Login Register Cart 0
Generic placeholder image

Endocrine, Metabolic & Immune Disorders - Drug Targets

Editor-in-Chief

ISSN (Print): 1871-5303
ISSN (Online): 2212-3873

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Erectile Dysfunction in Patients with Multiple Chronic Conditions: A Cross- Sectional Study

Author(s): Giuseppe Lisco, Nicola Bartolomeo, Maria Isabella Ramunni, Anna De Tullio, Matteo Domenico Carbone, Edoardo Guastamcchia, Giovanni De Pergola, Vincenzo Triggiani and Vito Angelo Giagulli*

Volume 23, Issue 3, 2023

Published on: 05 December, 2022

Page: [396 - 404] Pages: 9

DOI: 10.2174/1871530322666220523130212

Price: $65

Abstract

Background: The prevalence of erectile dysfunction (ED) rises with the number and severity of chronic diseases.

Aims: This cross-sectional study assessed the frequency and severity of ED in patients with multiple chronic conditions.

Methods: The 5-item International Index of Erectile Function questionnaire (IIEF-5) was used to diagnose and classify ED. The Charlson Comorbidity Index (CCI) was used to assess the burden of chronic comorbidity. The primary outcome was to assess the ED frequency according to CCI severity. The secondary outcomes included the assessment of the correlation between 1) IIEF-5 and total testosterone (TT), 2) CCI and TT, and 3) IIEF-5 and CCI. Lastly, the CCI and modified CCI (mCCI) performances were compared with each other.

Results: The overall frequency of ED increased along with the CCI score severity: 45% for CCI=0; 95% for CCI=1; 91% for CCI=2; 99% for CCI≥3 (p<.0001). CCI correlated negatively with TT levels and IIEF-5 score (r=-0.34 and -0.44; p<.0001). Compared to the CCI, a novel proposed mCCI performs well.

Discussion: The frequency and severity of ED are relevant in outpatients with sexual complaints and those with chronic comorbidities. Despite limitations, mCCI may be considered a reliable tool to assess the overall burden of multiple chronic conditions in patients with comorbidities.

Conclusion: ED is a reliable proxy of overall male health. Further studies are needed to confirm this potential application.

Keywords: Erectile dysfunction, Charlson comorbidity index, type 2 diabetes, comorbidities, cross-sectional study.

