Vitamin D deficiency more common in arteriogenic ED patients

Tuesday, August 26, 2014. An article published online on August 5, 2014, in the Journal of Sexual Medicine reports the finding of researchers from Milan, Italy, of an association between reduced vitamin D levels and a greater risk of erectile dysfunction (ED) caused by arterial factors.

The current study included 50 middle-aged men diagnosed with arteriogenic erectile dysfunction, 28 with borderline ED, and 65 with nonarteriogenic ED as determined by penile echo-color Doppler. Blood samples were analyzed for serum 25-hydroxyvitamin D levels and other factors.

Deficient vitamin D levels, defined by the authors of this study as less than 20 nanograms per milliliter (ng/mL), were uncovered in 45.9% of the participants. Severe deficiency, characterized by a level of less than 10 ng/mL, was observed in 5.6% of the group. Among those with deficient vitamin D levels, 38.6% had complete or severe ED, in comparison with 25.3% of nondeficient men.

In those with arteriogenic ED, vitamin D levels were significantly lower on average in comparison with the borderline and nonarteriogenic ED groups. Sixty-one percent of those with arteriogenic ED were vitamin D deficient in comparison with 30% of the borderline group and 42% of the men with nonarteriogenic ED. Among those with vitamin D levels lower than 20 mg/mL, the prevalence of arteriogenic ED was 45.6%, versus 22.3% in those with higher vitamin levels.

Authors Alessandra Barassi, MD, and her colleagues remark that ED may appear years before cardiovascular disease is diagnosed, possibly due to the smaller size of the arteries involved. "Low vitamin D levels may be an independent, potentially modifiable ED risk factor, particularly for dysfunction of arteriogenic etiology," they write. "We suggest routine measurement of vitamin D in ED patients, with replacement therapy as required."

Researchers at the Mayo Clinic in Rochester, Minnesota, selected six randomized clinical trials that included a total of 740 men with an average age of 55.4 years for their analysis. The trials evaluated the effects of exercise and lifestyle change, a Mediterranean diet, an interval exercise program, weight loss, and treatment with the drug atorvastatin on cardiovascular risk factors. Erectile dysfunction was evaluated via questionnaire responses.

The analysis affirmed that improvements in cardiovascular risk factors were associated with a reduction in erectile dysfunction. Separate analyses of lifestyle and drug treatment were also both associated with a significant benefit.

"Therapies currently used for the treatment of ED include oral therapy with phosphodiesterase type 5 (PDE-5) inhibitors, which are highly effective in the treatment of ED," the authors write. "However, we demonstrate that cardiovascular risk factor reduction improves ED even in men who are not responsive to PDE-5 inhibitors."

"Our findings suggest that cardiovascular risk factor reduction provides incremental benefits in ED well beyond that achieved with the use of PDE-5 inhibitors," they add. "Adoption of lifestyle modifications and cardiovascular risk factor reduction will provide incremental benefit regardless of PDE-5 inhibitor use."

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Health Concern

Erectile Dysfunction

This is because erectile dysfunction and CVD share similar risk factors, including aging, hypertension, obesity, and a sedentary lifestyle (Hannan 2009; Ewane 2012; Nunes 2012). Furthermore, erectile dysfunction itself has been shown to independently increase the risk of CVD, stroke, and all-cause death (Kolodny 2011; Heidelbaugh 2010). Since erectile dysfunction often precedes some cardiovascular events by 2–5 years (Nehra 2012), erectile dysfunction is viewed as a potential early warning sign for CVD (Meldrum 2011). Early detection is critical since CVD is a major cause of disability and death (Ewane 2012). The abbreviation "ED" can help make this issue easy to understand and remember. For instance, "ED" stands not only for "Erectile Dysfunction", but also "Endothelial Dysfunction", "Exercise & Diet" (for prevention), and "Early Detection" of risk factors, which can help avoid "Early Death" due to CVD (Jackson 2006).

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