevalence of herbal use among patients with diabetes in Jordan.

Background and Objectives : Since the extent of elevation of liver transaminases in type 2 diabetics in Jordan and most of the Middle East is unknown, we estimated the prevalence of elevated liver transaminase levels among patients with type 2 diabetes and determined associated risk factors. Methods : This study was performed on 1014 consecutive type 2 diabetic outpatients who attended the National Center for Diabetes, Endocrinology and Genetics in Amman, Jordan. The patients' age ranged between 26-85 years with a mean age of 56.8 (+9.8). Three- hundred and fifty three (54.5%) were males with a median age of 58 years (ranging between 26-82 years), and four hundred and sixty one (45.5%) were females with a median age of 57 years (ranging between 28-85 years). Body mass index, waist circumference, lipid profile, and hepatic transaminase levels were recorded. Ultraonography was performed in those with elevated alanine transaminase levels. Results : Overall, the prevalence of elevated alanine transaminase (ALT) level was 10.4%(n=105) with the gender-wise prevalence being 12.8%(n=71) in men and 7.4%(n=34) in women. The prevalence of elevated aspartate transaminase (AST) levels was 5.4%(n=56) with the gender-wise prevalence being 5.6%(n=31) in men and 5.4%(n=25) in women.. Only 4.5%(n=44) showed elevated levels of both ALT and AST. Male gender (OR=2.35, CI:1.5-3.8) and high waist circumference (OR=1.9, CI:1.2-3.2) were associated with increased risk of elevated ALT levels. Younger patients had a higher tendency to have elevated ALT compared to those over 65 years (OR=12.4 for patients aged 25-45years, and OR=5.8 for those who were 45-65 years old). Non-insulin use was associated with a high odds ratio for elevated ALT levels (OR=1.7, CI: 1.1-2.9). Conclusions : Elevated ALT and AST levels are found in 10.4% and 5.4% of our type 2 diabetic patients respectively. Male gender, younger age, higher waist circumference; as an indicator of central obesity, as well as non insulin use are independent predictors of elevated liver transaminase levels.

OBJECTIVES: Determine factors associated with poor glycemic control among Jordanian patients with Type 2 diabetes. METHODS: A systematic random sample of 917 patients was selected from all patients with Type 2 diabetes over a period of 6 months in 2008. A prestructured questionnaire sought information about sociodemographic, clinical characteristics, self-care management behaviours, medication adherence, barriers to adherence, and attitude towards diabetes. Weight, height, and waist circumferences were measured. All available last readings of hemoglobin A1c (HbA1c), fasting blood sugar measurements and lipid were abstracted from patients' records. Poor glycemic control was defined as HbA1c >/=7%. RESULTS: Of the total 917 patients, 65.1% had HbA1c >/=7%. In the multivariate analysis, increased duration of diabetes (>7 years vs.</=7years)(OR=1.99, P</=.0005), not following eating plan as recommended by dietitians (OR=2.98, P</=.0005), negative attitude towards diabetes, and increased barriers to adherence scale scores were significantly associated with increased odds of poor glycemic control. CONCLUSION: The proportion of patients with poor glycemic control was high, which was nearly comparable to that reported from many countries. Longer duration of diabetes and not adherent to diabetes self-care management behaviors were associated with poor glycemic control. An educational program that emphasizes lifestyle modification with importance of adherence to treatment regimen would be of great benefit in glycemic control.

This study was conducted to determine the prevalence of the metabolic syndrome (MeS) and its associated factors among patients undergoing cardiac catheterization in north Jordan. A cross-sectional study was conducted among patients who underwent cardiac catheterization at King Abdullah University Hospital in north Jordan. Data from 360 patients were collected through personal interview, medical records, and anthropometric measurements. MeS was defined using National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) and International Diabetes Federation (IDF) criteria. The prevalence of MeS among patients undergoing cardiac catheterization in north Jordan was 64.7% according to NCEP ATP III criteria and 76.7% according to IDF criteria. About 96.7% of the participants had at least 1 metabolic abnormality. Sex, body mass index, and family history of cardiovascular disease were the only variables significantly associated with MeS. The prevalence of MeS among patients undergoing cardiac catheterization in north Jordan is considerably high, especially among women.

