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Association between cardiometabolic index and erectile dysfunction among US adults: a cross-sectional analysis of the National Health and Nutrition Examination Survey 2001-2004

International Journal of Impotence Research (2023)Cite this article

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Abstract

The aim of this study was to assess the association between a new metabolic index, the cardiometabolic index (CMI) and erectile dysfunction (ED). The data for this study relied on the National Health and Nutrition Examination Survey (NHANES), a cross-sectional database, between 2001 and 2004. The CMI was calculated as the following formula: Triglyceride (TG) (mmol/L)/ High density lipid-cholesterol (HDL-C) (mmol/L) ×waist-height ratio (WHtR). The multivariate logistic regression analyses were conducted to assess the association between CMI and ED, supplemented by subgroup analysis and dose-response curves. Finally, a total of 1367 adult male participants were identified, and the mean CMI was 0.83 ± 0.02. Multivariate logistic regression analysis showed that in model 2 controlling for all potential confounders, CMI was significantly associated with ED (OR = 1.49, 95% CI: 1.09, 2.04) (p = 0.017). Subsequently, we convert the CMI from a continuous variable to a categorical variable (Tertiles). The results showed that male participants in CMI Tertile 3 group had a higher risk of ED than those in Tertile 1 group in model 2 (OR = 2.07, 95% CI: 1.12, 3.83, P = 0.024). The subgroup analysis of model 2 demonstrated that CMI was significantly associate with ED in participants aged ≥50 y (OR = 2.31, 95% CI: 1.35, 3.95, P = 0.005), body mass index (BMI) > 30 kg/m2 (OR = 1.78, 95% CI: 1.10, 2.90, P = 0.023), with hypertension (OR = 1.89, 95% CI: 1.63, 3.45, P = 0.020), with diabetes mellitus (OR = 1.67, 95% CI: 1.13, 2.47, P = 0.015), with cardiovascular disease (CVD) (OR = 1.54, 95% CI: 1.12, 2.10, P = 0.011) and smoking (OR = 2.07, 95% CI: 1.26, 3.39, P = 0.007). This study demonstrates a strong association between CMI and ED and an increased risk of ED with higher CMI levels. More prospective studies with large samples and good designs are needed to validate our results in the future.

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Fig. 1: Flow chart of the study population identification.
Fig. 2: The association between CMI Tertiles (T1, T2, T3) and ED prevalence presented with OR and 95% CI.
Fig. 3: Density dose-response relationship between CMI with ED prevalence.
Fig. 4: Sensitivity analysis of the association between CMI Tertiles (T1, T2, T3) and severe ED prevalence presented with OR and 95% CI.
Fig. 5: Sensitivity density dose-response relationship between CMI with severe ED prevalence.

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Data availability

Data are available on reasonable request from the corresponding authors.

References

  1. NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. Jama. 1993;270:83–90.

    Article  Google Scholar 

  2. Amidu N, Owiredu WK, Gyasi-Sarpong CK, Woode E, Quaye L. Sexual dysfunction among married couples living in Kumasi metropolis, Ghana. BMC Urol. 2011;11:3.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 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 

  4. Lewis RW, Fugl-Meyer KS, Corona G, Hayes RD, Laumann EO, Moreira ED Jr., et al. Definitions/epidemiology/risk factors for sexual dysfunction. J Sex Med. 2010;7:1598–607.

    Article  PubMed  Google Scholar 

  5. Braun M, Wassmer G, Klotz T, Reifenrath B, Mathers M, Engelmann U. Epidemiology of erectile dysfunction: results of the ‘Cologne Male Survey’. Int J Impot Res. 2000;12:305–11.

    Article  CAS  PubMed  Google Scholar 

  6. Pinnock CB, Stapleton AM, Marshall VR. Erectile dysfunction in the community: a prevalence study. Med J Aust. 1999;171:353–7.

