Does vitamin D deficiency contribute to erectile dysfunction?

Serum Vitamin D Level and Erectile Dysfunction in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

INTRODUCTION

A few studies involved the relationship between vitamin D and diabetes mellitus (DM) with erectile dysfunction (ED), and no meta-analysis was conducted to pool these data. The main purpose of our study was to examine the changes in serum vitamin D levels in patients with DM combined with ED.

METHODS

An extensive search was performed, including the following words: "erectile dysfunction," "diabetes," and "vitamin D." Databases, including Cochrane Library, PubMed, and Web of Science, were retrieved to identify studies published up to September 30, 2021. Four studies were eligible for our meta-analysis.

RESULTS

The weighted mean difference and their corresponding 95% confidence intervals were calculated to the data we selected. The results showed that the level of vitamin D in DM with ED was significantly lower (12.5 nmol/mL) than patients with diabetes alone (p = 0.002).

CONCLUSION

Our novel meta-analysis suggests that vitamin D may be a risk factor for DM with ED, which can provide a new idea for the treatment and prevention of DM with ED.

Vitamin D and Platelets: A Menacing Duo in COVID-19 and Potential Relation to Bone Remodeling

Global data correlate severe vitamin D deficiency with COVID-19-associated coagulopathy, further suggesting the presence of a hypercoagulable state in severe COVID-19 patients, which could promote thrombosis in the lungs and in other organs. The feedback loop between COVID-19-associated coagulopathy and vitamin D also involves platelets (PLTs), since vitamin D deficiency stimulates PLT activation and aggregation and increases fibrinolysis and thrombosis. Vitamin D and PLTs share and play specific roles not only in coagulation and thrombosis but also during inflammation, endothelial dysfunction, and immune response. Additionally, another ‘fil rouge’ between vitamin D and PLTs is represented by their role in mineral metabolism and bone health, since vitamin D deficiency, low PLT count, and altered PLT-related parameters are linked to abnormal bone remodeling in certain pathological conditions, such as osteoporosis (OP). Hence, it is possible to speculate that severe COVID-19 patients are characterized by the presence of several predisposing factors to bone fragility and OP that may be monitored to avoid potential complications. Here, we hypothesize different pervasive actions of vitamin D and PLT association in COVID-19, also allowing for potential preliminary information on bone health status during COVID-19 infection.

Relation of glycated hemoglobin and vitamin D deficiency with erectile dysfunction in patients with type 2 diabetes mellitus

Erectile dysfunction (ED) is seen very often in the men with type 2 diabetes mellitus (DM). Due to the ability of vitamin D to reduce endothelial damage and oxidative stress, its role in preventing cardiovascular risk has been demonstrated in some studies. Since ED and cardiovascular disease have common pathogenic mechanisms, many studies have evaluated a possible relationship between vitamin D deficiency and ED. Total 120 patients with type 2 diabetes mellitus were evaluated in this study. Vitamin D and HbA1c values were statistically compared according to International Index of Erectile Dysfunction (IIEF-5) scores. 23.3% of 120 patients had mild, 38.3% had mild to moderate, 21.7% had moderate and 16.7% had severe ED. There was statistically difference in vitamin D levels of the patients according to IIEF-5 scores. Also, significant difference was found in HbA1c levels between the patients with severe ED and other groups. Cut-off point for vitamin D and HbA1c were determined according to IIEF-5 score in patients who were divided in to two groups (14.41 and 11.1). A statistically significant correlation was found between both cut-off points and IIEF-5 scores. Our study shows that patients with ED have a vitamin D deficiency and a poor glycemic control.

Novel predictive risk factor of erectile dysfunction: Serum 25-hydroxy vitamin D

The present study aimed to investigate the association between the severity of erectile dysfunction (ED) and serum 25-hydroxy vitamin D. It also sought to determine the cut-off level of serum 25-hydroxy vitamin D for ED. This study included 130 men who had ED between 2018 and 2019. Patients were divided into three groups according to their scores on the international index of erectile function-5 (IIEF-5) Turkish validated short form questionnaire. The serum 25-hydroxy vitamin D results were compared between the groups. The mean age of the patients was 49.28 ± 13.62 years. Groups 1, 2 and 3 included 44 (33.8%) patients with severe ED, 56 (43.1%) patients with moderate ED and 30 (23.1%) patients with mild ED, respectively. Statistical significance was observed between the groups and serum 25-hydroxy vitamin D levels. A positive correlation was detected between the IIEF-5 scores, serum testosterone and serum 25-hydroxy vitamin D levels. A cut-off level for serum 25-hydroxy vitamin D was calculated as 27.32 ng/ml. During multivariate analysis, we found that serum 25-hydroxy vitamin D levels were independent prognostic risk factors for decreased IIEF-5 scores. Decreased serum 25-hydroxy vitamin D levels were associated with decreased IIEF-5 scores. Therefore, vitamin D replacement therapy may improve symptoms.