OBJECTIVE To assess the pathophysiologic composition and age structure of erectile dysfunction (ED) in men visiting outpatient clinics in China. METHODS We studied 3327 consecutive ED outpatients (median age 39 years) from 2006 to 2010 in the 5 training hospitals in China. Every patient was independently evaluated by an experienced urologist/andrologist using comprehensive diagnostic procedures. The simplified International Index of Erectile Function was used to assess the severity of ED. RESULTS Most patients (95.0%) were <60 years old, and none were >70 years old. The psychogenic patients were younger and had greater percentage than any other patients. Vasculogenic factors were a major etiology of organic ED. A significant difference was found in the age distribution between the patients with psychogenic ED and those with organic ED (P =.000). Diabetes, hypertension, coronary artery disease, and hyperlipidemia played significant roles in affecting the severity of ED in a statistical model, including age. The International Index of Erectile Function scores decreased with age (rs =-0.199, P =.000). Moreover, the percentage of severe and moderate cases increased with age (P =.003 and P =.002, respectively). However, the constituent ratio of patients sharply declined from 30.3% to 4.5% with age. CONCLUSION The number of men visiting outpatient clinics with psychological ED is greater than the number with organic causes in China. The age of the Chinese patients with ED who seek medical help is young and this is mainly because of inadequate sex education to young men and because most older patients are reluctant to visit the hospital just for the loss of erectile function.

Erectile dysfunction is a common health problem affecting the quality of life of men of all ages. The aim of this study was to find the prevalence of and significant risk factors for erectile dysfunction among men of all nationalities attending primary health care centres in Qatar for any reason. Respondents aged > 30 years (n = 1139) completed the sexual health inventory for men plus a questionnaire about their demographic characteristics, lifestyle habits and presence of chronic diseases. The total prevalence of erectile dysfunction was 56.9%(32.7% mild and 2.3% severe cases). All studied sociodemographic variables showed a significant association with erectile dysfunction. A lower prevalence of erectile dysfunction was found in smokers and those who exercised. More than 1 sexual partner, obesity and having a chronic disease (hypertension, coronary heart disease, hypercholesterolaemia or diabetes mellitus) were significantly positively associated with erectile dysfunction.

INTRODUCTION The association between erectile dysfunction (ED) and coronary artery disease (CAD) has been described in various settings, but it is unclear if there is an independent interaction with age. AIM To investigate the interaction of age in the association between ED and CAD. METHODS This case-control study was conducted among 242 patients referred for elective coronary angiography. One hundred fourteen patients with significant CAD were identified as cases and 128 controls without significant CAD. ED was evaluated by the erectile function domain of the International Index of Erectile Function (IIEF) questionnaire, determined by a score ≤ 25 points. MAIN OUTCOME MEASURES Significant CAD was based on stenosis of 50% or greater in the diameter in at least one of the major epicardial vessels or their branches. The analysis was conducted in the whole sample and according to the age strata, controlling for the effects of cardiovascular risk factors, testosterone, and C-reactive protein. Results.  Patients had on average 58.3 ± 8.9 years. CAD and ED were associated exclusively in patients younger than 60 years (ED in 68.8% of patients with CAD vs. 46.7% of patients without CAD, P = 0.009). The association was independent of cardiovascular risk factors, testosterone and C-reactive protein (risk ratio 2.3, 95% confidence interval from 1.04 to 5.19). Severity of CAD was higher in patients younger than 60 years with ED. CONCLUSIONS Men with less than 60 years of age who report ED presented a higher risk of having chronic CAD and more severe disease diagnosed by coronary angiography.

