Background: Erectile dysfunction (ED) is associated with cardiovascular events. High-sensitivity C-reactive protein (hsCRP) is a cardiovascular risk marker. The aim of this study is to determine whether hsCRP is useful in evaluating ED. Methods: In 121 patients with ED, age, ED type and severity, time since onset of ED, weight, height, BMI, body fat percentage, waist and hip circumference, hsCRP and hormone profile were studied. Patients were classified as low or moderate-high cardiovascular risk based on hsCRP levels. A descriptive and univariate study was performed. A logistic regression was used to establish factors associated with low versus moderate-high cardiovascular risk and hsCRP. Results: Most patients had moderate-severe ED (70%). 74% had a moderate-high cardiovascular risk based on hsCRP levels, and 33.9 and 34.7% had hypogonadism according to total (TT) and free testosterone. In the univariate analysis, a relationship between hsCRP and TT and physical examination variables was observed (p < 0.05). In the multivariate analysis, TT was found to be a predictor (OR: 0.676; 95% CI: 0.491-0.029). Higher cardiovascular risk was found in the hypogonadic group (OR: 5.51; 95% CI: 1.185-25.662) and waist- to-hip ratio (p = 0.008; OR: 1.361; 95% CI: 1.075-1.612). Conclusions: A majority of patients with ED have high cardiovascular risk based on hsCRP levels and there is an association with hypogonadism and obesity.

1.
Martín-Morales A, Sánchez-Cruz J, Saenz de Tejada I, Rodríguez-Vela L, Jimenez-Cruz J, Burgos-Rodríguez R: Prevalence and independent risk factors for erectile dysfunction in Spain: results of the Epidemiologia de la Disfunción Eréctil Masculina Study. J Urol 2001;166:569-575.
2.
Kawanishi Y, Lee KS, Kimura K, et al: Screening of ischemic heart disease with cavernous artery blood flow in erectile dysfunctional patients. Int J Impot Res 2001;13:100-103.
3.
Blaha MJ, Budoff MJ, DeFilippis AP, Blankstein R, Rivera JJ, Agatston A, O'Leary DH, Lima J, Blumenthal RS, Nasir K: Associations between C-reactive protein, coronary artery calcium and cardiovascular events: implications for the JUPITER population from MESA, a population-based cohort study. Lancet 2011;378:684-692.
4.
Bank AJ, Billups KL, Kaiser DR, Kelly AS, Wetterling RA, Tsai MY, Hanson N: Relation of C-reactive protein and other cardiovascular risk factors to penile vascular disease in men with erectile dysfunction. Int J Impot Res 2003;15:231-236.
5.
Chiurlia E, D'Amico R, Ratti C, Granata A, Romagnoli R, Modena M: Subclinical coronary artery atherosclerosis in patients with erectile dysfunction. J Am Coll Cardiol 2005;46:1503-1506.
6.
Dandona P, Dhindsa S: Update: hypogonadotropic hypogonadism in type 2 diabetes and obesity. J Clin Endocrinol Metab 2011;96:2643-2651.
7.
Guay A, Jacobson J: The relationship between testosterone levels, the metabolic syndrome (by two criteria), and insulin resistance in a population of men with organic erectile dysfunction. J Sex Med 2007;4:1046-1055.
8.
Lukacs B: Assessment of male sexual function. Prostate Cancer Prostatic Dis 2001;4 (suppl 1):S7-S11.
9.
Vermeulen A, Verdonck L, Kaufman JM: A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab 1999;84:3666-3672.
10.
Wang C, Nieschlag E, Swerdloff R, Behre HM, Hellstrom WJ, Gooren LJ, Kaufman JM, Legros JJ, Lunenfeld B, Schulman C, Thompson M, Weidner W, Wu W: Investigation, treatment and monitoring of late onset hypogonadism in males: ISA, ISSAM, EAU, EAA and ASA recommendations. J Androl 2009;30:1-9.
11.
Bassuk S, Rifai N, Ridker P: High-sensitivity C-reactive protein: clinical importance. Curr Probl Cardiol 2004;29:439-493.
12.
Taskinen MR: Is metabolic syndrome the main threat to human health in the twenty-first century? Arterioscler Thromb Vasc Biol 2007;27:2275.
13.
