How to cite: Miner MM. Worsening Cardiometabolic Health: Treatment of Obesity/GLP 1 RA PDE5 Meds & Reduction of All-Cause Mortality.” Grand Rounds in Urology. November 2025. Accessed Jan 2026. https://grandroundsinurology.com/worsening-cardiometabolic-health-treatment-of-obesity-glp-1-ra-pde5-meds-reduction-of-all-cause-mortality
Summary
Martin M. Miner, MD, Clinical Professor of Family Medicine and Urology, Brown University, Providence, Rhode Island, emphasizes that men continue to experience shorter life expectancy than women in most countries, identifying poor cardiometabolic health as a primary contributor. Citing data on rates of diabetes, obesity, and cardiometabolic health in American adults, Dr. Miner describes the current situation as a decades-long metabolic pandemic that significantly impacts morbidity and mortality
Dr. Miner explains that management should focus on cardiovascular risk modification, depression screening, and weight prevention. The treatment landscape is evolving toward glucagon-like peptide-1 (GLP-1) receptor agonists, such as semaglutide and tirzepatide, which promote weight reduction, improve glycemic control, lower blood pressure, and reduce sleep apnea. These medications also decrease major cardiovascular events and have beneficial effects on semen parameters, gonadotropins, and testosterone levels. However, Dr. Miner cautions that rapid weight loss may contribute to sarcopenia, emphasizing the importance of preserving lean muscle mass and suggesting possible synergy with low-dose testosterone therapy in select men.
Dr. Miner further highlights that erectile dysfunction (ED) serves as a clinical indicator of subclinical cardiovascular disease. Multiple studies demonstrate that exposure to phosphodiesterase type 5 (PDE5) inhibitors is associated with lower risks of myocardial infarction, stroke, dementia, and all-cause mortality. He argues that GLP-1 receptor agonists and PDE5 inhibitors represent complementary approaches for improving men’s cardiometabolic and sexual health.
ABOUT THE AUTHOR
Martin M. Miner, MD, is founder and internist at the Lifespan Men’s Health Center and former chair of the Department of Family Medicine for Miriam Hospital in Providence, Rhode Island. He is also a clinical professor of family medicine and urology at the Warren Alpert Medical School of Brown University in Providence. Dr. Miner earned his MD at the University of Cincinnati College of Medicine in Ohio. He completed his residency at Brown University and spent time working with the Indian Health Service Corps and the Public Health Service. Dr. Miner presently holds memberships in the American Academy of Family Physicians, the Rhode Island and Massachusetts Academy of Family Physicians, and the American Urological Association (AUA), and is a Fellow of the Sexual Medicine Society of North America. He is president-elect of the Androgen Society and has participated as a member of the AUA in the development of guidelines for erectile dysfunction, Peyronie's disease, testosterone deficiency, and early screening for prostate cancer. He is the former president of the American Society of Men’s Health. Dr. Miner has published extensively in the areas of erectile dysfunction and cardiovascular disease, benign prostatic hyperplasia, and lower urinary tract symptoms, as well as male sexuality and hormone replacement therapy in men.