    Article  CAS  PubMed  Google Scholar 

  7. Nicolosi A, Glasser DB, Kim SC, Marumo K, Laumann EO. Sexual behaviour and dysfunction and help-seeking patterns in adults aged 40-80 years in the urban population of Asian countries. BJU Int. 2005;95:609–14.

    Article  PubMed  Google Scholar 

  8. Nicolosi A, Moreira ED Jr., Shirai M, Bin Mohd Tambi MI, Glasser DB. Epidemiology of erectile dysfunction in four countries: cross-national study of the prevalence and correlates of erectile dysfunction. Urology. 2003;61:201–6.

    Article  PubMed  Google Scholar 

  9. Sasayama S, Ishii N, Ishikura F, Kamijima G, Ogawa S, Kanmatsuse K, et al. Men’s Health Study: epidemiology of erectile dysfunction and cardiovascular disease. Circ J. 2003;67:656–9.

    Article  PubMed  Google Scholar 

  10. Rosen RC, Link CL, O’Leary MP, Giuliano F, Aiyer LP, Mollon P. Lower urinary tract symptoms and sexual health: the role of gender, lifestyle and medical comorbidities. BJU Int. 2009;3:42–7.

    Article  Google Scholar 

  11. Inman BA, Sauver JL, Jacobson DJ, McGree ME, Nehra A, Lieber MM, et al. A population-based, longitudinal study of erectile dysfunction and future coronary artery disease. Mayo Clin Proc. 2009;84:108–13.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Thompson IM, Tangen 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 

  13. Quek KF, Sallam AA, Ng CH, Chua CB. Prevalence of sexual problems and its association with social, psychological and physical factors among men in a Malaysian population: a cross-sectional study. J Sex Med. 2008;5:70–6.

    Article  PubMed  Google Scholar 

  14. Clark NG, Fox KM, Grandy S. Symptoms of diabetes and their association with the risk and presence of diabetes: findings from the Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD). Diabetes Care. 2007;30:2868–73.

    Article  PubMed  Google Scholar 

  15. Ponholzer A, Gutjahr G, Temml C, Madersbacher S. Is erectile dysfunction a predictor of cardiovascular events or stroke? A prospective study using a validated questionnaire. Int J Impot Res. 2010;22:25–9.

    Article  CAS  PubMed  Google Scholar 

  16. Chung SD, Chen YK, Lin HC, Lin HC. Increased risk of stroke among men with erectile dysfunction: a nationwide population-based study. J Sex Med. 2011;8:240–6.

    Article  PubMed  Google Scholar 

  17. Zhao D, Liu J, Wang M, Zhang X, Zhou M. Epidemiology of cardiovascular disease in China: current features and implications. Nat Rev Cardiol. 2019;16:203–12.

    Article  PubMed  Google Scholar 

  18. Ermis E, Ozbay Ozyilmaz S, Salabas E, Senol C, Cengiz M, Allahverdiyev S, et al. The relationship between erectile dysfunction and the Atherogenic Index of Plasma. Int J Impot Res. 2020;32:462–8.

    Article  PubMed  Google Scholar 

  19. Miner M, Parish SJ, Billups KL, Paulos M, Sigman M, Blaha MJ. Erectile Dysfunction and Subclinical Cardiovascular Disease. Sex Med Rev. 2019;7:455–63.

    Article  PubMed  Google Scholar 

  20. Martin-Morales A, Sanchez-Cruz JJ, Saenz de Tejada I, Rodriguez-Vela L, Jimenez-Cruz JF, Burgos-Rodriguez R. Prevalence and independent risk factors for erectile dysfunction in Spain: results of the Epidemiologia de la Disfuncion Erectil Masculina Study. J Urol. 2001;166:569–74.

    Article  CAS  PubMed  Google Scholar 

  21. Banks E, Joshy G, Abhayaratna WP, Kritharides L, Macdonald PS, Korda RJ, et al. Erectile dysfunction severity as a risk marker for cardiovascular disease hospitalisation and all-cause mortality: a prospective cohort study. PLoS Med. 2013;10:29.

