Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

A retrospective study of the relationship between biomarkers of atherosclerosis and erectile dysfunction in 988 men

International Journal of Impotence Research volume 19, pages 218–225 (2007)Cite this article

Abstract

Erectile dysfunction (ED) is associated with clinical atherosclerosis and several atherosclerotic risk factors including smoking, hypertension, dyslipidemia, diabetes mellitus, obesity and sedentary lifestyle. Clinical atherosclerosis is also associated with these same risk factors and with biomarkers of inflammation, thrombosis, endothelial cell activation. We evaluated the cross-sectional association between the degree of ED and levels of atherosclerotic biomarkers. A subcohort of 988 US male health professionals between the ages 46 and 81 years as part of an ongoing epidemiologic study had atherosclerotic biomarkers measured from blood collected in 1994–1995. These same men had in 2000, been retrospectively asked about erectile function in 1995 and in 2000. Biennial questionnaires since 1986 assessed medical conditions, medications, smoking, physical activity, body mass index, alcohol intake. The retrospective assessment of erectile function in 2000 for 1995 in these 988 men ranged from very good – 28.2%, good – 25.1%, fair – 19.2%, poor – 13.6%, to very poor – 13.9%. Men with poor to very poor erectile function compared to men with good and very good erectile function had 2.9 the odds of having elevated Factor VII levels (P=0.03), 1.9 times the odds of having elevated vascular cell adhesion molecule (P=0.13) and 2.0 times the odds of having elevated intracellular adhesion molecule (P=0.06) and 2.1 times the odds of having elevated total cholesterol/high-density lipoprotein ratio (P=0.02) comparing the top to bottom quintiles for each atherosclerotic biomarker after multivariate adjustment. Lipoprotein(a), homocysteine, interleukin-6 and tumor necrosis factor receptor, C-reactive protein and fibrinogen were not associated with the degree of erectile function after adjustment. We conclude that selected biomarkers for endothelial function, thrombosis and dyslipidemia but not inflammation are associated with the degree of ED in this cross-sectional analysis. Future studies evaluating the prospective association of ED, endothelial function and cardiovascular disease appear warranted.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Laumann EO, Paik A, Rosen RC . Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999; 281: 537–544.

    Article  CAS  PubMed  Google Scholar 

  2. Bacon CG, Mittleman MA, Kawachi I, Giovannucci E, Glasser DB, Rimm E . Sexual function in men older than 50 years of age: results from the health professional's follow-up study. Ann Intern Med 2003; 139: 161–168.

    Article  PubMed  Google Scholar 

  3. O'Kane PD, Jackson G . Erectile dysfunction: is there silent obstructive coronary artery disease? Int J Clin Pract 2001; 55: 219–220.

    CAS  PubMed  Google Scholar 

  4. Virag R, Bouilly P, Frydman D . Is impotence an arterial disorder? A study of arterial risk factors in 440 impotent men. Lancet 1985; 1: 181–184.

    Article  CAS  PubMed  Google Scholar 

  5. Jensen J, Lendorf A, Stimpel H, Frost J, Ibsen H, Rosenkide P . The prevalence and etiology of impotence in 101 male hypertensive outpatients. Am J Hypertens 1999; 12: 271–275.

    Article  CAS  PubMed  Google Scholar 

  6. Azadzoi KM, Saenz de Tejada I . Hypercholesterolemia impairs endothelium-dependent relaxation of rabbit corpus cavernosum smooth muscle. J Urol 1991; 146: 238–240.

    Article  CAS  PubMed  Google Scholar 

  7. Anderson TJ, Gerhard MD, Meredith IT, Charbonneau F, Delagrange D, Creager MA et al. Systemic nature of endothelial dysfunction in atherosclerosis. Am J Cardiol 1995; 75: 71B–74B.

    Article  CAS  PubMed  Google Scholar 

  8. Becker AJ, Uckert S, Stief CG, Scheller F, Knapp W, Hartmann U et al. Plasma levels of angiotensin II during different penile conditions in the cavernous and systemic blood of healthy men and men with erectile dysfunction. Urology 2001; 58: 805–810.

    Article  CAS  PubMed  Google Scholar 

  9. Blumentals WA, Gomez-Caminero A, Joo S, Vannappagari V . Should erectile dysfunction be considered as a marker for acute myocardial infarction? Results from a retrospective cohort study. Int J Impot Res 2004; 16: 350–353.