The relationship between erectile dysfunction severity, mean platelet volume and vitamin D levels

Background: The aim of this study was to evaluate the relationship between mean platelet volume (MPV) and vitamin D levels according to ED severity.Methods: Between October 2015 and September 2017, patients who applied to the andrology outpatient clinic with an ED complaint were retrospectively reviewed. Patients with diabetes, hypertension, hyperlipidemia, malignancy, late-onset hypogonadism and smokers were not included in the study. The International Erectile Function Index-Erectile Function (IIEF-EF) questionnaire was used to assess the levels of erectile function. According to this scoring system, patients were divided into two groups. IIEF score: between 17 and 25 = mild ED (Group 1) and IIEF score between 16 and 0 = moderate-severe ED (Group 2). Blood samples of the patients were taken from antecubital vein and MPV and 25-hydroxyvitamin D [25(OH)D] levels were evaluated.Results: Ninety patients were included in the study (Group 1: n = 41, Group 2: n = 49). The mean age of the patients was 41.07 ± 8.56 and the mean body mass index (BMI) was 27.59 ± 3.91. 25(OH)D levels were found to be statistically lower in Group 2 (18.85 ± 6.09; 13.98 ± 7.10; p = .001). MPV levels were found to be statistically higher in Group 2 (10.05 ± 0.81; 10.78 ± 1.16; p = .001). Correlation between IIEF-EF scores and 25(OH)D levels was positive (p = .03, r = 0.22). There was negative correlation between IIEF-EF scores and MPV and between 25(OH)D levels and MPV levels [p = .003 for IIEF-EF/MPV, p = .04, r = -0.23 for 25(OH)D/MPV].Conclusion: There is a significant positive correlation between ED severity and 25(OH)D levels and there is a significant negative correlation between ED severity and MPV levels.

The Correlations of Clinical and Biochemical Indices of Vitamin D with Erectile Dysfunction

Erectile dysfunction is a multifactorial disease; it has been demonstrated that endothelial dysfunction plays an essential role in the pathogenesis of this disease, and Vitamin D deficiency is considered to favor endothelial lesions.

Our study, based on a group of 58 patients who have erectile dysfunction and a control group of 26 healthy subjects, tends to confirm that low levels of vitamin D could potentiate the severity of erectile dysfunction, promoting endothelial dysfunction.

Statistical analysis using the Pearson’s correlation criteria showed a robust and significant correlation between vitamin D levels and erectile dysfunction severity (ρ=0.752, p<0.000) according to the SHIM (Sexual Health Inventory For Men) questionnaire. Also, in patients with erectile dysfunction, there is a strong association between vitamin D and testosterone levels (ρ=0.728, p<0.000). At the same time, a negative correlation between vitamin D and BMI (ρ=-0.517, p<0.000); cholesterol (ρ=-0.560, p<0.001), and triglycerides(ρ=-0.529, p<0.005) was observed. Also, a moderate correlation between erectile dysfunction severity degree and testosterone levels (ρ=0.544) was also detected, and the same severity parameter of erectile dysfunction correlates negatively with cholesterol levels (ρ=-0.534). In its turn, the testosterone level correlates negatively with other biochemical indices: cholesterol (ρ=-0.694) and triglycerides (ρ=-0.670).

Vitamin D level reduction, concomitantly with decreased testosterone and increased cholesterol, contributes to the development and maintenance of erectile dysfunction, more probably through endothelial mechanisms. The assessment of vitamin D values can be used as an independent marker in erectile dysfunction assessment. Thus, one of the diagnostic tests recommended for erectile dysfunction should be the determination of the vitamin D serum level.