« Previous Next »
Graphical Abstract

[1]
NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA, 1993, 270(1), 83-90.
[http://dx.doi.org/10.1001/jama.1993.03510010089036] [PMID: 8510302]
[2]
Dong, J.Y.; Zhang, Y.H.; Qin, L.Q. Erectile dysfunction and risk of cardiovascular disease: Meta-analysis of prospective cohort studies. J. Am. Coll. Cardiol., 2011, 58(13), 1378-1385.
[http://dx.doi.org/10.1016/j.jacc.2011.06.024] [PMID: 21920268]
[3]
Zhao, B.; Hong, Z.; Wei, Y.; Yu, D.; Xu, J.; Zhang, W. Erectile dysfunction predicts cardiovascular events as an independent risk factor: A systematic review and meta-analysis. J. Sex. Med., 2019, 16(7), 1005-1017.
[http://dx.doi.org/10.1016/j.jsxm.2019.04.004] [PMID: 31104857]
[4]
Burnett, A.L.; Nehra, A.; Breau, R.H.; Culkin, D.J.; Faraday, M.M.; Hakim, L.S.; Heidelbaugh, J.; Khera, M.; McVary, K.T.; Miner, M.M.; Nelson, C.J.; Sadeghi-Nejad, H.; Seftel, A.D.; Shindel, A.W. Erectile dysfunction: AUA guideline. J. Urol., 2018, 200(3), 633-641.
[http://dx.doi.org/10.1016/j.juro.2018.05.004] [PMID: 29746858]
[5]
Giagulli, V.A.; Moghetti, P.; Kaufman, J.M.; Guastamacchia, E.; Iacoviello, M.; Triggiani, V. Managing erectile dysfunction in heart failure. Endocr. Metab. Immune Disord. Drug Targets, 2013, 13(1), 125-134.
[http://dx.doi.org/10.2174/1871530311313010015] [PMID: 23369145]
[6]
Shamloul, R.; Ghanem, H. Erectile dysfunction. Lancet, 2013, 381(9861), 153-165.
[http://dx.doi.org/10.1016/S0140-6736(12)60520-0] [PMID: 23040455]
[7]
Wu, F.C.; Tajar, A.; Pye, S.R.; Silman, A.J.; Finn, J.D.; O’Neill, T.W.; Bartfai, G.; Casanueva, F.; Forti, G.; Giwercman, A.; Huhtaniemi, I.T.; Kula, K.; Punab, M.; Boonen, S.; Vanderschueren, D. Hypothalamic-pituitary-testicular axis disruptions in older men are differentially linked to age and modifiable risk factors: The European Male Aging Study. J. Clin. Endocrinol. Metab., 2008, 93(7), 2737-2745.
[http://dx.doi.org/10.1210/jc.2007-1972] [PMID: 18270261]
[8]
Wu, F.C.; Tajar, A.; Beynon, J.M.; Pye, S.R.; Silman, A.J.; Finn, J.D.; O’Neill, T.W.; Bartfai, G.; Casanueva, F.F.; Forti, G.; Giwercman, A.; Han, T.S.; Kula, K.; Lean, M.E.; Pendleton, N.; Punab, M.; Boonen, S.; Vanderschueren, D.; Labrie, F.; Huhtaniemi, I.T. Identification of late-onset hypogonadism in middle-aged and elderly men. N. Engl. J. Med., 2010, 363(2), 123-135.
[http://dx.doi.org/10.1056/NEJMoa0911101] [PMID: 20554979]
[9]
Rajfer, J. Relationship between testosterone and erectile dysfunction. Rev. Urol., 2000, 2(2), 122-128.
[PMID: 16985751]
[10]
Castela, A.; Vendeira, P.; Costa, C. Testosterone, endothelial health, and erectile function. ISRN Endocrinol., 2011, 2011, 839149.
[http://dx.doi.org/10.5402/2011/839149] [PMID: 22363891]
[11]
Rastrelli, G.; Corona, G.; Maggi, M. Both comorbidity burden and low testosterone can explain symptoms and signs of testosterone deficiency in men consulting for sexual dysfunction. Asian J. Androl., 2020, 22(3), 265-273.
[http://dx.doi.org/10.4103/aja.aja_61_19] [PMID: 31249270]
[12]
Silva, A.B.; Sousa, N.; Azevedo, L.F.; Martins, C. Physical activity and exercise for erectile dysfunction: Systematic review and meta-analysis. Br. J. Sports Med., 2017, 51(19), 1419-1424.
[http://dx.doi.org/10.1136/bjsports-2016-096418] [PMID: 27707739]
[13]
