Content area
Full Text
Key words:
Summary
Epidemiological studies have shown that elevated serum cholesterol and reduced high density lipoprotein (HDL) cholesterol levels are associated with an increased risk of erectile dysfunction (ED). This is another example of the link between ED and atherosclerosis,
Whether correcting a dyslipidaemic profile will result in a reduced risk of developing ED has not been established. Similarly, it is not known if such an intervention will improve symptoms in patients with established ED. The situation is further complicated by the likelihood that one of the rarer side-effects of fibrates and statins is ED.
There is a need for appropriately designed trials to establish if intervening with statins or fibrates is beneficial on a short- or long-term basis for the treatment orprevention of ED.
Background
The association between atherosclerotic arterial disease and erectile dysfunction is well-established. Perhaps its best-- known, if its also most extreme manifestation, is the Leriche syndrome described in the 1920s, comprising erectile dysfunction, claudication of the buttocks and aorto-iliac atherosclerosis. Since then it has become clear that erectile dysfunction can be associated with much less extensive and more patchy arterial disease, anywhere between the aorta and the penile arteries'. It is therefore a reasonable inference that risk factors for atherosclerotic arterial disease will also be risk factors for impotence. These include hypertension, diabetes and smoking, as well as the lipid disorders that are the subject of this article. While this topic has been explored in the last decade, it has not perhaps received as much attention as one might have expected.
Epidemiology
The largest relevant study up until now has been the Massachusetts Male Aging Study (MMAS)^sup 2^. This included a self-administered questionnaire given to 1290 men between the ages of 40 and 70 years, which revealed a 52% incidence of some degree of erectile dysfunction, with two-- thirds of these reporting moderate or total impotence. Interestingly, there was no correlation between impotence and total cholesterol levels, but a very clear one between concentrations of high-density lipoproteins (HDL) and erectile dysfunction. In men between 40 and 55 years the incidence of moderate impotence increased from 6.7 to 25% as HDL cholesterol decreased from 90 to 30mg/dl (2.3 to 0.8mmol/L). It is...