Mean Platelet Volume as a Marker of Vasculogenic Erectile Dysfunction and Future Cardiovascular Risk

Cardiovascular diseases are the main cause of mortality in the Western population, so the attempt to find a marker capable of predicting their early onset is not surprising. It is known that arteriogenic erectile dysfunction (ED) precedes the onset of a major coronary event by several years. However, a marker that is able to early identify those patients who should undergo further diagnostic investigations is, to date, missing. Recent research on this topic has focused on the role of the mean platelet volume (MPV), a marker of platelet activity that is high in most vascular diseases, such as coronary artery disease (CAD), stroke, peripheral artery disease (PAD), and ED. The basic pathophysiological mechanism of all these clinical conditions is atherosclerosis. Platelets play a central role in amplifying this process both indirectly by stimulating endothelial cells to produce inflammatory cytokines and chemokines, and directly through the expression of membrane receptors and the release of molecules that contribute to the formation of atherosclerotic plaque. The objective of this review is to critically analyze the evidence on the role of MPV in predicting the diagnosis and severity of vasculogenic ED and the possibility of using this simple marker as a first step to start a diagnostic process aimed at assessing the cardiovascular risk in these patients.

Serum vitamin D levels and type 2 diabetic erectile dysfunction: A protocol for systematic review and meta-analysis

INTRODUCTION

Diabetic erectile dysfunction (DED) has gradually become a worldwide problem. Due to the mechanism of DED is not clear, it is impossible to treat it pertinently. Recently, some studies have shown that vitamin D is associated with DED, type 2 diabetes mellitus (T2DM) and erectile dysfunction (ED), but there is no systematic review and meta-analysis on the relationship between vitamin D and DED.

METHODS AND ANALYSIS

The databases of English databases (PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Library) and Chinese databases (China National Knowledge Infrastructure, China Biology Medicine Database, Wanfang Database, VIP Database) will be retrieved. The search strategy that will be run in the PubMed and tailored to the other database when necessary is presented in . RevMan 5.3 and Stata 11.0 will be used for Systematic Review and Meta-analysis. This protocol reported under the Preferred Reporting ltems for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement, and we will report the systematic review by following the PRISMA statement.(Table is included in full-text article.) RESULTS:: Through a systematic review, and meta-analysis when necessary, we can obtain the relationship between vitamin D and DED. We will share our findings in the third quarter of 2021.

CONCLUSION

The association between serum vitamin D levels and type 2 diabetic erectile dysfunction will be assessed. Besides, the results of this review may provide some help for clinicians to make decisions.

ETHICS AND DISSEMINATION

Ethical approval is not required as the review is a secondary study based on published literature. The results will be published in a public issue journal to provide evidence-based medical evidence for urologists and andrologists to make better clinical decisions.

PROTOCOL REGISTRATION NUMBER

INPLASY202040164.

Is There an Association Between Vitamin D Deficiency and Erectile Dysfunction? A Systematic Review and Meta-Analysis

Erectile dysfunction (ED) is found very frequently in the male population, in particular in its arteriogenic form, which also represents an important predictor of cardiovascular diseases (CVDs). Some evidence suggests that vitamin D could play a role in cardiovascular risk prevention thanks to its ability to reduce endothelial damage, oxidative stress, the production of inflammatory cytokines, and dyslipidemia. Since ED and CVDs have pathogenic mechanisms in common, numerous studies have evaluated a possible association between vitamin D deficiency (blood concentrations of 25-hydroxyvitamin D < 20 ng/mL) and ED, but with conflicting results. This meta-analysis was therefore performed to clarify the discrepancy of the data so far published. To achieve this, articles have been searched extensively in the Pubmed, MEDLINE, Cochrane, Academic One Files, Google Scholar, and Scopus databases from the first day they were created until January 2020. The search strategy included pertinent Medical Subjects Headings (MeSH) terms. Of the 431 items retrieved, only eight observational studies were included, resulting in a total sample size of 4055 patients. It was found that 25-hydroxyvitaminD (25(OH)D) levels did not show any significant difference between patients with and without ED. However, when patients with vitamin D deficiency only were taken into account, the international index of erectile function (IIEF) score for erectile dysfunction was significantly worse than in controls. This association remained significant even when eugonadal-only patients were considered. Finally, we found that eugonadal patients with severe ED have lower 25(OH)D₃ levels than patients with mild ED. In conclusion, this meta-analysis suggests an association between vitamin D deficiency and the presence of severe forms of ED, independent of testicular function.