Cai, X.; Tian, Y.; Wu, T.; Cao, C.X.; Bu, S.Y.; Wang, K.J. The role of statins in erectile dysfunction: A systematic review and meta-analysis. Asian J. Androl., 2014, 16(3), 461-466.
[http://dx.doi.org/10.4103/1008-682X.123678] [PMID: 24556747]
[14]
Glina, F.P.A.; de Freitas Barboza, J.W.; Nunes, V.M.; Glina, S.; Bernardo, W.M. What is the impact of bariatric surgery on erectile function? A systematic review and meta-analysis. Sex. Med. Rev., 2017, 5(3), 393-402.
[http://dx.doi.org/10.1016/j.sxmr.2017.03.008] [PMID: 28526630]
[15]
Charlson, M.E.; Pompei, P.; Ales, K.L.; MacKenzie, C.R. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J. Chronic Dis., 1987, 40(5), 373-383.
[http://dx.doi.org/10.1016/0021-9681(87)90171-8] [PMID: 3558716]
[16]
Austin, S.R.; Wong, Y.N.; Uzzo, R.G.; Beck, J.R.; Egleston, B.L. Why summary comorbidity measures such as the Charlson comorbidity index and Elixhauser score work. Med. Care, 2015, 53(9), e65-e72.
[http://dx.doi.org/10.1097/MLR.0b013e318297429c] [PMID: 23703645]
[17]
Vermeulen, A.; Verdonck, L.; Kaufman, J.M. A critical evaluation of simple methods for the estimation of free testosterone in serum. J. Clin. Endocrinol. Metab., 1999, 84(10), 3666-3672.
[http://dx.doi.org/10.1210/jcem.84.10.6079] [PMID: 10523012]
[18]
Rosen, R.C.; Cappelleri, J.C.; Smith, M.D.; Lipsky, J.; Peña, B.M. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int. J. Impot. Res., 1999, 11(6), 319-326.
[http://dx.doi.org/10.1038/sj.ijir.3900472] [PMID: 10637462]
[19]
Bhasin, S.; Brito, J.P.; Cunningham, G.R.; Hayes, F.J.; Hodis, H.N.; Matsumoto, A.M.; Snyder, P.J.; Swerdloff, R.S.; Wu, F.C.; Yialamas, M.A. Testosterone therapy in men with hypogonadism: An endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab., 2018, 103(5), 1715-1744.
[http://dx.doi.org/10.1210/jc.2018-00229] [PMID: 29562364]
[20]
Salonia, A.; Bettocchi, C.; Carvalho, J. EAU guidelines on Sexual and Reproductive Health., Available from: https://uroweb.org/guideline/sexual-and-reproductive-health/
[21]
Giagulli, V.A.; Castellana, M.; Carbone, M.D.; Pelusi, C.; Ramunni, M.I.; De Pergola, G.; Guastamacchia, E.; Triggiani, V. Weight loss more than glycemic control may improve testosterone in obese type 2 diabetes mellitus men with hypogonadism. Andrology, 2020, 8(3), 654-662.
[http://dx.doi.org/10.1111/andr.12754] [PMID: 31919991]
[22]
Giagulli, V.A.; Carbone, M.D.; Ramunni, M.I.; Licchelli, B.; De Pergola, G.; Sabbà, C.; Guastamacchia, E.; Triggiani, V. Adding liraglutide to lifestyle changes, metformin and testosterone therapy boosts erectile function in diabetic obese men with overt hypogonadism. Andrology, 2015, 3(6), 1094-1103.
[http://dx.doi.org/10.1111/andr.12099] [PMID: 26447645]
[23]
Hackett, G. The burden and extent of comorbid conditions in patients with erectile dysfunction. Int. J. Clin. Pract., 2009, 63(8), 1205-1213.
[http://dx.doi.org/10.1111/j.1742-1241.2009.02088.x] [PMID: 19624788]
[24]
Chrysant, S.G. Antihypertensive therapy causes erectile dysfunction. Curr. Opin. Cardiol., 2015, 30(4), 383-390.
[http://dx.doi.org/10.1097/HCO.0000000000000189] [PMID: 26049386]
[25]
Salonia, A.; Castagna, G.; Saccà, A.; Ferrari, M.; Capitanio, U.; Castiglione, F.; Rocchini, L.; Briganti, A.; Rigatti, P.; Montorsi, F. Is erectile dysfunction a reliable proxy of general male health status? The case for the International Index of Erectile Function-Erectile Function domain. J. Sex. Med., 2012, 9(10), 2708-2715.
