Erectile Dysfunction as a Predictor of the Metabolic Syndrome in Aging Men: Results From the Massachusetts Male Aging Study

Purpose

The metabolic syndrome, characterized by central obesity, insulin dysregulation, abnormal lipids and borderline hypertension, is a precursor state for cardiovascular disease. We determined whether erectile dysfunction is predictive of the metabolic syndrome.

Materials and Methods

Data were obtained from the Massachusetts Male Aging Study, a population based prospective cohort observed at 3 points during approximately 15 years (T₁—1987 to 1989, T₂—1995 to 1997, T₃—2002 to 2004). The metabolic syndrome was defined by using a modification of the Adult Treatment Panel III guidelines. The association between erectile dysfunction and the metabolic syndrome was assessed using relative risks and 95% confidence intervals estimated using Poisson regression models.

Results

Analysis was conducted of 928 men without the metabolic syndrome at T₁. There were 293 men with incident metabolic syndrome, of which 56 had erectile dysfunction at baseline. Body mass index and the presence of 1 or 2 conditions constituting the metabolic syndrome definition were the strongest predictors of the metabolic syndrome. The association of erectile dysfunction with the metabolic syndrome (unadjusted RR 1.35, 95% CI 1.01–1.81) was modified by body mass index, with a stronger effect of erectile dysfunction in men with body mass index less than 25 (adjusted RR 2.09, 95% CI 1.09–4.02), and no erectile dysfunction and metabolic syndrome association in men with body mass index 25 or greater (adjusted RR 1.06, 95% CI 0.76–1.50).

Conclusions

Erectile dysfunction was predictive of the metabolic syndrome only in men with body mass index less than 25. This finding suggests that erectile dysfunction may provide a warning sign and an opportunity for early intervention in men otherwise considered at lower risk for the metabolic syndrome and subsequent cardiovascular disease.

Key Words:  impotence , metabolic syndrome X , epidemiology , aging

Abbreviations and Acronyms:  ATP III, Adult Treatment Panel III , BMI, body mass index , BP, blood pressure , CHD, coronary heart disease , CVD, cardiovascular disease , DM, type 2 diabetes , ED, erectile dysfunction , HDL, high density lipoprotein , LR, likelihood ratio , MetS, the metabolic syndrome , MMAS, Massachusetts Male Aging Study , NO, nitric oxide , RR, relative risk