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:

Surveillance of cardiovascular risk factors for outpatients in different erectile dysfunction severity

Abstract

We determined the association between the severity of erectile dysfunction (ED) and traditional cardiovascular risk factors, including metabolic syndrome (MS). A total of 141 ED patients were divided into three groups on the basis of ED severity, which was determined using the International Index of Erectile Function (IIEF) scores. The prevalence of MS among the ED patients was 32.6%. Significantly lower IIEF scores were noted in patients with MS than in patients without MS (7.6±6.4 vs 11.6±7.4, P=0.003). As assessed by the anthropometric indices of body mass index, waist circumference and waist-to-hip ratio, obesity was detected in 58.9, 54.6 and 32.6% of the patients, respectively. Of the 141 patients, 39 had mild, 24 had moderate and 78 had severe ED. Statistically significant differences were noted among the different ED severity groups with regard to the presence of hypertension, systolic blood pressure, presence of MS and number of MS components. Multivariate analysis showed that the odds ratio for high-low-density lipoprotein (LDL) cholesterol level in moderate and severe ED, determined with reference to mild ED, were 9.346 and 6.452, respectively. The presence of MS, number of MS components, and certain traditional cardiovascular risk factors, particularly high-LDL cholesterol level and hypertension, may influence the severity of ED.

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

Access options

Buy this article

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

Figure 1

Similar content being viewed by others

References

  1. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB . Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994; 151: 54–61.

    Article  CAS  PubMed  Google Scholar 

  2. Ayta IA, McKinlay JB, Krane RJ . The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. BJU Int 1999; 84: 50–56.

    Article  CAS  PubMed  Google Scholar 

  3. Gazzaruso C, Giordanetti S, De Amici E, Bertone G, Falcone C, Geroldi D et al. Relationship between erectile dysfunction and silent myocardial ischemia in apparently uncomplicated type 2 diabetic patients. Circulation 2004; 110: 22–26.

    Article  PubMed  Google Scholar 

  4. Montorsi P, Montorsi F, Schulman CC . Is erectile dysfunction the ‘tip of the iceberg’ of a systemic vascular disorder? Eur Urol 2003; 44: 352–354.

    Article  PubMed  Google Scholar 

  5. Cheitlin MD . Should the patient with coronary artery disease use sildenafil? Prev Cardiol 2003; 6: 161–165.

    Article  PubMed  Google Scholar 

  6. El-Sakka AI, Morsy AM, Fagih BI, Nassar AH . Coronary artery risk factors in patients with erectile dysfunction. J Urol 2004; 172: 251–254.

    Article  PubMed  Google Scholar 

  7. 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 

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

    Article  CAS  PubMed  Google Scholar 

  9. 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 

  10. Shabsigh R, Fishman IJ, Schum C, Dunn JK . Cigarette smoking and other vascular risk factors in vasculogenic impotence. Urology 1991; 38: 227–231.

    Article  CAS  PubMed  Google Scholar 

  11. Conti CR, Pepine CJ, Sweeney M . Efficacy and safety of sildenafil citrate in the treatment of erectile dysfunction in patients with ischemic heart disease. Am J Cardiol 1999; 83: 29C–34C.

    Article  CAS  PubMed  Google Scholar 

  12. Brunner H, Cockcroft JR, Deanfield J, Donald A, Ferrannini E, Halcox J, et al., Working Group on Endothelins and Endothelial Factors of the European Society of Hypertension. Endothelial function and dysfunction. Part II: Association with cardiovascular risk factors and diseases. A statement by the Working Group on Endothelins and Endothelial Factors of the European Society of Hypertension. J Hypertens 2005; 23: 233–246.

    Article  CAS  PubMed  Google Scholar 

  13. Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001; 24: 683–689.

    Article  CAS  PubMed  Google Scholar 

  14. Mykkanen L, Zaccaro DJ, Wagenknecht LE, Robbins DC, Gabriel M, Haffner SM . Microalbuminuria is associated with insulin resistance in nondiabetic subjects: the insulin resistance atherosclerosis study. Diabetes 1998; 47: 793–800.

    Article  CAS  PubMed  Google Scholar 

  15. Papamichael CM, Lekakis JP, Stamatelopoulos KS, Papaioannou TG, Alevizaki MK, Cimponeriu AT et al. Ankle-brachial index as a predictor of the extent of coronary atherosclerosis and cardiovascular events in patients with coronary artery disease. Am J Cardiol 2000; 86: 615–618.

    Article  CAS  PubMed  Google Scholar 

  16. Johnson RJ, Kivlighn SD, Kim YG, Suga S, Fogo AB . Reappraisal of the pathogenesis and consequences of hyperuricemia in hypertension, cardiovascular disease, and renal disease. Am J Kidney Dis 1999; 33: 225–234.

    Article  CAS  PubMed  Google Scholar 

  17. Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM . Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res 1999; 11: 319–326.

    Article  CAS  PubMed  Google Scholar 

  18. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486–2497.

