Journal of Cardio-diabetes and metabolic disorders

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Background: Atherosclerosis of penile vasculature and endothelial dysfunction are the main causes of erectile dysfunction (ED) in diabetes. Phosphodiesterase type 5 inhibitors (PDE5i) have been playing a significant role in the management of ED for around 40 years. As there are many promising studies about the effect of statins on endothelial dysfunction and symptomatic improvement in ED, we did this study to compare the effect of statins with PDE-5i. Aim: To study and compare the effect of statins and PDE-5i in ED patients with controlled diabetes mellitus. Materials and Methods: A randomized open-label parallel noninferiority institutional and comparative study was conducted in the Department of Internal Medicine, All India Institute of Medical Sciences Rishikesh, over a period of 12 months. Clinical and objective assessment of ED was based on the International Index of Erectile Function (IIEF)-5 questionnaire and peak systolic velocity (PSV) using Doppler, respectively. The study population was divided into two groups, of which one received atorvastatin 40 mg once daily at night time and the other group received sildenafil 100 mg once daily at night time. Baseline penile Doppler before therapy and 4 weeks after therapy was done. The effects of atorvastatin and sildenafil were compared with P value and statistical values. Outcomes and Results: A total of 79 patients were enrolled, of which 19 patients were excluded from the study due to their unwillingness. Quantitative variables were compared using Independent t test/Mann–Whitney test between the two groups and Wilcoxon signed-rank test was used for comparison between preintervention and postintervention groups. Qualitative variables were correlated using Chi-square test/Fisher’s exact test. The mean preintervention PSV in the atorvastatin group was 8.94 cm/s with a standard deviation of 8.15 cm/s, and the mean preintervention PSV in the sildenafil group was 10.04 cm/s with a standard deviation of 9.21 cm/s with a P value of 0.537 and 95% confidence interval (CI). The mean postintervention PSV in the atorvastatin group was 9.15 cm/s with a standard deviation of 8.22 cm/s, and the mean postintervention PSV in the sildenafil group was 10.67 cm/s with a standard deviation of 9.28 cm/s with a P value of 0.327 and 95% CI. Conclusions: Sildenafil has already been recognized as efficacious in ED and has been in use for almost 4 decades. In our study, we compared the effect of sildenafil and atorvastatin among diabetic patients between 40 and 70 years of age. Sildenafil has already shown significant subjective benefits to patients, as assessed through questionnaires. However, it did not reach a statistically significant value (PSV) within a one-month period. Nonetheless, when compared with statins, PDE5 inhibitors (PDE5i) demonstrated a positive subjective and objective response, as observed by the mean PSV difference between the two groups. Statins on the other hand have recently been studied for its pleiotropic effects on vascular smooth muscle. The role of statins is comparatively not up to the mark for PDE5i. Hence, we conclude this study with the finding that neither statins nor PDE5 inhibitors (PDE5i) demonstrated a significant increase in PSV at the end of the one-month period. Furthermore, it is evident that additional future studies and data collection are necessary to investigate the long-term effects of these treatments, as well as the combined effects of statins and PDE5i. Additionally, further research is needed to explore novel drugs and therapies for the treatment of erectile dysfunction (ED).

The coronavirus disease 2019 (COVID-19) pandemic has affected millions of people worldwide adversely affecting the cardiovascular health apart from predominant involvement of the lungs. Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) which is the agent of COVID-19 can affect various tissues other than lungs including heart and vascular tissues. Thus, cardiovascular diseases are common extra pulmonary manifestations of this illness. This review provides an insight into the cardiovascular manifestations of the COVID-19 disease.

Introduction: Diabetic foot ulcers are a common diabetic complication that can be lethal. Abnormal plantar pressures are hypothesized to influence the pathogenesis of neuropathic ulcers in the diabetic foot. Aim: To analyze the maximum plantar pressures and average plantar pressures in diabetic patients. Materials and Methods: The study used 62 diabetes individuals as participants. Body mass index was calculated, as well as illness duration and hemoglobin A1c. Plantar pressure was measured in static (standing) and dynamic (walking/taking a step on the mat) settings for all patients using the BTS (BTS is a bioengineering company based in Italy) walk system. The plantar pressures (kPa) at the five metatarsal regions, the mid-foot region, and the medial and lateral heel regions were measured. Results: We found that the maximum dynamic pressures were higher in at metatarsal region, which were above 600 kPa, which were considered a risk for ulceration. Conclusion: Persons with diabetes have higher maximum plantar pressures. These people are at high risk for foot ulceration in the metatarsal and mid-foot regions. This can be used as an indicator of the development of ulcers.

The cardio-metabolic disorders are now the leading cause of morbidity and mortality all around the world. Though genetics play a role, most of these diseases have a causal relationship with smoking, environmental pollution, unhealthy food habits, sedentary lifestyle, and alcohol abuse. Poor mental state, depression, and stress have also been found to aggravate the risk to develop these diseases. These diseases are thus clubbed under diseases related to unhealthy lifestyle. The pathogenesis of these diseases is atherosclerosis or hardening of the blood vessels that occur due to constant inflammatory stress aggravated by the above-said risk factors. Since last decade, every third death is caused by a cardiovascular disease. Apart from high mortality, these are chronic disorders with no permanent cure requiring life-long medication and lifestyle changes. The patients suffering from these diseases not only undergo a decrease in their physical endurance and functional capacity but also suffer from depression, self-pity, and financial burden leading to an unhealthy lifestyle and a vicious cycle. This causes a huge burden on the health care system in the country and hence requires a wholesome approach to the prevention and management of these diseases. The integrated wellness encompasses the best of conventional medicine and evidence-based complementary medicine and lifestyle measures to provide the patient a wholesome management plan. This aims to a better patient-doctor relationship, better compliance, trust, and better lifestyle choices. The center of the integrated wellness remains the patient rather than the disease.

Online since 8^th September 2020