    Article  Google Scholar 

  22. Hamilton SJ, Watts GF. Endothelial dysfunction in diabetes: pathogenesis, significance, and treatment. Rev Diabet Stud. 2013;10:133–56.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Wakabayashi I, Daimon T. The “cardiometabolic index” as a new marker determined by adiposity and blood lipids for discrimination of diabetes mellitus. Clin Chim Acta. 2015;438:274–8.

    Article  CAS  PubMed  Google Scholar 

  24. Gaziano JM, Hennekens CH, O’Donnell CJ, Breslow JL, Buring JE. Fasting triglycerides, high-density lipoprotein, and risk of myocardial infarction. Circulation. 1997;96:2520–5.

    Article  CAS  PubMed  Google Scholar 

  25. Jeppesen J, Hein HO, Suadicani P, Gyntelberg F. Relation of high TG-low HDL cholesterol and LDL cholesterol to the incidence of ischemic heart disease. An 8-year follow-up in the Copenhagen Male Study. Arterioscler Thromb Vasc Biol. 1997;17:1114–20.

    Article  CAS  PubMed  Google Scholar 

  26. Dobiásová M, Frohlich J. The plasma parameter log (TG/HDL-C) as an atherogenic index: correlation with lipoprotein particle size and esterification rate in apoB-lipoprotein-depleted plasma (FER(HDL)). Clin Biochem. 2001;34:583–8.

    Article  PubMed  Google Scholar 

  27. McLaughlin T, Reaven G, Abbasi F, Lamendola C, Saad M, Waters D, et al. Is there a simple way to identify insulin-resistant individuals at increased risk of cardiovascular disease? Am J Cardiol. 2005;96:399–404.

    Article  CAS  PubMed  Google Scholar 

  28. Cordero A, Laclaustra M, León M, Casasnovas JA, Grima A, Luengo E, et al. Comparison of serum lipid values in subjects with and without the metabolic syndrome. Am J Cardiol. 2008;102:424–8.

    Article  CAS  PubMed  Google Scholar 

  29. Hsieh SD, Muto T. Metabolic syndrome in Japanese men and women with special reference to the anthropometric criteria for the assessment of obesity: Proposal to use the waist-to-height ratio. Prev Med. 2006;42:135–9.

    Article  PubMed  Google Scholar 

  30. Lee CM, Huxley RR, Wildman RP, Woodward M. Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis. J Clin Epidemiol. 2008;61:646–53.

    Article  PubMed  Google Scholar 

  31. Gruson E, Montaye M, Kee F, Wagner A, Bingham A, Ruidavets JB, et al. Anthropometric assessment of abdominal obesity and coronary heart disease risk in men: the PRIME study. Heart. 2010;96:136–40.

    Article  CAS  PubMed  Google Scholar 

  32. Ashwell M, Gunn P, Gibson S. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes Rev. 2012;13:275–86.

    Article  CAS  PubMed  Google Scholar 

  33. Alberti KG, Zimmet P, Shaw J. The metabolic syndrome-a new worldwide definition. Lancet. 2005;366:1059–62.

    Article  PubMed  Google Scholar 

  34. Wakabayashi I, Sotoda Y, Hirooka S, Orita H. Association between cardiometabolic index and atherosclerotic progression in patients with peripheral arterial disease. Clin Chim Acta. 2015;446:231–6.

    Article  CAS  PubMed  Google Scholar 

  35. Wang H, Chen Y, Guo X, Chang Y, Sun Y. Usefulness of cardiometabolic index for the estimation of ischemic stroke risk among general population in rural China. Postgrad Med. 2017;129:834–41.

