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The relationship between erectile dysfunction and the Atherogenic Index of Plasma

A Correspondence to this article was published on 09 March 2020

A Comment to this article was published on 30 January 2020


The objective of this study was to compare the Atherogenic Index of Plasma (AIP) values as indicators of subclinical atherosclerosis among 124 patients with erectile dysfunction, which was thought to be vasculogenic and 126 control subjects who had no erectile dysfunction, and to compare cardiac performance values between both the groups using exercise stress tests (EST). Erectile function was assessed using the International Index of Erectile Function (IIEF-5) questionnaire form. AIP values were studied and compared between patients with ED (IIEF  <  22) and those without ED (IIEF  >  22) using the log10 TG/HDL-C formula. In addition, the correlation between the severity of ED and AIP was investigated according to IIEF-5 scoring. Metabolic equivalent (MET) values, maximal heart rates (max HR), and heart rate recovery (HRR) were evaluated with effort tests. AIP values were significantly higher in the ED group than in the control group (0.45  ±  0.27, and 0.37  ±  0.27; p  =  0.015). According to IIEF-5 scoring, AIP values increased as ED scores decreased. In the EST, MET score and max HR values were significantly lower in the ED group (METs: 11.1  ±  2.2, and 11.6  ±  2.2; p  =  0.045; Max HR: 162.8  ±  6.1, and 165  ±  8.7; p  =  0.019). Although not statistically significant, HRR values were lower in the ED group. Higher AIP values were found in the ED group, and a positive correlation was established between AIP and the severity of ED. In addition, lower performance during the EST and lower HRR values, again in the ED group, confirms cardiac interaction with ED. These results indicate the importance of referral of patients with ED from urology clinics to cardiology units for risk determination and cardiac assessment, even if they areasymptomatic.

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  1. Çayan S, Kendirci M, Yaman Ö, Aşçı R, Orhan İ, Usta MF, et al. Prevalence of erectile dysfunction in men over 40 years of age in Turkey: results from the Turkish Society of Andrology Male Sexual Health Study Group. Turk J Urol. 2017;43:122–9.

    Article  Google Scholar 

  2. Akkus E, Kadioglu A, Esen A, Doran S, Ergen A, Anafarta K, et al. Prevalence and correlates of erectile dysfunction in Turkey: a population-based study. Eur Urol. 2002;41:298–304.

    Article  Google Scholar 

  3. Lue TF. Erectile dysfunction. N Engl J Med. 2000;342:1802–13.

    Article  CAS  Google Scholar 

  4. Persu C, Cauni V, Gutue S, Albu ES, Jinga V, Geavlete P. Diagnosis and treatment of erectile dysfunction-a practical update. J Med Life. 2009;2:394–400.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Kendirci M, Nowfar S, Hellstrom WJ. The impact of vascular risk factors on erectile function. Drugs Today (Barc). 2005;41:65–74.

    Article  Google Scholar 

  6. Dobiásová M. AIP–atherogenic index of plasma as a significant predictor of cardiovascular risk: from research to practice. Vnitr Lek. 2006;52:64–71.

    PubMed  Google Scholar 

  7. Bhardwaj S, Bhattacharijee J, Bhatnagar MK, Tyagi S. Atherogenic index of plasma, castelli risk index and atherogenic coefficient - new parameters in assessing cardiovascular risk. Int J Pharm Biol Sci. 2013;3:359–64.

    Google Scholar 

  8. Niroumand S, Khajedaluee M, Khadem-Rezaiyan M, Abrishami M, Juya M, Khodaee G, et al. Atherogenic Index of Plasma (AIP): a marker of cardiovascular disease. Med J Islam Repub Iran. 2015;29:240.

    PubMed  PubMed Central  Google Scholar 

  9. Oztürk Mİ, Koca O, Keleş MO, Güneş M, Kaya C, Karaman MI. Question for a questionnaire: the International Index of Erectile Function. Int J Impot Res. 2011;23:24–6.

    Article  Google Scholar 

  10. Kennedy JW, Cobb LA, Samson WE. Robert Arthur Bruce, MD. Circulation. 2005;111:2410–2.

    Article  Google Scholar 

  11. Kligfield P, Lauer MS. Exercise electrocardiogram testing: beyond the ST segment. Circulation. 2006;114:2070–82.

    Article  Google Scholar 

  12. Friedewald WT, Levy RI, Fredrickson DS. “Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge,”. Clin Chem. 1972;18:499–502.

    Article  CAS  Google Scholar 

  13. DeBusk R, Drory Y, Goldstein I, Jackson G, Kaul S, Kimmel SE. Management of sexual dysfunction in patients with cardiovascular disease: recommendations of the Princeton Consensus Panel. Am J Cardiol. 2000;86:175–81.

    Article  CAS  Google Scholar 

  14. Dogru MT, Basar MM, Haciislamoglu A. The difference of heart rate recovery between males with and without erectile dysfunction. Ann Noninvasive Electrocardiol. 2010;15:223–9.

