Posts Tagged "Erectile dysfunction"

Drinking caffeinated beverages may be associated with a lower likelihood of erectile dysfunction (ED), according to study findings presented at the American Urological Association 2014 annual meeting. Lopez, et al., University of Texas Medical School, Houston, and colleagues analyzed data from 3,724 men aged 20 years and older who participated in the National Health and Nutrition Examination Survey (2001-2004), a cross-sectional survey of the general U.S. population. The researchers looked at 24-hour dietary recall to estimate intake of caffeine and caffeinated beverages. Overall, men in the 3rd quintile of total caffeine intake (85-170 mg/day) and the 4th quintile (171-303 mg/day) were less likely to report ED compared with men in the first (reference) quintile (0-7 mg/day).

Among overweight and obese men and those with hypertension, the researchers found a significantly decreased likelihood of reported ED among men in the 2nd, 3rd, 4th, and 5th quintiles compared with the reference quartile, after adjusting for multiple variables. The authors concluded that total caffeine intake equivalent to about 2-3 cups of coffee (250-375 mg/day) is associated with a significantly lower likelihood to report ED. The team noted that their study is strengthened by the use of a large representative sample of men in the U.S. and validated dietary recall methodology from NHANES. As NHANES is a cross-sectional study, they cannot infer causality or suggest a clinical practice change, the researchers pointed out.

Source: Renal And Urology News

Among men with high cholesterol and erectile dysfunction, a short course of statin therapy was associated with improvements in both measures, shows a new meta-analysis. The study was presented at the American College of Cardiology (ACC) 2014 Scientific Sessions and simultaneously published online in the Journal of Sexual Medicine

These findings “may improve adherence to statin therapy . . . [because] we know that in primary prevention a large proportion of patients stop talking [a statin] or take a much lower amount than prescribed,” lead investigator Dr John B Kostis (Rutgers Robert Wood Johnson Medical School New Brunswick, NJ) said during a press briefing. For example, in a 90 000-patient study, 35% took less than a quarter of prescribed statins and 60% took less than half, and in an 11 000-patient study, 47% of patients stopped taking the statin, he said.

Erectile dysfunction is often the first sign of CVD, like the canary in the coal mine, Kostis pointed out. “What do you do with a person who has erectile dysfunction? You evaluate them for CVD.”

“Over the years, it’s become apparent that erectile dysfunction is an indication of decreased vascular health in men and is considered by many to be a significant CV risk factor,” moderator Dr Jeffrey Kuvin (Tufts Medical Center, Boston, MA) echoed. “Whether erectile function improves due to a reduction in LDL-C or perhaps other pleiotropic effects of statins still remains unclear. I think [this] meta-analysis strongly shows that statin therapy improves erectile dysfunction after only a short duration of therapy.”

Erectile dysfunction affects an estimated 18 to 30 million American men, more often after age 40, and common causes include heart disease, high cholesterol, high blood pressure, diabetes, obesity, tobacco use, depression, and stress, according to an ACC statement.

Many older men have erectile dysfunction along with diabetes and atherosclerotic disease, for which they are frequently prescribed statins, Kostis noted. Previous research has suggested, however, that statin therapy may lower testosterone levels.

The investigators searched for randomized controlled trials that examined the effect of statin therapy on erectile function. They identified 11 such trials in which men completed the International Inventory of Erectile Function survey, which consists of five questions, each scored on a five-point scale, where low values represent poor sexual function.

The trials had an average of 53 patients per study, for a total of 647 patients. Men had an average age of 57.8 years and received statins for about 3.8 months.

During this time, average LDL-C levels dropped significantly from 138 to 91 mg/dL in the treated men but were virtually unchanged in control groups.

In men who took statins, erectile-function scores increased by 3.4 points, from 14.0 to 17.4 points—a 24.3% increase. The increase in erectile-function score was about one-third to one-half of that reported with phosphodiesterase inhibitors, such as sildenafil (Viagra, Pfizer), tadalafil (Cialis, Lilly), or vardenafil (Levitra, Bayer/GlaxoSmithKline), and larger than the effect of lifestyle modification or testosterone, Kostis said.

Some people have called statins a “double-edged sword,” he noted. On one hand, they improve endothelial function, which may improve blood flow to the penis; but on the other hand, they lower the level of cholesterol, a precursor of testosterone. However, these 11 studies showed that “the beneficial effect [of statins on erectile dysfunction] predominates.”

Strengths of the meta-analysis were that it included all published randomized trials about the topic, and the benefit remained after multiple sensitivity analyses. However, limitations were the inclusion of small studies with few participants and diverse statins, treatment duration (1.5 to six months), and patient types.

“A well-powered, placebo-controlled trial with a factorial design (for example, phosphodiesterase inhibitors, testosterone, and statin) would clarify the effect of statins in relevant patient subsets,” Kostis concluded. These drugs are not recommended as a primary treatment for erectile dysfunction in patients with normal cholesterol levels, he cautioned—another potential area for further rigorous research.

Source: Medscape