Erectile Dysfunction, Metabolic Syndrome, and Cardiovascular Risks

Facts and Controversies

Edward Sanchez; Alexander W. Pastuszak; Mohit Khera


Transl Androl Urol. 2017;6(1):28-36. 

In This Article

Shared Risk Factors

Several studies have demonstrated that common CVD risk factors are also risk factors for ED, including age, hypertension, diabetes, insulin resistance, smoking, increased body mass index (BMI), cholesterol, and decreased levels of high-density lipoprotein (HDL) cholesterol.[4] In a large, prospective study, Fung et al. assessed seven classic CVD risk factors in male subjects and subsequently evaluated these men for ED 25 years later. Mean age, BMI, cholesterol, and triglycerides were all significantly associated with an increased risk of ED.[5] A review of the Massachusetts Male Aging Study (MMAS) revealed that, after adjusting for age, a higher probability of ED correlated with a history of prior heart disease, hypertension, and diabetes.[6] A follow-up study revealed that cigarette smoking almost doubled the likelihood of moderate or complete ED.[7]

In obese men with a sedentary lifestyle, a significantly higher incidence of ED is observed than in normal men.[8] Obesity also increases the risk of ED as a function of BMI. A multivariate analysis performed in a cohort study of 22,086 American men found that, compared to men with BMI <25 kg/m2, those with a BMI of 25–26.9 kg/m2 had a 19% increased risk of developing ED, while those with BMI 27–29.9 kg/m2 had a 33% increased risk of developing ED.[9]

The link between ED and another known CVD risk factor, diabetes mellitus, is also strong. Males with both type 1 and type 2 diabetes are at increased risk of ED when compared with non-diabetic men.[10] The prevalence of ED in diabetic males ranges from 35–90%.[11] Kalter-Leibovici et al. observed severe ED in nearly one third of men with diabetes and noted that ED worsened in severity with both advancing age and diabetes duration.[12]