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Erectile dysfunction may be the first clinical sign of insulin resistance and endothelial dysfunction in young men

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Abstract

Objectives

The purpose of this study is to investigate the possible underlying pathogenesis of erectile dysfunction (ED) without well-known etiology in young men under the age of 40 years.

Methods

192 patients and 33 normal controls were enrolled. ED was evaluated by using the International Index of Erectile Function-5 (IIEF-5) questionnaire. Traditional cardiovascular risk factors, hormone levels, and vascular parameters were measured. Insulin resistance (IR) was measured by homeostasis model assessment (HOMA).

Results

Patients with ED had significantly higher levels of systolic blood pressure (SBP), high-sensitivity C-reactive protein (Hs-CRP), high Insulin resistance index (HOMA-IR) and carotid intima–media thickness (IMT), compared with controls. The brachial artery endothelium-dependent flow-mediated vasodilation (FMD) values were significantly lower in ED patients. By multivariate logistic regression analysis, FMD, SBP, Hs-CRP and HOMA-IR were significantly associated with ED. In receiver-operating characteristic (ROC) analysis, FMD was a significant predictor of ED (area under the curve (AUC) 0.933, p < 0.001). The cutoff value of FMD <10.4 % had sensitivity of 81.3 % and specificity of 100 %. HOMA-IR was also proven to be predictor of ED (AUC of HOMA-IR 0.759, p < 0.001).

Conclusions

ED may be the first clinical sign of endothelial dysfunction and a clinical marker of cardiovascular and metabolic diseases. Subclinical endothelial dysfunction and insulin resistance may be the underlying pathogenesis of ED in young patients without well-known etiology. Measurement of FMD, HOMA-IR can improve our ability to predict and treat ED, as well as subclinical cardiovascular disease early in young men.

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Acknowledgments

This work was supported by National Natural Science Foundation (No. 81070488, No. 30871047, Beijing, China), Guangdong Province Science Foundation (No. 2012B 031800288, Guangzhou, China).

Conflict of interest

None declared.

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Authors and Affiliations

  1. Department of Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

    Fengjuan Yao, Donghong Liu, Hong Lin, Yanqiu Liu, Rui Fan & Cuiling Li

  2. Department of Cardiovascular Medicine, Key Laboratory on Assisted Circulation, Ministry of Health, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

    Lijuan Liu & Yan Zhang

  3. Department of Urology and Andrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

    Yanping Huang & Chunhua Deng

Authors
  1. Fengjuan Yao
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  2. Lijuan Liu
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  3. Yan Zhang
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  5. Donghong Liu
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  10. Chunhua Deng
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Corresponding authors

Correspondence to Yan Zhang or Chunhua Deng.

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Yao, F., Liu, L., Zhang, Y. et al. Erectile dysfunction may be the first clinical sign of insulin resistance and endothelial dysfunction in young men. Clin Res Cardiol 102, 645–651 (2013). https://doi.org/10.1007/s00392-013-0577-y

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  • DOI: https://doi.org/10.1007/s00392-013-0577-y

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