Men with erectile dysfunction had a better than threefold improvement in erectile function after receiving statin treatment compared with men randomized to placebo in a meta-analysis of 11 controlled studies with a total of more than 600 patients.
Although the result suggests that statin treatment helps men with erectile dysfunction (ED), the evidence is not strong enough to warrant starting statin treatment when the patient has no established indication for the drug, said Dr. John B. Kostis, who summarized the results of the study during a webcast held prior to the annual meeting of the American College of Cardiology, where he is presenting the data.
He called for a multifactorial trial that could assess the roles for statin, treatment, a phosphodiesterase type 5 inhibitor,and testosterone treatment both individually and in combinations.
Dr. John B. Kostis
"Erectile dysfunction is the canary in the coal mine. It can be the first sign of cardiovascular disease," said Dr. Kostis, John G. Detwiler professor of cardiology, professor of medicine and pharmacology, and director of the Cardiovascular Institute at the Rutgers Robert Wood Johnson Medical School in New Brunswick, N.J. "When a man has erectile dysfunction and no explanation like prostatectomy, he should be evaluated for his cardiovascular risk and treated with a statin if that’s justified," he said during the webcast.
"Over the years it’s become apparent that erectile dysfunction is an indication of reduced vascular health in men, and it is considered by many to be a significant cardiovascular disease risk factor," commented Dr. Jeffrey T. Kuvin of the division of cardiology at Tufts Medical Center in Boston. "The results of this meta-analysis strongly show that statin treatment improves erectile dysfunction after only a short duration of treatment. Whether erectile dysfunction improves because of reduced levels of low-density lipoprotein cholesterol or other pleiotropic effects of statins remains unclear," said Dr. Kuvin.
Dr. Kostis and his associate reviewed 11 randomized controlled trials that compared the effect of statin treatment on erectile function with placebo as a primary or secondary endpoint. The 11 studies involved a total of 647 men with ED and an average age of 58 years. The average duration of treatment was 4 months. On statin treatment the average level of LDL cholesterol fell from 138 mg/dL at baseline to 91 mg/dL, while men on placebo had no meaningful change in their LDL cholesterol level.
The meta-analysis showed that after treatment with a statin for an average of 4 months, the level of erectile function increased 3.4-fold compared with patients in the placebo group. "This benefit is clinically relevant. It’s about a third of what’s achieved with a phosphodiesterase type 5 inhibitor, and perhaps slightly more than what is achieved with nondrug treatments," Dr. Kostis said. The analyses he and his associate ran did not examine the impact of individual statin types or dosages, and he said that even though the study combined results from 11 studies, the overall number of patients remained relatively small.
Dr. Kostis noted that three actions of statins may contribute to the effect seen. Improved erectile function could result from the cholesterol-lowering effect and from their pleiotropic effects, such as boosting blood levels of nitric oxide, acting as antioxidants, and in general improving vascular function. "Erectile dysfunction is also endothelial dysfunction," Dr. Kostis said. Statin treatment may also worsen erectile function by reducing testosterone production as a consequence of reduced cholesterol. The net effect of statins likely results from all three of these pathways.
Dr. Kostis said that he had no relevant financial disclosures. Dr. Kuvin had no financial disclosures.
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