Vitamin D and Male Erectile Function: An Updated Review

Literature support that vitamin-D is important for different systems of the human body including, but not limited to endocrine and immune systems, vasculature and endothelial function of the body. Male erectile function depends on many factors and can be perceived as a health indicator of the body. Epidemiological data have shown that vitamin-D deficiency is also associated with erectile dysfunction. In this review, our aim is to interpret the mechanisms by which vitamin-D might regulate anatomy and physiology of penis. Evidence showed that vitamin-D is needed for an adequate erectile function. Briefly, vitamin-D is crucial for a better healthy body and sexual activity.

Vitamin D and health in the Mediterranean countries

Vitamin D, traditionally well known for its role in maintaining optimal health through its contribution to calcium metabolism and skeletal health, has received increased attention over the past two decades, with considerable focus being placed on its nonskeletal benefits. This paper is a narrative review of the nonskeletal health benefits of vitamin D, of particular interest to inhabitants of Mediterranean countries, namely, autism, cancer, cardiovascular disease, chronic obstructive pulmonary disease, dental caries, diabetes mellitus, erectile dysfunction, hypertension, metabolic syndrome, respiratory tract infections, all-cause mortality, and pregnancy and birth outcomes, because of the relatively high incidence and/or prevalence of these disorders in this region. Currently, the best evidence is coming out of observational studies related to serum 25-hydroxyvitamin D [25(OH)D] concentrations. Vitamin D clinical trials have generally been poorly designed and conducted, usually being based on vitamin D dose rather than 25(OH)D concentration. The optimal 25(OH)D concentration is above 75 nmol/l (30 ng/ml), with even better health outcomes in the range of 100-150 nmol/l. Achieving these concentrations with vitamin D₃ supplements will require 1000-4000 IU/day of vitamin D₃. Sensible sun exposure should also be encouraged. Countries should also consider fortifying grain and dairy products with vitamin D₃.

Serum L-carnitine and vitamin D levels may be low among oral sildenafil citrate non-responders

This cross-sectional comparative study aimed to compare serum L-carnitine and 25(OH)D levels between men with ED non-responding for oral sildenafil citrate and healthy volunteers. Overall, 192 men, recruited from two University Hospitals, were allocated into two equal groups of matched age; healthy potent men and men with ED non-responders for oral sildenafil citrate. Oral sildenafil citrate non-responders self-reported inadequate erectile responses after four attempts using 100 mg with the manufacturer's guidelines relative to meals, associated medications, and sexual stimulation/arousal. Exclusion criteria were: diabetes, cardiovascular disorders, beta blockers treatment, morbid obesity, thyroid disorders, post-radical prostatectomy, and hepatic/renal failure. All participants were subjected to; history taking, clinical examination, validated IIEF-5 questionnaire, estimation of serum L-carnitine by calorimetric method and serum 25(OH)D by ELISA method. Compared with potent controls, ED men non-responders for oral sildenafil citrate showed significant decreases in the mean serum L-carnitine level (16.8 ± 3.6 uM/L versus 66.3 ± 11.9 uM/L, P = 0.001), the mean serum 25(OH)D level (21.2 ± 7.1 ng/ml versus 54.6 ± 7.9 ng/mL, P = 0.001) and IIEF-5 score (7.8 ± 2.6 versus 23.9 ± 1.3). Serum L-carnitine showed significant positive correlation with IIEF-5 scores (r = 0.873, P = 001), serum 25(OH)D (r = 0.796, P = 0.001) and significant negative correlation with the age (r = -0.515, P = 0.001). Serum 25(OH)D showed significant positive correlation with IIEF-5 scores (r = 0.855, P = 0.001) and significant negative correlation with the age (r = -0.223, P = 0.005). It is concluded that normal homeostasis of serum L-carnitine and 25(OH)D play a role in male sexual health being significantly decreased in ED non-responding for oral sildenafil citrate.