[http://dx.doi.org/10.1111/j.1743-6109.2012.02869.x] [PMID: 22897643]
[26]
Favilla, V.; Russo, G.I.; Reale, G.; Leone, S.; Castelli, T.; La Vignera, S.; Condorelli, R.A.; Calogero, A.E.; Cimino, S.; Morgia, G. Predicting erectile dysfunction in sexually active patients seeking prostate health screening: Proposal for a multivariable risk stratification. Int. J. Impot. Res., 2015, 27(6), 201-205.
[http://dx.doi.org/10.1038/ijir.2015.15] [PMID: 26224573]
[27]
García-Cruz, E.; Carrión, A.; Ajami, T.; Álvarez, M.; Correas, M.Á.; García, B.; García, J.V.; González, C.; Portillo, J.A.; Romero-Otero, J.; Simón, C.; Torremadé, J.; Vigués, F.; Alcaraz, A. The patient’s comorbidity burden correlates with the erectile dysfunction severity. Actas Urol. Esp., 2018, 42(1), 57-63.
[http://dx.doi.org/10.1016/j.acuroe.2017.03.012] [PMID: 28641871]
[28]
Kouidrat, Y.; Pizzol, D.; Cosco, T.; Thompson, T.; Carnaghi, M.; Bertoldo, A.; Solmi, M.; Stubbs, B.; Veronese, N. High prevalence of erectile dysfunction in diabetes: A systematic review and meta-analysis of 145 studies. Diabet. Med., 2017, 34(9), 1185-1192.
[http://dx.doi.org/10.1111/dme.13403] [PMID: 28722225]
[29]
Mitidieri, E.; Cirino, G.; d’Emmanuele di Villa Bianca, R.; Sorrentino, R. Pharmacology and perspectives in erectile dysfunction in man. Pharmacol. Ther., 2020, 208, 107493.
[http://dx.doi.org/10.1016/j.pharmthera.2020.107493] [PMID: 31991196]
[30]
Fan, Y.; Hu, B.; Man, C.; Cui, F. Erectile dysfunction and risk of cardiovascular and all-cause mortality in the general population: A meta-analysis of cohort studies. World J. Urol., 2018, 36(10), 1681-1689.
[http://dx.doi.org/10.1007/s00345-018-2318-3] [PMID: 29725807]
[31]
Yannas, D.; Frizza, F.; Vignozzi, L.; Corona, G.; Maggi, M.; Rastrelli, G. Erectile dysfunction is a hallmark of cardiovascular disease: Unavoidable matter of fact or opportunity to improve men’s health? J. Clin. Med., 2021, 10(10), 2221.
[http://dx.doi.org/10.3390/jcm10102221] [PMID: 34065601]
[32]
Harris, M.I.; Klein, R.; Welborn, T.A.; Knuiman, M.W. Onset of NIDDM occurs at least 4-7 yr before clinical diagnosis. Diabetes Care, 1992, 15(7), 815-819.
[http://dx.doi.org/10.2337/diacare.15.7.815] [PMID: 1516497]
[33]
Imam, H.; Sundström, J.; Lind, L. Evaluation of time delay between discovery of a high blood pressure in a health screening survey and hypertension diagnosis. Blood Press., 2020, 29(6), 370-374.
[http://dx.doi.org/10.1080/08037051.2020.1782726] [PMID: 32603237]
[34]
Mirone, V.; Imbimbo, C.; Bortolotti, A.; Di Cintio, E.; Colli, E.; Landoni, M.; Lavezzari, M.; Parazzini, F. Cigarette smoking as risk factor for erectile dysfunction: Results from an Italian epidemiological study. Eur. Urol., 2002, 41(3), 294-297.
[http://dx.doi.org/10.1016/S0302-2838(02)00005-2] [PMID: 12180231]
[35]
Selvin, E.; Burnett, A.L.; Platz, E.A. Prevalence and risk factors for erectile dysfunction in the US. Am. J. Med., 2007, 120(2), 151-157.
[http://dx.doi.org/10.1016/j.amjmed.2006.06.010] [PMID: 17275456]

Rights & Permissions Print Cite
Article Metrics
18
2
© 2024 Bentham Science Publishers | Privacy Policy