Serum cholesterol and erectile dysfunction

Clinical bottom line

Hyperlipidaemia appears to be somewhat more common in men with erectile dysfunction. Lowering cholesterol is a good thing in itself, and may improve erectile function in some men. The main message is that keeping cholesterol low may well be good for erectile function as well as for other reasons.

Background

Being overweight is known to be associated with erectile dysfunction. Being overweight is also associated with raised serum cholesterol levels.

Search

A brief search looked in PubMed for studies of any design published between 2001 and 2005.

Results

Four studies appeared to be relevant, and are summarised in Table 1. Two of them showed elevated total or LDL cholesterol, or both, in men with erectile dysfunction compared with men without erectile dysfunction of similar age. Another had high rates of higher LDL cholesterol.

A fourth study examined the effects of lowering cholesterol levels with statin in a very small number of men with raised cholesterol as their only risk factor for erectile dysfunction. Most had improved erections, and penile function tests also improved.

Table 1: Recent studies associating serum cholesterol and erectile dysfunction

Reference	Study	Main results
M Nikoobakht et al. Int J Impot Res 2005 17: 523-526 Iran	Comparison of lipid profile of 100 men with organic ED with 100 healthy individuals, mean age 44 years.	Significantly higher total and LDL cholesterol in ED group, but not HDL or triglyceride Odds ratio for total cholesterol >6.2 mmol/L was 1.7, and HDL >4.1 mmo/L was 2.0
EA Saltzman et al. J Urol 2004 172: 255-258 USA	18 men had raised cholesterol as their only risk factor for ED, and 9 participated in the study. Their mean age was 50 years. Atorvastatin for about 4 months decreased serum cholesterol	8 of 9 had improved erections, and IIEF EF scores roase from average of 14 to 21. There was increased penile rigidity.
T Roumeguere et al. Eur Urol 2003 44: 355-359. Belgium	215 men with ED were compared with 100 men without ED, mean age 60 years	Prevalence of total cholesterol >5.2 mmol/L was 71% in ED vs 52% in normal men Increased CHD risk 57% of ED men, 33% in normal men
MK Walczak et al. J Gend Speciif Med 2002 5: 19-24 USA	154 men with ED recruited, who underwent full examination	74% had LDL cholesterol above 3.1 mmol/L, and 79% had BMI above 26

Comment

This is not surprising, and there is even speculation that erectile dysfunction could be an early sign of vascular disease in men, as it is associated with being overweight and sedentary, unless there is a specific cause for ED (like prostate surgery). However, this limited amount of evidence has to be contrasted with suggestions of increased reporting of erectile dysfunction in men on cholesterol-lowering drugs, though again without much evidence.

This is confusing, and it needs more focussed studies to elucidate what is going on.