Síndrome metabólico e medicina sexual. Conceitos actuais e avaliação básica

By the year 2025, it is estimated that more than 320 million men will be affected by erectile dysfunction. The association between risk factors for atherosclerosis and erectile dysfunction is focused around an insulin resistance syndrome known as the metabolic syndrome. Since metabolic syndrome is a precursor state of coronary heart disease and type II diabetes, the identification of a reliable precursor of the metabolic syndrome would provide an excellent opportunity for the development of preventive attitudes for coronary heart disease, type II diabetes and its complications. The authors review the current concepts and actual management in the metabolic syndrome in the context of erectile dysfunction. The rationale for the incorporation of erectile dysfunction to improve preventive vascular health in men is based in the fact that erectile dysfunction could be a predictive state of the metabolic syndrome. A new paradigm shift is probably in process in the way that male sexual health examination in the context of erectile dysfunction is being transformed into male sexual health and, ultimately, male health. The erectile dysfunction/metabolic syndrome link now mandates a proper evaluation of erectile dysfunction, and we should now consider the need of a fasting blood glucose, fasting lipid panel, measurement of waist circumference and measurement of blood pressure as requisite features of male sexual health evaluation. Identification of the metabolic syndrome on erectile dysfunction evaluation can objectively be measured by endothelial dysfunction and inflammation markers such as CRP, HgbA1c, IL-6 and others. Treatment options of the metabolic syndrome are based in the aggressive management of cardiovascular risk factors, rehabilitation of endothelial function and the improvement of the efficacy of the usual erectile dysfunction medical treatments. The search for men with no obvious cardiovascular risk factors is crucial for obtaining the best results, specially in the field of prevention.