Abstract
Objectives Elevated levels of serum homocysteine (Hcy) have been associated with cardiovascular diseases and endothelial dysfunction, conditions closely associated with erectile dysfunction (ED). This meta-analysis was aimed to assess serum Hcy levels in subjects with ED compared to controls in order to clarify the role of Hcy in the pathogenesis of ED. Methods Medline, Embase, and the Cochrane Library were searched for publications investigating the possible association between ED and Hcy. Results were restricted by language, but no time restriction was applied. Standardized mean difference (SMD) was obtained by random effect models. Results A total of 9 studies were included in the analysis with a total of 1320 subjects (489 subjects with ED; 831 subjects without ED). Pooled estimate was in favor of increased Hcy in subjects with ED with a SMD of 1.00, 95% CI 0.65–1.35, p < 0.0001. Subgroup analysis based on prevalence of diabetes showed significantly higher SMD in subjects without diabetes (1.34 (95% CI 1.08–1.60)) compared to subjects with diabetes (0.68 (95% CI 0.39–0.97), p < 0.0025 versus subgroup w/o diabetes). Conclusions Results from our meta-analysis suggest that increased levels of serum Hcy are more often observed in subjects with ED; however, increase in Hcy is less evident in diabetic compared to nondiabetic subjects. This study is registered with Prospero registration number CRD42018087558.
Highlights
Prevalence of erectile disorders increases steadily with aging, from 1 to 10% in men younger than 40 years up to 70–100% in men older than 70 years [1, 2]
Several meta-analysis studies have confirmed the association with consistently elevated levels of homocysteine (Hcy) and the risk of CV diseases: Boushey and colleagues [11] reported a 1.6 OR for coronary artery disease in men following an increase of 5 μmol/l in serum Hcy levels, whereas Clarke et al [12] described that a reduction of 25% of serum Hcy was associated with an 11% lower risk of ischemic heart disease and Initial results from research n = 30
Serum Hcy was significantly higher among subjects with erectile dysfunction (ED) compared to controls (SMD 1.00, p < 0 0001,) (Figure 2)
Summary
Prevalence of erectile disorders increases steadily with aging, from 1 to 10% in men younger than 40 years up to 70–100% in men older than 70 years [1, 2]. ED shares the same risk factors of many cardiovascular (CV) affections [9]. In these regards, hyperhomocysteinemia (HHcy) has sprung into attention for its involvement in endothelial dysfunction [10]. Several meta-analysis studies have confirmed the association with consistently elevated levels of homocysteine (Hcy) and the risk of CV diseases: Boushey and colleagues [11] reported a 1.6 OR (95% CI 1.4–1.7) for coronary artery disease in men following an increase of 5 μmol/l in serum Hcy levels, whereas Clarke et al [12] described that a reduction of 25% of serum Hcy was associated with an 11% lower risk of ischemic heart disease and Initial results from research n = 30. Records excluded No full text = 2 Animal study = 5 Case reports = 2 Reviews = 4 Editorial = 1.
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