ORIGINAL RESEARCH—ENDOCRINOLOGY: Incidence of Metabolic Syndrome and Insulin Resistance in a Population with Organic Erectile Dysfunction


André T. Guay, Center for Sexual Function, Lahey Clinic North Shore, 1 Essex Center Drive, Peabody, MA, USA. Tel: (978) 538-4655; Fax: (978) 538-4712; E-mail: Andre.T.Guay@lahey.org


Introduction.  Advanced age in men is accompanied by an increased prevalence of cardiovascular disease (CVD) and erectile dysfunction (ED). Prior studies revealed that 56% of an ED population have asymptomatic myocardial ischemia, 75% of men with CAD have symptoms of ED, and 91% of our ED patients have cardiovascular risks.

Aim.  Because metabolic syndrome (MS) and insulin resistance (IR) are both predictors of CVD, we wished to evaluate these parameters in our population.

Methods.  Our men (N = 154) were evaluated for multiple cardiovascular risk factors and graded on severity of ED. The severity of ED was evaluated by the Sexual Health Inventory for Men (SHIM) questionnaire. The prevalence of MS was determined by NCEP/ATP III criteria. Insulin resistance was measured by QUICKI.

Main Outcome Measures.  Bivariate associations among total cholesterol/high-density lipoprotein (HDL), triglyceride/HDL, and Quantitative Insulin Sensitivity Check Index (QUICKI) were compared. Chi-square analysis was used to evaluate the relation between the presence and severity of IR with the severity of ED.

Results.  The total cholesterol/HDL ratio was moderately and negatively correlated with QUICKI (r = −0.33; P < 0.01) and similarly for the triglyceride/HDL ratio (r = −0.32; P < 0.01). Metabolic syndrome was present in 43% of our ED population as opposed to 24% in a matched patient population. Approximately 79.2% of our total population had IR and 73.3% of the nondiabetic portion (N = 120) had IR, compared to 26% in a general population study. Metabolic syndrome (P = 0.01), IR (P = 0.01), and fasting blood sugar (FBS) >110 mg/dL (P = 0.01) correlated positively and moderately with increasing severity of ED by SHIM score.

Conclusion.  Men with ED have a high incidence of MS and IR. Early detection of metabolic disease in patients with ED may be a gateway to the reduction endothelial dysfunction in younger men with increased cardiovascular risk but who present for treatment of ED alone.