European Group for the Study of Insulin Resistance (EGIR): Frequency of the WHO metabolic syndrome in European cohorts, and alternative definition of an insulin resistance syndrome. Diabetes Metab (Paris) 2002;28:364-376.
14.
Alberti KG, Eckel RH, Grundy SM, Simmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, et al: Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heath, Lung and Blood institute; American Heath Association; World Hearth Federation; International Atherosclerotic Society; and International Association for the Study of Obesity. Circulation 2009;120:1640-1645.
15.
Sairam K, Kulinskaya A, Bousted GB, Hanbury DC, McNicholas TA: Prevalence of undiagnosed diabetes mellitus in male erectile dysfunction. BJU Int 2001;88:68-71.
16.
Montorsi P, Ravagnani PM, Galli S, Salonia A, Briganti A, Werba J, Montorsi F: Association between erectile dysfunction and coronary artery disease: matching the right target with the right test in the right patient. Eur Urol 2006;50:721-731.
17.
Martínez-Jabaloyas JM, Queipo A, Pastor F, Gil M, Chuan P: Testosterone levels in men with erectile dysfunction. BJU Int 2006;97:1278-1283.
18.
Corona G, Monami M, Rastrelli G, Aversa A, Tishova Y, Saad F, Lenzi A, Forti G, Mannuci E, Maggi M: Testosterone and metabolic syndrome: a meta-analysis study. J Sex Med 2011;8:272-283.
19.
Vlachopuolos C, Rokkas K, Ioakeimidis N, Stefanadis C: Inflammation, metabolic syndrome, erectile dysfunction and coronary artery disease: common links. Eur Urol 2007;52:1590-1600.
20.
Ridker PM, Danielson E, Fonseca FA, Genest J, Goto AM Jr, Kastelein JJ, Koenig W, Libby P, Lorenzatti AJ, Macfadyen JG, Nordestgaard BG, Shepherd J, Willerson JT, Glynn RJ, JUPITER Trial Study Group: Reduction in C-reactive protein and LDL-cholesterol and cardiovascular event rates after initiation of rosuvastatin: a prospective study of the JUPITER trial. Lancet 2009;373:1175-1182.
21.
Libby P, Ridker PM, Maseri A: Inflammation and atherosclerosis. Circulation 2002;105:1135-1143.
22.
Zambon JP, De Mendoza RR, Langer M, Karam A, Santos R, Maluf JA, Roger E: Cardiovascular and metabolic syndrome risk among men with and without erectile dysfunction: case-control study. Sao Paulo Med J 2010;128:137-140.
23.
Kaplan SA, Johnson-Levonas AO, Lin J, Shan AK, Meehan AG: Elevated high sensitivity C-reactive protein levels in aging men with low testosterone. Aging Male 2010;13:108-112.
24.
Ho SC, Chen YM, Woo JL, Leung SS, Lam TH, Janus ED: Association between anthropometric indices and cardiovascular risk factors. Int J Obes Relat Metab Disord 2001;25:1689-1697.
25.
Magnani JW, Lopez FL, Maclehose RF, Crow RS, Alonso A: P wave indices, obesity and the metabolic syndrome: the atherosclerosis risk in communities study. Obesity (Silver Spring) 2012;20:666-672.
26.
Pitsavos C, Panagiotakos DB, Tzima N, Lentzas Y, Chrysohoou C, Das UN, Stefanadis C: Diet, exercise, and C-reactive protein levels in people with abdominal obesity: the ATTICA epidemiological study. Angiology 2007;58:225-233.
27.
Wu XY, Mao JF, Lu SY, Zhang Q, Shi YF: Testosterone replacement therapy improves insulin sensitivity and decreases high sensitivity C-reactive protein levels in hypogonadotropic hypogonadal young male patients. Chin Med J 2009;122:2846-2850.
28.
Makhsida N, Shah J, Yan G, Fisch H, Shabsigh H: Hypogonadism and metabolic syndrome: implications for the testosterone therapy. J Urol 2005;174:827-834.
29.
Aversa A, Bruzziches R, Francomano D, Rosano G, Isidori AM, Lonzi A, Spera G: Effects of testosterone undecanoate on cardiovascular risk factors and atherosclerosis in middle-aged men with late-onset hypogonadism and metabolic syndrome: a 24-month, randomized, double-blind, placebo controlled study. J Sex Med 2010;7:3495-3503.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.