PubMed Health⌕ Search

Biomedical subjects

Varant Kupelian

Publications and source records attributed to Varant Kupelian.

13 recordsLinked to original sources
PubMed2007

The natural progression and remission of erectile dysfunction: results from the Massachusetts Male Aging Study.

PURPOSE: Erectile dysfunction affects more than 150 million men and is strongly associated with cardiovascular disease. A 1992 National Institutes of Health consensus development panel identified erectile dysfunction progression and spontaneous remission as priorities for investigation, but there are few data describing the natural course of the disorder following its initial presentation. This analysis estimates the frequency of erectile dysfunction progression and remission among aging men, and assesses the relation of progression/remission to demographics, socioeconomic factors, comorbidities and modifiable lifestyle characteristics. MATERIALS AND METHODS: Data from the Massachusetts Male Aging Study, a longitudinal study of men (401) 40 to 70 years old, were analyzed to assess erectile dysfunction severity following initial presentation of symptoms. Logistic regression was used to estimate the odds of erectile dysfunction progression/remission as a function of covariates. RESULTS: A total of 141 subjects (35%) exhibited erectile dysfunction remission (95% CI: 30%, 40%). Of 323 subjects with minimal or moderate baseline erectile dysfunction 107 (33%) exhibited erectile dysfunction progression (95% CI: 28%, 38%). The 78 subjects with complete erectile dysfunction were considered ineligible for progression and 45 (58%) of these exhibited complete erectile dysfunction at followup. Age and body mass index were associated with progression and remission, while smoking and self-assessed health status were associated with progression only. CONCLUSIONS: Natural remission and progression occur in a substantial number of men with erectile dysfunction. The association of body mass index with remission and progression, and the association of smoking and health status with progression, offer potential avenues for facilitating remission and delaying progression using nonpharmacological intervention. The benefits of such interventions for overall men's health may be far-reaching.

Aged↗
PubMed2006

The relative contributions of aging, health, and lifestyle factors to serum testosterone decline in men.

CONTEXT: Although it is known that serum testosterone (T) concentrations decline with age, the relative contributions of changes in health and lifestyle to that decline have not been adequately assessed. OBJECTIVE: The objective of this study was to establish the relative importance of aging, health, and lifestyle in contributing to male T decline. DESIGN: A prospective cohort study of health and endocrine functioning in randomly selected men with a baseline visit (T1, 1987-1989) and two follow-up visits (T2, 1995-1997; T3, 2002-2004) was conducted. SETTING: An observational study of men residing in greater Boston, Massachusetts, was conducted. PARTICIPANTS: Participants included 1667 men aged 40 to 70 at baseline; follow-up was conducted on 947 (57%) and 584 (35%) at T2 and T3, respectively. MAIN OUTCOME MEASURES: Main outcome measures included total serum T, calculated free T (FT), and SHBG. RESULTS: There were substantial declines in total serum T and FT levels associated with aging alone. However, many health and lifestyle changes were associated with accelerated decline. A 4- to 5-kg/m2 increase in body mass index or loss of spouse was associated with declines in total serum T comparable to that associated with approximately 10 yr of aging. Results were similar for FT, but fewer factors were associated with SHBG after age was taken into account. CONCLUSIONS: Both chronological aging and changes in health and lifestyle factors are associated with declines in serum T. Comorbidities and lifestyle influences may be as strongly associated with declining T levels as is aging itself over the short- to midterm. These results suggest the possibility that age-related hormone decline may be decelerated through the management of health and lifestyle factors.

Adult↗
PubMed2006

Prevalence of lower urinary tract symptoms and effect on quality of life in a racially and ethnically diverse random sample: the Boston Area Community Health (BACH) Survey.