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ABSTRACT Introduction. There are no reported studies assessing the relation between diet and erectile dysfunction (ED) in men with diabetes. Aim. In the present study, we explored the relation between consumption of a Mediterranean-type diet and ED in a population of type 2 diabetic men. Methods. Patients with type 2 diabetes were enrolled if they had a diagnosis of type 2 diabetes for at least six months but less than 10 years, age 35-70 years, body mass index (BMI) of 24 or higher, HbA1c of 6.5% or higher, treatment with diet or oral drugs. All diabetic patients were invited to complete a food-frequency questionnaire and self-report measures of sexual function. A total of 555 (90.8%) of the 611 diabetic men completed both questionnaires and were analyzed in the present study. Main Outcome Measures. Adherence to a Mediterranean diet was assessed by a 9-point scale that incorporated the salient characteristics of this diet (range of scores, 0-9, with higher scores indicating greater adherence). ED was assessed with the International Index of Erectile Function-5. Results. Diabetic men with the highest scores (6-9) had lower BMI, waist circumference, and waist-to-hip ratio, a lower prevalence of obesity and metabolic syndrome, a higher level of physical activity, and better glucose and lipid profiles than the diabetic men who scored <3 points on the scale. The proportion of sexually active men showed a significant increase across tertiles of adherence to Mediterranean diet (from 65.1% to 74.4%, P = 0.01). Moreover, men with the highest score of adherence were more likely to have a lower prevalence of global ED (51.9% vs. 62%, P = 0.01) and severe ED (16.5% vs. 26.4%, P = 0.01) as compared with low adherers. Conclusions. In men with type 2 diabetes, greater adherence to Mediterranean diet is associated with a lower prevalence of ED. Giugliano F, Maiorino MI, Bellastella G, Autorino R, De Sio M, Giugliano D, and Esposito K. Adherence to Mediterranean diet and erectile dysfunction in men with type 2 diabetes. J Sex Med **;**:**-**.

The purpose of this study was to determine the prevalence of ED and its health-related correlates in a nonselected population from a Mediterranean country. The abridged 5-item version of the international index of erectile function (IIEF-5) was used as a diagnostic tool. A total of 905 men aged 18 years and above from Jordan were included in the study and answered the questions about medical history, lifestyle habits and sexual behavior. A logistic regression model was used to identify significant independent risk factors for ED. In this sample the prevalence of all degrees of ED was estimated as 49.9%. In this group of men, the degree was mild in 25%, moderate in 13.5% and severe in 11.4%. The prevalence of severe ED increased from 2.7% in men in their twenties to 38.6% in their sixties and 46% in those aged 70 years and above. Age is the single most significant risk factor. Other important risk factors include lower household income, physical inactivity, obesity, smoking, diabetes mellitus hypertension and ischemic heart disease. This study provides a quantitative estimate of the prevalence and the main risk factors for ED in our region. This condition, which represents a source of distress, should be evaluated more effectively by rigorous and standardized methods, particularly as effective treatments are now available.International Journal of Impotence Research advance online publication, 21 January 2010; doi:10.1038/ijir.2009.65.

Introduction. Erectile dysfunction (ED) is now beginning to be considered as an early manifestation of a subclinical systemic vascular disorder and may be an index of subclinical coronary artery disease (CAD). Aim. To further evaluate whether ED is a predicting factor for CAD while adjusting for other common risk factors. Methods. One hundred eighty-three patients with newly diagnosed and documented CAD and 134 participants without CAD were enrolled in this case-control study at our referral center. Univariate and multivariate logistic regression analysis were performed to assess the effect of classic risk factors and ED severity on CAD; calculating odds ratio (OR) and 95% confidence interval (CI). Adjustments were made for potential confounding factors including age, hypertension, diabetes, dyslipidemia, obesity, and smoking. Main Outcome Measures. The prevalence of ED and the distribution of CAD risk factors (age, smoking, lipid profile, hypertension, obesity, and diabetes mellitus) were evaluated. The 5-item International Index of Erectile Function was used to evaluate the presence and the severity of ED. Results. The prevalence of ED in CAD-positive and CAD-negative groups was 88.5% and 64.2%, respectively (P < 0.05). A statistically significant difference was found for all risk factors (except total cholesterol and low-density lipoprotein levels), and also ED prevalence between studied groups. Adjusted OR for age, diabetes, hypertension, hypercholesterolemia, and smoking demonstrated a significant confounding effect. Our results also revealed a significant association between severe ED and CAD (OR: 2.22, 95% CI: 1.11-6.03; P < 0.05). Conclusion. This study suggests that ED could be considered as a surrogate marker which can predict the occurrence of CAD, and severe ED could be regarded as an independent risk predictor in addition to the established ones.