    Article  Google Scholar 

  15. Dhabuwala CB, Kumar A, Pierce JM. Myocardial infarction and its influence on male sexual function. Arch Sex Behav. 1986;15:499–504.

    Article  CAS  Google Scholar 

  16. Korpelainen JT, Kauhanen ML, Kemola H, Malinen U, Myllylä VV. Sexual dysfunction in stroke patients. Acta Neurol Scand. 1998;98:400–5.

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  18. Solomon H, Man JW, Wierzbicki AS, Jackson G. Relation of erectile dysfunction to angiographic coronary artery disease. Am J Cardiol. 2003;91:230–1.

    Article  Google Scholar 

  19. Montorsi P, Ravagnani PM, Galli S, Salonia A, Briganti A, Werba JP, et al. Association between erectile dysfunction and coronary artery disease: matching the right target with the right test in the right patient. Eur Urol. 2006;50:721–31.

    Article  Google Scholar 

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

    Article  Google Scholar 

  21. Jackson G, Boon N, Eardley I, Kirby M, Dean J, Hackett G. Erectile dysfunction and coronary artery disease prediction: evidence-based guidance and consensus. Int J Clin Pract. 2010;64:848–57.

    Article  CAS  Google Scholar 

  22. Zhan Y, Xu T, Tan X. Two parameters reflect lipid-driven inflammatory state in acute coronary syndrome: atherogenic index of plasma, neutrophil-lymphocyte ratio. BMC Cardiovasc Disord. 2016;16:96.

    Article  Google Scholar 

  23. Akbas EM, Timuroglu A, Ozcicek A, Ozcicek F, Demirtas L, Gungor A, et al. Association of uric acid, Atherogenic index of plasma and albuminuria in diabetes mellitus. Int J Clin Exp Med. 2014;7:5737–43.

    PubMed  PubMed Central  Google Scholar 

  24. Kalelioğlu T, Ünalan P, Kök B, Sözen Ş, Yüksel Ö, Akkuş M. Atherogenic index of plasma as a cardiovascular risk marker in manic, depressive, and euthymic stages of bipolar disorder. Turk Kardiyol Dern Ars. 2018;46:32–8.

    PubMed  Google Scholar 

  25. Uslu AU, Kucuk A, Icli A, Cure E, Sakiz D, Arslan S, et al. Plasma atherogenic index is an independent indicator of subclinical atherosclerosis in systemic lupus erythematosus. Eurasia J Med. 2017;49:193–7.

    Article  CAS  Google Scholar 

  26. Freeman JV, Dewey FE, Hadley DM, Myers J, Froelicher VF. Autonomic nervous system interaction with the cardiovascular system during exercise. Prog Cardiovasc Dis. 2006;48:342–62.

    Article  Google Scholar 

  27. Gordon DJ, Leon AS, Ekelund LG, Sopko G, Probstfield JL, Rubenstein C, et al. Smoking, physical activity, and other predictors of endurence and heart rate response to exercise in asymtomatic hypercholesterolemic men. Am J Epidemiol. 1987;125:587–600.

    Article  CAS  Google Scholar 

  28. Imai K, Sato H, Hori M, Kusuoka H, Ozaki H, Yokoyama H, et al. Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure. J Am Coll Cardiol. 1994;24:1529–35.

    Article  CAS  Google Scholar 

  29. Higgins JP, Higgins JA. Electrocardiographic exercise stress testing: an update beyond the ST segment. Int J Cardiol. 2007;116:285–99.

    Article  Google Scholar 

  30. Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS. Heart rate recovery immediately after exercise as a predictor of mortality. N Engl J Med. 1999;341:1351–7.

    Article  CAS  Google Scholar 

  31. Cole CR, Foody JM, Blackstone EH, Lauer MS. Heart rate recovery after submaximal exercise testing as a predictor of mortality in a cardiovascularly healthy cohort. Ann Intern Med. 2000;132:552–5.

    Article  CAS  Google Scholar 

  32. Shetler K, Marcus R, Froelicher VF, Vora S, Kalisetti D, Prakash M, et al. Heart rate recovery: validation and MethodologicvIssues. J Am Coll Cardiol. 2001;38:1980–7.

    Article  CAS  Google Scholar 

  33. Lipinski JM, Vetrovec GW, Froelicher VF. Importance of the first two minutes of heart ratevrecovery after exercise treadmill testing in predicting mortality and the presence of coronary artery disease in men. Am J Cardiol. 2004;93:445–9.

    Article  Google Scholar 

  34. Jouven X, Empana JP, Schwartz PJ, Desnos M, Courbon D, Ducimetière P. Heart rate profile during exercise as a predictor of sudden death. N Engl J Med. 2005;352:1951–8.

    Article  CAS  Google Scholar 

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Correspondence to Emrah Ermis.

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Ermis, E., Ozbay Ozyilmaz, S., Salabas, E. et al. The relationship between erectile dysfunction and the Atherogenic Index of Plasma. Int J Impot Res 32, 462–468 (2020).

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