European Journal of Cardiovascular Medicine

Erectile dysfunction (ED) is defined as the persistent inability to attain or maintain an erection sufficient for satisfactory sexual performance. It is a common yet often underreported condition that significantly impacts the quality of life, emotional well-being, and interpersonal relationships of affected individuals [1,2]. While psychological factors contribute to its etiology, growing evidence supports the predominance of vascular and metabolic factors in its pathophysiology. In particular, ED is closely associated with chronic conditions such as atherosclerosis, diabetes mellitus, hypertension, and dyslipidemia, all of which impair penile hemodynamics through endothelial dysfunction and reduced nitric oxide availability [3].

Dyslipidemia, characterized by elevated levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglycerides, and/or decreased high-density lipoprotein cholesterol (HDL-C), contributes to atherosclerotic plaque formation in vascular beds, including the penile arteries. This impairs vasodilation and penile perfusion, leading to erectile dysfunction. Several studies have reported a high prevalence of dyslipidemia among patients with ED, especially in those with underlying metabolic disorders like type 2 diabetes mellitus (T2DM) [2,4].

In India and other developing regions, the dual burden of dyslipidemia and ED is escalating due to sedentary lifestyles, poor dietary habits, and increasing incidence of diabetes and obesity [1,5,6]. Despite this, there is limited region-specific data, particularly from tertiary care settings, examining the independent role of dyslipidemia in the development of ED

This study was undertaken to assess the prevalence of dyslipidemia among men with erectile dysfunction and to determine whether dyslipidemia serves as an independent risk factor for ED in a sample of adult males attending a tertiary care centre in Kurnool, Andhra Pradesh.

Study Design and Setting

This study was a hospital-based cross-sectional analytical study conducted in the Department of General Medicine at Kurnool Medical College, Kurnool, a tertiary care teaching hospital in Andhra Pradesh, India. The study was conducted over a period of one year, from November 2022 to October 2023.

Study Population

The study included 100 male participants, aged between 30 and 65 years, who attended the outpatient or inpatient departments of the hospital during the study period. Participants were recruited using convenient sampling.

Inclusion Criteria

• Male patients aged 30–65 years
• Willing to give informed consent
• Able to complete the erectile function questionnaire

Exclusion Criteria

History of psychiatric illness or neurological disorders

• Previous pelvic or spinal surgery
• Use of medications known to impair sexual function (e.g., antidepressants, antipsychotics, beta-blockers)
• Known hormonal disorders affecting erectile function

Assessment of Erectile Dysfunction

Erectile dysfunction was evaluated using the International Index of Erectile Function-5 (IIEF-5) questionnaire. A score of ≤21 was considered indicative of ED, with further categorization based on severity.

Lipid Profile Assessment

All participants underwent a fasting lipid profile, which included measurements of total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides. Dyslipidemia was defined according to NCEP ATP III guidelines:

Total cholesterol ≥ 200 mg/dL

LDL-C ≥ 130 mg/dL

HDL-C < 40 mg/dL

Triglycerides ≥ 150 mg/dL

Data Collection

Demographic and clinical data were collected using a structured proforma. This included information on age, body mass index (BMI), lifestyle habits (smoking, alcohol), and comorbid conditions (diabetes, hypertension).

Statistical Analysis

All data were compiled and analyzed using SPSS software. Descriptive statistics were used to summarize demographic and clinical characteristics.Chi-square test was applied to compare categorical variables..Independent t-test was used for comparison of continuous variables between groups..Multivariate logistic regression analysis was performed to identify independent risk factors for erectile dysfunction.A p-value of <0.05 was considered statistically significant.

A total of 100 male participants aged between 30 and 65 years were included in the study. Among them, 58 were diagnosed with erectile dysfunction (ED) based on the International Index of Erectile Function (IIEF-5) scores, while 42 participants without ED served as controls.

Prevalence of Dyslipidemia:
Dyslipidemia was observed in 67% of the overall study population. Among participants with ED, 46 individuals (79.3%) had dyslipidemia compared to 21 individuals (50.0%) in the non-ED group. This difference was statistically significant (p = 0.002), indicating a strong association between dyslipidemia and erectile dysfunction (Table 1).