BACKGROUND: Previous studies of lower urinary tract symptoms (LUTS) have focused on men, with few studies including minority populations. The Boston Area Community Health (BACH) Survey is designed to study the prevalence and impact of LUTS among both men and women in a racially, ethnically, and socioeconomically diverse population. METHODS: The BACH Survey used a stratified 2-stage cluster design to randomly sample 5506 adults aged 30 to 79 from the city of Boston, Mass (2301 men, 3205 women, 1770 blacks, 1877 Hispanics, and 1859 whites). Data were obtained using interviewer and self-administered questionnaires. The presence of LUTS was defined as an American Urological Association symptom index score of 8 or above. Quality of life was assessed using the Medical Outcomes Study 12-Item Short Form Survey (SF-12), and a measure of bother was based on the interference of urinary symptoms with various activities. Analyses were weighted to the Boston population using SUDAAN version 9.0 statistical software. RESULTS: The overall prevalence of LUTS was 18.7% and increased with age (10.5% at age 30-39 years to 25.5% at age 70-79 years) but did not differ by sex or race/ethnicity. Quality of life was significantly reduced among those with LUTS, as measured by the bother of symptoms and the SF-12 component scores. Prevalence of prescription medication use for urinary symptoms was low even among participants with LUTS, with more than 90% of participants reporting no medication use. CONCLUSIONS: In this population-based, racially and ethnically diverse random sample, LUTS were common among both men and women and increased substantially with age. Lower urinary tract symptoms had a negative impact on quality of life across age, sex, and race/ethnic groups.

Adult↗
PubMed2006

A population-level decline in serum testosterone levels in American men.

CONTEXT: Age-specific estimates of mean testosterone (T) concentrations appear to vary by year of observation and by birth cohort, and estimates of longitudinal declines in T typically outstrip cross-sectional decreases. These observations motivate a hypothesis of a population-level decrease in T over calendar time, independent of chronological aging. OBJECTIVE: The goal of this study was to establish the magnitude of population-level changes in serum T concentrations and the degree to which they are explained by secular changes in relative weight and other factors. DESIGN: We describe a prospective cohort study of health and endocrine functioning in randomly selected men of age 45-79 yr. We provide three data collection waves: baseline (T1: 1987-1999) and two follow-ups (T2: 1995-1997, T3: 2002-2004). SETTING: This was an observational study of randomly selected men residing in greater Boston, Massachusetts. PARTICIPANTS: Data obtained from 1374, 906, and 489 men at T1, T2, and T3, respectively, totaling 2769 observations taken on 1532 men. MAIN OUTCOME MEASURES: The main outcome measures were serum total T and calculated bioavailable T. RESULTS: We observe a substantial age-independent decline in T that does not appear to be attributable to observed changes in explanatory factors, including health and lifestyle characteristics such as smoking and obesity. The estimated population-level declines are greater in magnitude than the cross-sectional declines in T typically associated with age. CONCLUSIONS: These results indicate that recent years have seen a substantial, and as yet unrecognized, age-independent population-level decrease in T in American men, potentially attributable to birth cohort differences or to health or environmental effects not captured in observed data.

Age Factors↗
PubMed2006

Low sex hormone-binding globulin, total testosterone, and symptomatic androgen deficiency are associated with development of the metabolic syndrome in nonobese men.