    Article  PubMed  Google Scholar 

  36. Wang H, Chen Y, Sun G, Jia P, Qian H, Sun Y. Validity of cardiometabolic index, lipid accumulation product, and body adiposity index in predicting the risk of hypertension in Chinese population. Postgrad Med. 2018;130:325–33.

    Article  PubMed  Google Scholar 

  37. Dursun M, Besiroglu H, Otunctemur A, Ozbek E. Association between cardiometabolic index and erectile dysfunction: A new index for predicting cardiovascular disease. Kaohsiung J Med Sci. 2016;32:620–3.

    Article  PubMed  Google Scholar 

  38. Curtin LR, Mohadjer LK, Dohrmann SM, Kruszon-Moran D, Mirel LB, Carroll MD, et al. National Health and Nutrition Examination Survey: sample design, 2007-2010. Vital Health Stat 2. 2013:1-23.

  39. Farag YMK, Guallar E, Zhao D, Kalyani RR, Blaha MJ, Feldman DI, et al. Vitamin D deficiency is independently associated with greater prevalence of erectile dysfunction: The National Health and Nutrition Examination Survey (NHANES) 2001-2004. Atherosclerosis. 2016;252:61–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Lopez DS, Wang R, Tsilidis KK, Zhu H, Daniel CR, Sinha A, et al. Role of Caffeine Intake on Erectile Dysfunction in US Men: Results from NHANES 2001-2004. PLoS One. 2014;10:e0123547.

    Article  PubMed  Google Scholar 

  41. Selvin E, Burnett AL, Platz EA. Prevalence and risk factors for erectile dysfunction in the US. Am J Med. 2007;120:151–7.

    Article  PubMed  Google Scholar 

  42. Loprinzi PD, Edwards M. Association Between Objectively Measured Physical Activity and Erectile Dysfunction among a Nationally Representative Sample of American Men. J Sex Med. 2015;12:1862–4.

    Article  PubMed  Google Scholar 

  43. Rahman HH, Niemann D, Munson-McGee SH. Association of albumin to creatinine ratio with urinary arsenic and metal exposure: evidence from NHANES 2015-2016. Int Urol Nephrol. 2022;54:1343–53.

    Article  CAS  PubMed  Google Scholar 

  44. Janiszewski PM, Janssen I, Ross R. Abdominal obesity and physical inactivity are associated with erectile dysfunction independent of body mass index. J Sex Med. 2009;6:1990–8.

    Article  PubMed  Google Scholar 

  45. Kahn HS. The lipid accumulation product is better than BMI for identifying diabetes: a population-based comparison. Diabetes Care. 2006;29:151–3.

    Article  PubMed  Google Scholar 

  46. Kahn HS. The “lipid accumulation product” performs better than the body mass index for recognizing cardiovascular risk: a population-based comparison. BMC Cardiovasc Disord. 2005;5:26.

    Article  PubMed  PubMed Central  Google Scholar 

  47. de Graaf J, Hak-Lemmers HL, Hectors MP, Demacker PN, Hendriks JC, Stalenhoef AF. Enhanced susceptibility to in vitro oxidation of the dense low density lipoprotein subfraction in healthy subjects. Arterioscler Thromb. 1991;11:298–306.

    Article  PubMed  Google Scholar 

  48. Tribble DL, Holl LG, Wood PD, Krauss RM. Variations in oxidative susceptibility among six low density lipoprotein subfractions of differing density and particle size. Atherosclerosis. 1992;93:189–99.

    Article  CAS  PubMed  Google Scholar 

  49. Galeano NF, Milne R, Marcel YL, Walsh MT, Levy E, Ngu’yen TD, et al. Apoprotein B structure and receptor recognition of triglyceride-rich low density lipoprotein (LDL) is modified in small LDL but not in triglyceride-rich LDL of normal size. J Biol Chem. 1994;269:511–9.

    Article  CAS  PubMed  Google Scholar 

  50. Anber V, Griffin BA, McConnell M, Packard CJ, Shepherd J. Influence of plasma lipid and LDL-subfraction profile on the interaction between low density lipoprotein with human arterial wall proteoglycans. Atherosclerosis. 1996;124:261–71.