    Article  CAS  PubMed  Google Scholar 

  10. Blumentals WA, Gomez-Caminero A, Joo S, Vannappagari V . Is erectile dysfunction predictive of peripheral vascular disease? Aging Male 2003; 6: 217–221.

    Article  CAS  PubMed  Google Scholar 

  11. Greenstein A, Chen J, Miller H . Does severity of ischemic coronary disease correlate with erectile function? Int J Impot Res 1997; 9: 123–126.

    Article  CAS  PubMed  Google Scholar 

  12. Feldman HA, Johannes CB, Derby CA, Kleinman KP, Mohr BA, Araujo AB et al. Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts Male Aging Study. Prev Med 2000; 30: 328–338.

    Article  CAS  PubMed  Google Scholar 

  13. Tan RS, Pu SJ . The inter-linked depression, erectile dysfunction, and coronary heart disease syndrome in older men: a triad often under diagnosed. J Gender Specif Med 2003; 6: 31–36.

    Google Scholar 

  14. Kim SW, Paick J, Park DW, Chae IH, Oh BH . Potential predictors of asymptomatic ischemic heart disease in patients with vasculogenic erectile dysfunction. Urology 2001; 58: 441–445.

    Article  CAS  PubMed  Google Scholar 

  15. Thompson IM, Tanger CM, Goodman PJ, Probstfield JL, Moinpour CM, Coltman CA . Erectile dysfunction and subsequent cardiovascular disease. JAMA 2005; 294: 2996–3002.

    Article  CAS  PubMed  Google Scholar 

  16. Burchardt M, Burchardt T, Anastasiadis AG, Kiss AJ, Shabsigh A, de La Taille A et al. Erectile dysfunction is a marker for cardiovascular complications and psychological functioning in men with hypertension. Int J Impot Res 2001; 13: 276–281.

    Article  CAS  PubMed  Google Scholar 

  17. Hashimoto M, Kozaki K, Eto M, Akishita M, Ako J, Iijima K et al. Association of coronary risk factors and endothelium-dependent flow mediated dilatation of the brachial artery. Hypertens Res 2000; 23: 233–238.

    Article  CAS  PubMed  Google Scholar 

  18. Widlansky ME, Gokce N, Keaney Jr JF, Vita JA . The clinical implications of endothelial dysfunction. J Am Coll Cardiol 2003; 42: 149–160.

    Article  Google Scholar 

  19. DeAngelis L, Marfella MA, Siniscalchi M, Marino L, Nappo F, Giugliano F et al. Erectile and endothelial dysfunction in type II diabetes: a possible link. Diabetologia 2001; 44: 1155–1160.

    Article  CAS  Google Scholar 

  20. Solomon H, Man JW, Jackson G . Erectile dysfunction and the cardiovascular patient endothelial dysfunction is the common denominator. Heart 2003; 89: 251–253.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Maas R, Schwedhelm E, Albsmeier J, Boger RH . The pathophysiology of erectile dysfunction related to endothelial dysfunction and mediators of vascular function. Vasc Med 2002; 7: 213–225.

    Article  PubMed  Google Scholar 

  22. Pai JK, Pischon T, Ma J, Manson JE, Hankinson SE, Joshipura K et al. Inflammatory markers and the risk of coronary heart disease in men and women. N Engl J Med 2004; 351: 2599–2610.

    Article  CAS  PubMed  Google Scholar 

  23. Pai JK, Hankinson SE, Thadhani R, Rifai N, Pischon T, Rimm EB . Moderate alcohol consumption and lower levels of inflammatory biomarkers in US men and women. Atherosclerosis 2006; 186: 113–120.

    Article  CAS  PubMed  Google Scholar 

  24. Derby CA, Araujo AB, Johannes CB, Feldman HA, McKinlay JB . Measurement of erectile dysfunction in population-based studies: the use of a single question self-assessment in the Massachusetts Male Aging Study. Int J Impot Res 2000; 12: 197–204.

    Article  CAS  PubMed  Google Scholar 

  25. Rimm EB, Stampfer MJ, Colditz GA, Chute CG, Litin LB, Willett WC . Validity of self-reported waist and hip circumference in men and women. Epidemiology 1990; 1: 466–473.

    Article  CAS  PubMed  Google Scholar 

  26. Chasan-Taber S, Rimm EB, Stampfer MJ, Speigelman D, Colditz GA, Giovannucci E et al. Reproducibility and validity of a self-administered physical activity questionnaire for male health professionals. Epidemiology 1996; 7: 81–86.