BACKGROUND: The metabolic syndrome (MetS), characterized by central obesity, lipid and insulin dysregulation, and hypertension, is a precursor state for cardiovascular disease. The purpose of this analysis was to determine whether low serum sex hormone levels or clinical androgen deficiency (AD) predict the development of MetS. METHODS: Data were obtained from the Massachusetts Male Aging Study, a population-based prospective cohort of 1709 men observed at three time points (T1, 1987-1989; T2, 1995-1997; T3, 2002-2004). MetS was defined using a modification of the ATP III guidelines. Clinical AD was defined using a combination of testosterone levels and clinical signs and symptoms. The association between MetS and sex hormone levels or clinical AD was assessed using relative risks (RR), and 95% confidence intervals (95% CI) were estimated using Poisson regression models. RESULTS: Analysis was conducted in 950 men without MetS at T1. Lower levels of total testosterone and SHBG were predictive of MetS, particularly among men with a body mass index (BMI) below 25 kg/m2 with adjusted RRs for a decrease in 1 sd of 1.41 (95% CI, 1.06-1.87) and 1.65 (95% CI, 1.12-2.42). Results were similar for the AD and MetS association, with RRs of 2.51 (95% CI, 1.12-5.65) among men with a BMI less than 25 compared with an RR of 1.22 (95% CI, 0.66-2.24) in men with a BMI of 25 or greater. CONCLUSIONS: Low serum SHBG, low total testosterone, and clinical AD are associated with increased risk of developing MetS over time, particularly in nonoverweight, middle-aged men (BMI, <25). Together, these results suggest that low SHBG and/or AD may provide early warning signs for cardiovascular risk and an opportunity for early intervention in nonobese men.

Adult↗
PubMed2006

Is there a relationship between sex hormones and erectile dysfunction? Results from the Massachusetts Male Aging Study.

PURPOSE: The prevalence of erectile dysfunction increases as men age. Simultaneously, age related changes occur in male endocrine functioning. We examined the association between erectile dysfunction and total testosterone, bioavailable testosterone, sex hormone-binding globulin and luteinizing hormone. MATERIALS AND METHODS: Data were obtained from the Massachusetts Male Aging Study, a population based cohort study of 1,709 men. Self-reported erectile dysfunction was dichotomized as moderate or severe vs none or mild. Odds ratios and 95% CI were used to assess the association between sex hormone levels and erectile dysfunction. Multiple logistic regression models were used to adjust for potential confounders including age, body mass index, partner availability, phosphodiesterase type 5 inhibitor use, depression, diabetes and heart disease. RESULTS: Using data from the most recent followup, analyses were conducted on 625 men with complete data. A moderate decrease in erectile dysfunction risk was observed with increasing total testosterone and bioavailable testosterone levels. However, this effect was not apparent after controlling for potential confounders. Increased luteinizing hormone levels (8 IU/l or greater) were associated with a higher risk of erectile dysfunction (adjusted OR 2.91, 95% CI 1.55-5.48) compared to luteinizing hormone levels less than 6 IU/l. A significant interaction between luteinizing hormone and total testosterone levels showed that increased testosterone levels were associated with a decrease in risk of erectile dysfunction among men with luteinizing hormone levels greater than 6 IU/l. CONCLUSIONS: In this large population based cohort of older men we found no association among total testosterone, bioavailable testosterone, sex hormone-binding globulin and erectile dysfunction. Testosterone levels were associated with a decrease in risk of erectile dysfunction only in men with increased luteinizing hormone levels.

Age Factors↗
PubMed2006

Erectile dysfunction as a predictor of the metabolic syndrome in aging men: results from the Massachusetts Male Aging Study.

PURPOSE: The metabolic syndrome, characterized by central obesity, insulin dysregulation, abnormal lipids and borderline hypertension, is a precursor state for cardiovascular disease. We determined whether erectile dysfunction is predictive of the metabolic syndrome. MATERIALS AND METHODS: Data were obtained from the Massachusetts Male Aging Study, a population based prospective cohort observed at 3 points during approximately 15 years (T(1)-1987 to 1989, T(2)-1995 to 1997, T(3)-2002 to 2004). The metabolic syndrome was defined by using a modification of the Adult Treatment Panel III guidelines. The association between erectile dysfunction and the metabolic syndrome was assessed using relative risks and 95% confidence intervals estimated using Poisson regression models. RESULTS: Analysis was conducted of 928 men without the metabolic syndrome at T(1). There were 293 men with incident metabolic syndrome, of which 56 had erectile dysfunction at baseline. Body mass index and the presence of 1 or 2 conditions constituting the metabolic syndrome definition were the strongest predictors of the metabolic syndrome. The association of erectile dysfunction with the metabolic syndrome (unadjusted RR 1.35, 95% CI 1.01-1.81) was modified by body mass index, with a stronger effect of erectile dysfunction in men with body mass index less than 25 (adjusted RR 2.09, 95% CI 1.09-4.02), and no erectile dysfunction and metabolic syndrome association in men with body mass index 25 or greater (adjusted RR 1.06, 95% CI 0.76-1.50). CONCLUSIONS: Erectile dysfunction was predictive of the metabolic syndrome only in men with body mass index less than 25. This finding suggests that erectile dysfunction may provide a warning sign and an opportunity for early intervention in men otherwise considered at lower risk for the metabolic syndrome and subsequent cardiovascular disease.