    Article  CAS  PubMed  Google Scholar 

  51. Mongraw-Chaffin M, Foster MC, Anderson CAM, Burke GL, Haq N, Kalyani RR, et al. Metabolically Healthy Obesity, Transition to Metabolic Syndrome, and Cardiovascular Risk. J Am Coll Cardiol. 2018;71:1857–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Tang X, Wu M, Wu S, Tian Y. Continuous metabolic syndrome severity score and the risk of CVD and all-cause mortality. Eur J Clin Invest. 2022;52:e13817.

    Article  PubMed  Google Scholar 

  53. Guay AT. ED2: erectile dysfunction = endothelial dysfunction. Endocrinol Metab Clin North Am. 2007;36:453–63.

    Article  PubMed  Google Scholar 

  54. 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  PubMed  Google Scholar 

  55. Gandaglia G, Briganti A, Jackson G, Kloner RA, Montorsi F, Montorsi P, et al. A systematic review of the association between erectile dysfunction and cardiovascular disease. Eur Urol. 2014;65:968–78.

    Article  PubMed  Google Scholar 

  56. Johannes CB, Araujo AB, Feldman HA, Derby CA, Kleinman KP, McKinlay JB. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. J Urol. 2000;163:460–3.

    Article  CAS  PubMed  Google Scholar 

  57. Maas R, Schwedhelm E, Albsmeier J, Böger RH. The pathophysiology of erectile dysfunction related to endothelial dysfunction and mediators of vascular function. Vasc Med. 2002;7:213–25.

    Article  PubMed  Google Scholar 

  58. O’Donnell AB, Araujo AB, Goldstein I, McKinlay JB. The validity of a single-question self-report of erectile dysfunction. Results from the Massachusetts Male Aging Study. J Gen Intern Med. 2005;20:515–9.

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

Funding

The National Natural Science Foundation of China (Grant No. 82071637).

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Author notes

  1. These authors contributed equally: Yuyang Zhang, Xu Wu, Guodong Liu.

Authors and Affiliations

  1. Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China

    Yuyang Zhang, Xu Wu, Guodong Liu, Wei Zhang & Xiansheng Zhang

  2. Institute of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China

    Yuyang Zhang, Xu Wu, Guodong Liu, Wei Zhang & Xiansheng Zhang

  3. Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, Anhui, China

    Yuyang Zhang, Xu Wu, Guodong Liu, Wei Zhang & Xiansheng Zhang

  4. Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China

    Xingliang Feng

  5. Department of Urology, The First People’s Hospital of Changzhou, Changzhou, Jiangsu, China

    Xingliang Feng

  6. Department of Urology, Peking University First Hospital Institute of Urology, Peking University Andrology Center, Beijing, China

    Hui Jiang

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YYZ conceived/designed the work that led to the submission, acquired data, played an important role in interpreting the results, drafted and revised the manuscript, approved the final version, and agreed to be accountable for all aspects of the work. XW acquired data, played an important role in interpreting the results, drafted the manuscript, approved the final version, and agreed to be accountable for all aspects of the work. GDL acquired data, revised the manuscript, approved the final version, and agreed to be accountable for all aspects of the work. XLF, HJ, and XSZ conceived/designed the work that led to the submission approved the final version, and agreed to be accountable for all aspects of the work. WZ acquired data, revised the manuscript, approved the final version, and agreed to be accountable for all aspects of the work.

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Correspondence to Xingliang Feng or Xiansheng Zhang.

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Zhang, Y., Wu, X., Liu, G. et al. Association between cardiometabolic index and erectile dysfunction among US adults: a cross-sectional analysis of the National Health and Nutrition Examination Survey 2001-2004. Int J Impot Res (2023). https://doi.org/10.1038/s41443-023-00801-6

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