Statin Therapy Improves Erectile Function, Study Says

Statins cause a clinically relevant improvement of erectile function, a finding that researchers hope will encourage more men with cardiovascular disease to remain compliant with statin therapy.

“Men who receive statins for the primary or secondary prevention of cardiovascular disease may also perceive an improvement in erectile function,” lead author John B. Kostis, MD, Director of the Cardiovascular Institute and Associate Dean for Cardiovascular Research at Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, told ConsultantLive.

Dr Kostis pointed out that “data do not support the use of statins to improve erectile function in men who are not prescribed statins for prevention of cardiovascular disease.”

Erectile dysfunction is common in older men, especially among those with comorbidities such as diabetes mellitus and atherosclerotic disease, where statins are frequently prescribed. Previous research has suggested a negative association between statin therapy and testosterone levels, leading to questions about the effects of these widely used medications on the quality of erection.

In a meta-analysis of previous studies on erectile dysfunction and statins, Dr Kostis and colleagues identified 11 randomized controlled trials that measured erectile function using the International Inventory of Erectile Function. This is a self-administered survey with 5 questions, each scored on a 5-point scale and totaled, with lower values representing poorer sexual function.

Analysis of all 11 studies combined found a statistically significant effect of statins on erectile function in men who had both high cholesterol levels and erectile dysfunction. Overall, erectile function scores rose by 3.4 points in men who took statins (from 14.0 to 17.4), a 24% increase. “The increase in erectile function scores with statins was more than that observed in the few studies examining the effect of lifestyle change. It was about one-third of what has been reported with phosphodiesterase type 5 (PDE5) inhibitors,” said Dr Kostis.

Statins may affect erectile function through several pathways, including by helping blood vessels dilate properly and improving vascular blood flow to the penis, which often is restricted in men with erectile dysfunction. “Statins may increase availability of nitric oxide, a potent vasodilator of the penile arteries that causes erection,” Dr Kostis said. “In addition, through lowering cholesterol they improve endothelial integrity and function.”

However, cholesterol is a precursor of testosterone, and therefore statins may lower synthesis of testosterone. “The balance was a beneficial effect of statins on erectile function,” Dr Kostis said. “In the studies included in this meta-analysis, overall, the beneficial effects predominated.” Larger studies with longer duration and studies in combination with PDE5 inhibitors or testosterone need to be performed, he noted.

Dr Kostis thinks the results of the study may help improve compliance with statins. “Statins improved erectile function. The more immediate benefit of improving erectile function might help increase adherence to statin therapy among patients who need statins for primary or secondary prevention of cardiovascular disease,” he suggested.

The researchers simultaneously published their results online in the March 29, 2014 issue of the Journal of Sexual Medicine at the time of presentation at the American College of Cardiology’s Annual Scientific Session.