BACKGROUND: Previous studies have supported the association between hypertension and erectile dysfunction (ED). In addition, a significant correlation between hypertension in men and ED has been well established. OBJECTIVES: The aim of this study was to investigate the prevalence of ED, its severity and other sexual function domains in hypertensive patients in Qatar. DESIGN AND SETTING: Cross-sectional study conducted between January and December 2006 at the Hamad General Hospital. SUBJECTS: Qatari and nonQatari nationals 25 to 75 years of age were approached to participate in this study, 642 (75.5%) gave their consent. MATERIALS AND METHODS: Qatari and nonQatari men aged 25 to 75 years who gave consent were interviewed face-to-face. Sexual function was evaluated with the International index of erectile function. RESULTS: A total of 642 (75.5%) men responded, mean age of subjects was 57.1 +/- 11.9 years. The prevalence of ED in hypertensive patients was 58.3%. 21.2% of hypertensive men reported severe ED, 20.7% moderate ED and 16.4% mild ED. The comorbidities and risk factors were significantly more prominent in ED patients than in those with normal ED for hypercholesterolemia (P=0.009), diabetes (P=0.022) for hypertriglyceridemia (P=0.033) and myocardial ischemia (P=0.042). CONCLUSIONS: Our results have shown a greater prevalence of ED in the hypertensive men in the population of Qatar. The presence of another risk factor in addition to elevated blood pressure can increase the likelihood of ED.

ABSTRACT: BACKGROUND: Diabetes mellitus has become a major health issue in the United States and contributes to morbidity and mortality from coronary artery disease. Despite lifestyle changes and medications that have been shown to decrease complications and death, many persons have poor glycemic control. The purpose of this study is to determine the prevalence of elevated Hemoglobin A1c levels, a marker of glycemic control in patients presenting for coronary artery bypass surgery, and to determine if risk factors for diabetes mellitus could identify those patients with an elevated hemoglobin A1c. METHODS: All patients undergoing coronary artery bypass surgery had hemoglobin A1c levels determined immediately preoperatively. Proportions were used to describe the number of patients with elevated levels. Linear regression and receiver operator characteristic curves were used to evaluate the accuracy of risk factors to identify patients with elevated levels. RESULTS: 83 of 87 (95%) diabetic patients had elevated A1c levels (>= 6.0%), with 55 of 87 (63%) having inadequate control - A1c levels >= 7.0. 93 of 163 (57%) non-diabetic patients had elevated A1c levels (>= 6.0%), with 19 (12%) having levels >= 7.0%. Risk factors for diabetes mellitus poorly predicted which patient had elevated A1c levels. CONCLUSION: The prevalence of elevated hemoglobin levels in patients undergoing coronary artery bypass surgery is high and routine measurement should be done to permit institution of lifestyle modifications and medication changes that decrease complications and death from diabetes mellitus.

Introduction. Vascular etiologies are the most common risk factors for erectile dysfunction (ED). Published studies have reported the associations of GNB3 C825T polymorphism with many vascular diseases. However, there are few reports about the association between this gene polymorphism and ED. Aim. To investigate the associations among GNB3 C825T polymorphism, ED, and related risk factors in Taiwanese subjects. Methods. A total of 155 patients with ED and 81 healthy controls were enrolled. All men had complete clinical histories taken. The 5-item International Index of Erectile Function (IIEF-5) was used to assess erectile conditions. The GNB3 C825T polymorphisms were determined using the polymerase chain reaction-restriction fragment length polymorphism method. Main Outcome Measures. Patients with ED were defined as those having an IIEF-5 of <21. Results. Two hundred thirty-six men were enrolled with a mean (standard deviation) age of 59.0 (10.2) years. Diabetes mellitus (DM), hypertension, and age were the three most significant independent risk factors for ED in a multiple logistic regression analysis (P = 0.008, 0.003, and 0.007, respectively). The prevalence of DM, hypertension, and body mass index (BMI) was significantly higher in GNB3 825T allele (CT/TT) carriers (P = 0.023, 0.049, and 0.035, respectively). There was no significant difference of ED prevalence between T and C allele carriers (69.1% vs. 56.2%, P = 0.07). However, the T allele carriers had significantly lower IIEF-5 scores (P = 0.02) associated with an increment of the T allele number (16.4[CC] vs. 14.4[CT] vs. 13.2[TT], P = 0.04). Conclusions. In the present study, DM, hypertension, and BMI had significant associations with GNB3 825T allele carriers. Our results failed to show a significant association of the GNB3 C825T polymorphisms with ED prevalence. However, we cannot exclude that the presence of the T allele might influence the risk for ED severity indirectly through an increased risk for some vascular diseases.