Negative Impact of Metabolic Syndrome on the Responsiveness to Sildenafil in Japanese Men

Abstract

Introduction Several recent studies suggested that the prevalence of erectile dysfunction (ED) was higher in men with metabolic syndrome (MS). Aim We analyzed the impact of MS on the responsiveness to sildenafil. Methods A total of 133 ED patients were evaluated for the prevalence of MS and graded on severity of ED. MS was diagnosed according to the International Diabetes Federation (IDF) definition. The severity of ED was evaluated by the International Index of Erectile Function (IIEF) questionnaire. Hormonal parameters were measured for all patients, and the IIEF questionnaire was conducted after administration of eight tablets of 50-mg doses of sildenafil. If the scores to questions 3 and 4 of the IIEF were 4 or higher after administration, the patients were defined as responders to sildenafil. Main Outcome Measures To clarify the negative impact of MS on the responsiveness to sildenafil. Results The mean age of the patients was 56.9 years, and 25 patients were diagnosed with MS. The IIEF-erectile function score and the response rate for sildenafil decreased as the number of MS components increased. Logistic regression analysis showed that the presence of MS along with severity of ED and history of pelvic surgery were significant independent risk factors of nonresponse for sildenafil. The hazard ratio for the presence of MS was 3.30 (95% confidence interval [CI]: 1.17–9.73). No meaningful association was observed between total testosterone or free testosterone levels and MS in this population. Conclusion We demonstrated the negative impact of MS on the responsiveness to sildenafil. Erectile function and response rate for sildenafil decreased as the number of MS components increased.

A Comprehensive Review of Metabolic Syndrome Affecting Erectile Dysfunction

“…Thus, combined treatment of PDE5i, vardenafil, and T is effective and safe, and improves erectile function, hormonal, lipid and carbohydrate blood profile, insulin resistance‐related MetS, ED, and overall quality of life [177]. The negative impact of MetS on the responsiveness to sildenafil has been demonstrated [178].…”

The SIAMS-ED Trial: A National, Independent, Multicentre Study on Cardiometabolic and Hormonal Impairment of Men with Erectile Dysfunction Treated with Vardenafil

“…Over the age of 40 years, moderate to severe ED is reported in about 30 to 35% of men [1]. However in men with hypertension the prevalence ranges from 26% to 68% and in those matching the diagnostic criteria for metabolic syndrome (MS) it ranges from 34% to 90% [2–4], with a progressive impairment of erectile function (EF) in parallel with the number of metabolic syndrome criteria met [5]. Since scientific societies revisited the diagnostic criteria for metabolic syndrome, there have been a number of studies describing its association with ED.…”

Treatment Strategy for Non-Responders to PDE5 Inhibitors

“…Furthermore, atorvastatin improved the effects of sildenafil on EF in hypercholesterolemic patients with ED 17. In line with this, Suetomi et al6 demonstrated the negative effect of MS on the response to sildenafil. Although the detailed mechanism is unclear, this result might motivate men to reduce these risk factors, especially those who did not respond to treatment with a PDE5 inhibitor initially.…”

“…Therefore, it is possible that patients with MS respond differently to PDE5 inhibitors. Suetomi et al6 demonstrated the negative impact of MS on the response to sildenafil.…”