Statins for erectile dysfunction proposed

By Caroline Price

Family doctors should offer men with erectile dysfunction (ED) treatment with a statin - not only to improve their quality of life but also to reduce their future cardiovascular risk.

So say UK researchers who report that treatment with simvastatin for 6 months improved sexual health-related quality of life and reduced 10-year cardiovascular risk in a study of 173 men aged 40 years or older with ED.

The team argues that, although erectile function was not significantly improved by simvastatin, the approach was beneficial overall ‑ and cost-effective.

None of the men in the study were considered to be at high cardiovascular risk, but Daksha Trivedi (University of Hertfordshire, UK) and colleagues explain that ED is often associated with endothelial dysfunction and is recognized as a marker for underlying vascular disease.

In their randomized trial, conducted in UK primary care practices, men who received 40 mg simvastatin daily had a statistically greater improvement in male ED-specific quality of life measures than did men who received placebo, at 5% versus 2%. A greater benefit was seen with simvastatin in men with severe ED, with corresponding improvements of 12% versus 5%.

Improvement in erectile function (on the International Index of Erectile Function-5 score) with simvastatin was not statistically greater than that with placebo, however (mean change in score, 1.28 vs 0.07).

Nevertheless, Trivedi and team report, both low-density lipoprotein levels and estimated 10-year cardiovascular risk were significantly reduced in the simvastatin group.

Based on their results, the probability that simvastatin treatment of ED would be cost-effective was 86% at the willingness-to-pay threshold of £ 20,000 (US$ 31,080; € 25,001), and 83% at the threshold of £ 30,000 (US$ 46,615; € 37,499).

"Identifying men with ED provides the opportunity to modify future cardiovascular risk and improve male ED-specific quality of life," write the authors, reporting their findings in BJU International.

They say their findings "could influence primary care practice in a number of ways, such as including questions on ED during routine consultations, relevant clinic protocols (eg, diabetes, hypertension, heart disease) and in men with lower urinary tract symptoms."

Furthermore, they add: "Raising awareness of the links between ED and cardiovascular disease provides an opportunity to provide lifestyle advice."

The team calls for larger trials with longer follow up and using a more potent statin to establish the effects on erectile function and cost-effectiveness.

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