    Article  Google Scholar 

  19. Bortolotti A, Parazzini F, Colli E, Landoni M . The epidemiology of erectile dysfunction and its risk factors. Int J Androl 1997; 20: 323–334.

    Article  CAS  PubMed  Google Scholar 

  20. Roumeguere T, Wespes E, Carpentier Y, Hoffmann P, Schulman CC . Erectile dysfunction is associated with a high prevalence of hyperlipidemia and coronary heart disease risk. Eur Urol 2003; 44: 355–359.

    Article  PubMed  Google Scholar 

  21. Azadzoi KM, Goldstein I . Erectile dysfunction due to atherosclerotic vascular disease: the development of an animal model. J Urol 1992; 147: 1675–1681.

    Article  CAS  PubMed  Google Scholar 

  22. Sullivan ME, Thompson CS, Dashwood MR, Khan MA, Jeremy JY, Morgan RJ et al. Nitric oxide and penile erection: is erectile dysfunction another manifestation of vascular disease? Cardiovasc Res 1999; 43: 658–665.

    Article  CAS  PubMed  Google Scholar 

  23. Kloner RA, Mullin SH, Shook T, Matthews R, Mayeda G, Burstein S et al. Erectile dysfunction in the cardiac patient: how common and should we treat? J Urol 2003; 170: S46–S50.

    Article  PubMed  Google Scholar 

  24. Bansal TC, Guay AT, Jacobson J, Woods BO, Nesto RW . Incidence of metabolic syndrome and insulin resistance in a population with organic erectile dysfunction. J Sex Med 2005; 2: 96–103.

    Article  PubMed  Google Scholar 

  25. Esposito K, Giugliano F, Martedì E, Feola G, Marfella R, D’Armiento M et al. High proportions of erectile dysfunction in men with the metabolic syndrome. Diabetes Care 2005; 28: 1201–1203.

    Article  PubMed  Google Scholar 

  26. Paick JS, Yang JH, Kim SW, Ku JH . Severity of erectile dysfunction in married impotent patients: interrelationship with anthropometry, hormones, metabolic profiles and lifestyle. Int J Urol 2007; 14: 48–53.

    Article  CAS  PubMed  Google Scholar 

  27. Richardson D, Vinik A . Etiology and treatment of erectile failure in diabetes mellitus. Curr Diab Rep 2002; 2: 501–509.

    Article  PubMed  Google Scholar 

  28. Romeo JH, Seftel AD, Madhun ZT, Aron DC . Sexual function in men with diabetes type 2: association with glycemic control. J Urol 2000; 163: 788–791.

    Article  CAS  PubMed  Google Scholar 

  29. Walczak MK, Lokhandwala N, Hodge MB, Guay AT . Prevalence of cardiovascular risk factors in erectile dysfunction. J Gend Specif Med 2002; 5: 19–24.

    PubMed  Google Scholar 

  30. Derby CA, Mohr BA, Goldstein I, Feldman HA, Johannes CB, McKinlay JB . Modifiable risk factors and erectile dysfunction: can lifestyle changes modify risk? Urology 2000; 56: 302–306.

    Article  CAS  PubMed  Google Scholar 

  31. Kupelian V, Shabsigh R, Araujo AB, O’Donnell AB, McKinlay JB . Erectile dysfunction as a predictor of the metabolic syndrome in aging men: results from the Massachusetts Male Aging Study. J Urol 2006; 176: 222–226.

    Article  PubMed  Google Scholar 

  32. Heidler S, Temml C, Broessner C, Mock K, Rauchenwald M, Madersbacher S et al. Is the metabolic syndrome an independent risk factor for erectile dysfunction? J Urol 2007; 177: 651–654.

    Article  PubMed  Google Scholar 

  33. Demir T, Demir O, Kefi A, Comlekci A, Yesil S, Esen A . Prevalence of erectile dysfunction in patients with metabolic syndrome. Int J Urol 2006; 13: 385–388.

    Article  PubMed  Google Scholar 

  34. Vallance P, Chan N . Endothelial function and nitric oxide: clinical relevance. Heart 2004; 85: 342–350.

    Article  Google Scholar 

  35. Wheatcroft SB, Williams IL, Shah AM, Kearney MT . Pathophysiological implications of insulin resistance on vascular endothelial function. Diabet Med 2003; 20: 255–268.

    Article  CAS  PubMed  Google Scholar 

  36. Rastogi S, Rodriguez JJ, Kapur V, Schwarz ER . Why do patients with heart failure suffer from erectile dysfunction? A critical review and suggestions on how to approach this problem. Int J Impot Res 2005; 17 (Suppl. 1): S25–S36.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Chang Gung Memorial Hospital for financially supporting this research under Contract No. CMRPG 660051.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J-J Shee.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chang, ST., Chu, CM., Hsu, JT. et al. Surveillance of cardiovascular risk factors for outpatients in different erectile dysfunction severity. Int J Impot Res 21, 116–121 (2009). https://doi.org/10.1038/ijir.2009.1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijir.2009.1

Keywords

This article is cited by

Search

Quick links