Adult↗
PubMed2006

Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort.

BACKGROUND: Although muscle strength and mass are highly correlated, the relationship between direct measures of low muscle mass (sarcopenia) and strength in association with mortality has not been examined. METHODS: Total mortality rates were examined in the Health, Aging and Body Composition (Health ABC) Study in 2292 participants (aged 70-79 years, 51.6% women, and 38.8% black). Knee extension strength was measured with isokinetic dynamometry, grip strength with isometric dynamometry. Thigh muscle area was measured by computed tomography (CT) scan, and leg and arm lean soft tissue mass were determined by dual energy x-ray absorptiometry (DXA). Both strength and muscle size were assessed as in gender-specific Cox proportional hazards models, with age, race, comorbidities, smoking status, level of physical activity, fat area by CT or fat mass by DXA, height, and markers of inflammation, including interleukin-6, C-reactive protein, and tumor necrosis factor-alpha considered as potential confounders. RESULTS: There were 286 deaths over an average of 4.9 (standard deviation = 0.9) years of follow-up. Both quadriceps and grip strength were strongly related to mortality. For quadriceps strength (per standard deviation of 38 Nm), the crude hazard ratio for men was 1.51 (95% confidence interval, 1.28-1.79) and 1.65 (95% confidence interval, 1.19-2.30) for women. Muscle size, determined by either CT area or DXA regional lean mass, was not strongly related to mortality. In the models of quadriceps strength and mortality, adjustment for muscle area or regional lean mass only slightly attenuated the associations. Further adjustment for other factors also had minimal effect on the association of quadriceps strength with mortality. Associations of grip strength with mortality were similar. CONCLUSION: Low muscle mass did not explain the strong association of strength with mortality, demonstrating that muscle strength as a marker of muscle quality is more important than quantity in estimating mortality risk. Grip strength provided risk estimates similar to those of quadriceps strength.

Age Factors↗
PubMed2006

The androgen receptor gene CAG repeat polymorphism does not predict increased risk of heart disease: longitudinal results from the Massachusetts Male Ageing Study.

OBJECTIVE: Sex steroids may contribute to the increased prevalence of heart disease (HD) in men compared to age-matched women. Androgens bind their cognate receptor, and androgen action is inversely proportional to the number of CAG repeats in exon 1 of the androgen receptor gene. Longer, less androgenic CAG repeats have been associated with higher high-density lipoprotein (HDL) levels, which might protect against HD. Therefore, we hypothesized that CAG repeat length contributes to HD risk in men. DESIGN: Longitudinal, population-based cohort study. POPULATION: One thousand thirty-four participants from the Massachusetts Male Ageing Study, a cohort of 1709 men from the Boston area, aged 40-70, observed at three time points over 15 years. METHODS: Poisson regression. MEASUREMENTS: Heart disease was determined by self-report, medical records or from the National Death Index. Lipids and hormones were measured from blood samples drawn at each time point. CAG repeat length was assessed from DNA collected at the second time point. RESULTS: We found no increased risk of HD associated with CAG repeat length in our analyses. Moreover, CAG repeat length was not related to body mass index, HDL, low-density lipoprotein or waist to hip ratio in this cohort; nor did CAG repeat length predict changes in these variables over 15 years of follow-up. CONCLUSIONS: In contrast to previous smaller, cross-sectional analyses, in this large cohort of community-dwelling men followed over 15 years, CAG repeat length was not related to the incidence or prevalence of HD or alterations in HDL. If androgens impact HD risk, this effect is unlikely to be mediated via CAG repeat length.