Table 1: Distribution of Erectile Dysfunction and Dyslipidemia

Chi-square test, p = 0.002 (statistically significant)

Figure 1. Distribution of Dyslipidemia among participants with and without Erectile Dysfunction

Lipid Profile Comparison:
Participants with ED exhibited significantly deranged lipid parameters compared to those without ED. Mean total cholesterol and LDL-C levels were markedly higher in the ED group (216.4 ± 32.1 mg/dL and 139.7 ± 24.2 mg/dL, respectively) than in the non-ED group (192.3 ± 29.6 mg/dL and 119.6 ± 20.8 mg/dL, respectively). Conversely, HDL-C was significantly lower in the ED group (35.2 ± 6.5 mg/dL) than in controls (43.1 ± 7.2 mg/dL), while triglyceride levels were significantly elevated in the ED group (181.6 ± 42.8 mg/dL) versus the non-ED group (154.2 ± 37.5 mg/dL). All differences were statistically significant (p < 0.05) (Table 2).

Table 2: Lipid Profile Comparison Between ED and Non-ED Groups

Figure 2. Lipid Profile Comparison Between ED and Non-ED Groups

Risk Factor Analysis:
Multivariate logistic regression analysis demonstrated that dyslipidemia was an independent risk factor for erectile dysfunction, with an odds ratio (OR) of 2.87 (95% CI: 1.31–6.31; p = 0.008). Increasing age and the presence of diabetes were also significantly associated with higher odds of ED (OR = 1.12 and 1.89, respectively). BMI and hypertension were not statistically significant in the final model (Table 3).

Table 3: Logistic Regression Analysis for Risk Factors of Erectile Dysfunction

The present study demonstrated a significant association between dyslipidemia and erectile dysfunction (ED) among adult males attending a tertiary care hospital. A higher prevalence of dyslipidemia was observed among participants with ED (79.3%) compared to those without ED (50.0%), with the difference being statistically significant (p = 0.002). These findings reinforce the growing body of evidence linking lipid abnormalities to ED, highlighting dyslipidemia as a potential modifiable risk factor [7,8].

Elevated levels of total cholesterol, LDL-C, and triglycerides, along with reduced HDL-C levels, were significantly associated with ED in our population. These findings align with earlier studies that have reported dyslipidemia as an independent contributor to endothelial dysfunction and reduced nitric oxide availability—key pathophysiological mechanisms in erectile dysfunction [8,9]. Azad et al. also demonstrated a similar association between lipid derangements and ED in patients with type 2 diabetes mellitus, further supporting the vascular hypothesis in ED pathogenesis [9].

Our multivariate logistic regression analysis confirmed dyslipidemia as an independent predictor of ED (OR = 2.87, p = 0.008), even after adjusting for confounding variables such as age, BMI, diabetes, and hypertension. Age and diabetes also emerged as significant risk factors, consistent with findings from previous population-based and hospital-based studies [10,13]. However, BMI and hypertension did not reach statistical significance in our cohort, which could be due to limited sample size or the presence of overlapping metabolic disturbances.

Additional evidence from international studies supports the broader cardiovascular risk implications of ED. For example, Vrentzos et al. and Romero-Velez et al. highlighted the overlap between dyslipidemia and ED among patients with cardiovascular disease and HIV respectively, suggesting systemic vascular compromise as a common pathway [8,11]. Moreover, ED is now increasingly recognized as an early clinical marker of subclinical cardiovascular disease, particularly in young and middle-aged men [12].

The present findings underscore the need for routine screening of erectile function in men with dyslipidemia, especially those with coexisting diabetes or advancing age. Addressing dyslipidemia through lifestyle modification and pharmacotherapy may yield dual benefits—improving both cardiovascular and sexual health [7,10,14].

Despite the strengths of a well-defined cohort and use of a validated questionnaire (IIEF-5), the study is limited by its cross-sectional design, which precludes causal inference. Other important contributors to ED, such as serum testosterone levels, psychological stress, and physical activity, were not evaluated. Future longitudinal studies with broader metabolic and psychosocial profiling are warranted to confirm and extend these findings.

This study establishes a significant association between dyslipidemia and erectile dysfunction among adult males attending a tertiary care centre. Participants with ED had markedly higher levels of total cholesterol, LDL-C, and triglycerides, and lower HDL-C levels, indicating a strong link between lipid abnormalities and impaired erectile function. Dyslipidemia emerged as an independent risk factor for ED, alongside age and diabetes. These findings emphasize the importance of routine lipid profile screening in men presenting with ED and suggest that early identification and management of dyslipidemia could have dual benefits improving both cardiovascular and sexual health. Further prospective studies are recommended to confirm these associations and explore therapeutic outcomes.

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