Serum Levels of Asymmetric Dimethylarginine and Testosterone Among Egyptian Type 2 Diabetic Men with Erectile Dysfunction as Risk Markers for Coronary Artery Disease

Background: Erectile dysfunction (ED) is now beginning to be considered as an index of subclinical coronary artery disease (CAD). ED has been shown to precede the development of CAD in men with type 2 DM. Moreover ED may be a significant marker for diabetes. There is a strong evidence that endogenous testosterone has a protective role on the endothelium. It may be an independent risk factor for increased CAD. Asymmetric dimethylarginine (ADMA) is found to be increased in conditions associated with atherosclerosis and considered as plasma marker of endothelial function as well as endothelial dysfunction. ADMA level is usually high in case of atherogenesis. Objective: To measure serum ADMA and testosterone levels in type 2 diabetic patients with ED for detection of their value as risk markers for Coronary artery diseases. Patients and Methods: The study was conducted on Fifty participants; Thirty of them were diabetic with mean duration ±SD (6.97±1.6ys), mean duration of ED±SD (3.03±1.43ys), their meanage±SD (39.47±4.1ys) (group1). Twenty apparently healthy age matched group as controls (group 2), their mean age±SD (37.65±2.91ys). Clinical assessment was done for all participants regarding CAD (by Electrocardiogram and Echocardiography) and DM. Penile Doppler for ED patients. Samples were taken from both group for measuring HbA1c, fasting blood sugar, fasting lipid profile (TC, TG, LDL-c, HDL-c), prolactin, ADMA, free and total testosterone (FT), (TT) as well as other routine investigations. Informed consent was taken from all participants. Results: Non significant difference in serum prolactin level was found between group 1 and group 2. Significantly higher serum FBS, TC, TG, LDL-c, ADMA levels and also HbA1c were found in group1 as compared to group 2. However serum levels of FT, TT, HDL-c were significantly lower in group1 as compared to group 2. Conclusion: Serum ADMA and testosterone levels may considered as risk markers for endothelial dysfunction and atherogenesis in diabetic men with ED. Therefore ED should alert diabetic men and healthcare givers to the future risk of developing CAD. Testosterone replacement is recommended for diabetic males diagnosed as ED with low testosterone.