    Article  CAS  PubMed  Google Scholar 

  27. Willett WC, Reynolds RD, Cottrell-Hoechner S, Sampson L, Browne ML . Validation of a semi-quantitative food frequency questionnaire: a comparison with a 1-year diet record. J Am Diet Assoc 1987; 87: 43–47.

    CAS  PubMed  Google Scholar 

  28. Kaiser DR, Billups K, Mason C, Wetterling R, Lundberg JL, Bank AJ et al. Impaired brachial artery endothelium dependent and independent vasodilation in men with erectile dysfunction and no other clinical cardiovascular disease. J Am Coll Cardiol 2004; 43: 179–184.

    Article  PubMed  Google Scholar 

  29. Chiurlia E, D'Amico R, Ratti C, Granata AR, Romagnoli R, Modena MG . Subclinical coronary artery atherosclerosis in patients with erectile dysfunction. J Am Coll Cardiol 2005; 46: 1503–1506.

    Article  PubMed  Google Scholar 

  30. Bocchio M, Desideri G, Scarpelli P, Necozione S, Properzi G, Spartera C et al. Endothelial cell activation in men with erectile dysfunction without cardiovascular risk factors and overt vascular damage. J Urol 2004; 171: 1601–1604.

    Article  PubMed  Google Scholar 

  31. Esposito K, Giugliano F, Di Palo C, Marfella R, D'Andrea F, D'Armiento M et al. Effect of Lifestyle changes on erectile dysfunction in obese men. A randomized controlled trial. JAMA 2004; 291: 2978–2984.

    Article  CAS  PubMed  Google Scholar 

  32. Sullivan ME, Miller MA, Bell CR, Jagroop IA, Thompson CS, Khan MA et al. Fibrinogen, lipoprotein(a), and lipids in patients with erectile dysfunction. A preliminary study. Int Angiol 2001; 20: 195–199.

    CAS  PubMed  Google Scholar 

  33. Fung MM, Bettencourt R, Barrett-Connor E . Heart disease risk factors predict erectile dysfunction 25 years later. The Rancho Bernardo Study. J Am Coll Cardiol 2004; 43: 1405–1411.

    Article  PubMed  Google Scholar 

  34. Bacon CG, Hu FB, Giovannucci E, Glasser DB, Mittleman MA, Rimm EB . Association of type and duration of diabetes with erectile dysfunction in a large cohort of men. Diabetes Care 2002; 25: 1458–1463.

    Article  PubMed  Google Scholar 

  35. Saltzman EA, Guay AT, Jacobson J . Improvement in erectile function in men with organic erectile dysfunction by correction of elevated cholesterol levels: a clinical observation. J Urol 2004; 172: 255–258.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The National Institutes of Health provided funding for HPFS general follow-up and measurement of biomarkers. Pfizer, Inc. provided funding for the evaluation of ED and the analysis of the data linking biomarkers to degree of ED. One of the co-authors, Dr Glasser, is employed by Pfizer, Inc. The first and last authors made all the final decisions regarding the design, conduct and reporting of the study and the decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, RI, USA

    C B Eaton

  2. Department of Family Medicine, Brown Medical School, Providence, RI, USA

    C B Eaton & M Miner

  3. Department of Nutrition, Harvard School of Public Health, Boston, MA, USA

    Y L Liu & E B Rimm

  4. Institute for Prevention of Cardiovascular Disease, Beth Israel Deaconess Medical Center, Boston, MA, USA

    M A Mittleman

  5. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    M A Mittleman & E B Rimm

  6. US Urology Group, Pfizer Inc., New York, NY, USA

    D B Glasser

  7. Department of Medicine, Channing Laboratory, Harvard Medical School and Brigham & Women's Hospital, Boston, MA, USA

    E B Rimm

Authors
  1. C B Eaton
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Y L Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M A Mittleman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M Miner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D B Glasser
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E B Rimm
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C B Eaton.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Eaton, C., Liu, Y., Mittleman, M. et al. A retrospective study of the relationship between biomarkers of atherosclerosis and erectile dysfunction in 988 men. Int J Impot Res 19, 218–225 (2007). https://doi.org/10.1038/sj.ijir.3901519

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijir.3901519

Keywords

Search

Advanced search

Quick links