Aging↗
PubMed2005

Elevated aortic pulse wave velocity, a marker of arterial stiffness, predicts cardiovascular events in well-functioning older adults.

BACKGROUND: Aging results in vascular stiffening and an increase in the velocity of the pressure wave as it travels down the aorta. Increased aortic pulse wave velocity (aPWV) has been associated with mortality in clinical but not general populations. The objective of this investigation was to determine whether aPWV is associated with total and cardiovascular (CV) mortality and CV events in a community-dwelling sample of older adults. METHODS AND RESULTS: aPWV was measured at baseline in 2488 participants from the Health, Aging and Body Composition (Health ABC) study. Vital status, cause of death and coronary heart disease (CHD), stroke, and congestive heart failure were determined from medical records. Over 4.6 years, 265 deaths occurred, 111 as a result of cardiovascular causes. There were 341 CHD events, 94 stroke events, and 181 cases of congestive heart failure. Results are presented by quartiles because of a threshold effect between the first and second aPWV quartiles. Higher aPWV was associated with both total mortality (relative risk, 1.5, 1.6, and 1.7 for aPWV quartiles 2, 3, and 4 versus 1; P=0.019) and cardiovascular mortality (relative risk, 2.1, 3.0, and 2.3 for quartiles 2, 3, and 4 versus 1; P=0.004). aPWV quartile was also significantly associated with CHD (P=0.007) and stroke (P=0.001). These associations remained after adjustment for age, gender, race, systolic blood pressure, known CV disease, and other variables related to events. CONCLUSIONS: Among generally healthy, community-dwelling older adults, aPWV, a marker of arterial stiffness, is associated with higher CV mortality, CHD, and stroke.

Aged↗
PubMed2003

Sarcopenia: alternative definitions and associations with lower extremity function.

OBJECTIVES: To compare two sarcopenia definitions and examine the relationship between them and lower extremity function and other health related factors using data from the baseline examination of the Health Aging and Body Composition (Health ABC) Study. DESIGN: Observational cohort study. SETTING: Two U.S. communities in Memphis, Tennessee, and Pittsburgh, Pennsylvania. PARTICIPANTS: Participants were aged 70 to 79 (N=2984, 52% women, 41% black). MEASUREMENTS: Participants were assessed using dual energy x-ray absorptiometry and were classified as sarcopenic using two different approaches to adjust lean mass for body size: appendicular lean mass divided by height-squared (aLM/ht2) and appendicular lean mass adjusted for height and body fat mass (residuals). RESULTS: These methods differed substantially in the classification of individuals as being sarcopenic, especially those who were more obese. The former method was highly correlated with body mass index and identified fewer overweight or obese individuals as sarcopenic. In both men and women, none of the obese group would be considered sarcopenic using the aLM/ht2 method, compared with 11.5% of men and 21.0% of women using the residuals method. In men, both classifications of sarcopenia were associated with smoking, poorer health, lower activity, and impaired lower extremity function. Fewer associations with health factors were noted in women, but the classification based on both height and fat mass was more strongly associated with lower extremity functional limitations (odds ratio (OR)=0.9, 95% confidence interval (CI)=0.7-1.2 for low kg/ht2; OR=1.9, 95% CI=1.4-2.5 for lean mass adjusted for height and fat mass). CONCLUSION: These findings suggest that fat mass should be considered in estimating prevalence of sarcopenia in women and in overweight or obese individuals.

Absorptiometry, Photon↗