Effects of Vitamin D Restricted Diet Administered during Perinatal and Postnatal Periods on the Penis of Wistar Rats

Vitamin D deficiency is common in pregnant women and infants. The present study aimed to investigate the effects of vitamin D restricted diet on the Wistar rats offspring penis morphology. Mother rats received either standard diet (SC) or vitamin D restricted (VitD) diet. At birth, offspring were divided into SC/SC (from SC mothers, fed with SC diet) and VitD/VitD (from VitD mothers, fed with VitD diet). After euthanasia the penises were processed for histomorphometric analysis. The VitD/VitD offspring displayed metabolic changes and reduction in the cross-sectional area of the penis, corpus cavernosum, tunica albuginea, and increased area of the corpus spongiosum. The connective tissue, smooth muscle, and cell proliferation percentages were greater in the corpus cavernosum and corpus spongiosum in the VitD/VitD offspring. The percentages of sinusoidal spaces and elastic fibers in the corpus cavernosum decreased. The elastic fibers in the tunica albuginea of the corpus spongiosum in the VitD/VitD offspring were reduced. Vitamin D restriction during perinatal and postnatal periods induced metabolic and structural changes and represented important risk factors for erectile dysfunction in the penis of the adult offspring. These findings suggest that vitamin D is an important micronutrient in maintaining the cytoarchitecture of the penis.

The relationship between vitamin D level and erectile dysfunction in patients with type 2 diabetes mellitus

Recent studies have suggested that a relationship could exist between 25-hydroxyvitamin D [25(OH)D] deficiency and erectile dysfunction (ED). The present study evaluated the relationship between 25(OH)D levels and ED in male patients with type 2 diabetes mellitus (DM). The study included 98 patients with type 2 DM aged between 18-80 years. The International Index of Erectile Function (IIEF-5) Questionnaire was administered. The patients were divided into three groups according to IIEF-5 scoring: IIEF-5 score between 5-10, severe ED; IIEF-5 score between 11-20, moderate ED; IIEF-5 score between 21-25, no ED. Biochemical parameters, 25(OH)D and hormonal analysis tests were obtained in all patients. All parameters were compared between these three groups. Of 98 patients included in the study, 32 had severe ED, 45 had moderate ED and 21 had no ED. The mean age was 55.12 ± 9.39 years and the mean 25(OH)D level was 13.69 ± 8.15 ng/ml. When the three groups were compared, 25(OH)D levels were significantly lower in patients with the IIEF-5 score between 5-10 (p = 0.020). There was a moderate positive relationship between IIEF-5 score and 25(OH)D level (r = 0.21, p = 0.038). The patients with severe ED have considerably lower 25(OH)D levels.

The role of vitamin D supplementation on erectile function

In the last few years growing evidence highlighted vitamin D (VD) deficiency is one of the several dynamics that associates with increased atherosclerotic cardiovascular (ASCV) diseases. ASCV diseases and erectile dysfunction (ED) share common risk factors such as diabetes mellitus, hypertension, smoking, hyperlipidemia, and a sedentary lifestyle. The aim of this review was to summarize current progress in VD research by focusing effect of low VD level on different body systems and erectile function. Here we examine research linking VD deficiency and ED and discuss how VD influences ED and its classic risk factors that also associate to increased ED risk. We also summarize research indicating that VD associates with reduced risk of several nonvascular contributing factors for ED. Available literature demonstrates relatively high rates of low VD serum levels in ED patients. Based on the preclinical and clinical data available in the literature, to date, we infer that VD play a critical role in maintaining erectile function in humans. Nevertheless, this should also be tested through randomized controlled studies on the effect of VD supplementation with larger population.

Vitamin D treatment improves levels of sexual hormones, metabolic parameters and erectile function in middle-aged vitamin D deficient men

BACKGROUND

The associations between serum vitamin D (VD), serum testosterone (TT) and metabolic syndrome are complex and with limited published research, particularly on the effects of VD treatment on sexual hormones, erectile function and the metabolic syndrome.

OBJECTIVES

This study assessed whether a monthly high dose VD treatment for 12 months in VD deficient middle-aged men was associated with: changes in levels of sexual hormones, improvement of diabetes control and metabolic syndrome components, better erectile function [International Index of Erectile Function (IIEF)-5 questionnaire]; and changes in a prostate marker.

MATERIALS AND METHODS

Descriptive research of a prospective study, conducted between October 2014 and September 2015, 102 male patients ≥35 [(±SD: 53.2 ± 10.5), (range 35-64)] years with deficient serum VD level (<30 ng/mL) were included in the study. Participants were followed up for one year, with monitoring at 3-, 6-, 9- and 12-months. At the initial baseline visit, a complete medical examination was conducted, and blood was drawn for laboratory tests for above biochemical and hormonal variables under examination. Participants received an initial VD (Ergocalciferol; oral solution 600 000 IU/1.5 ml), and followed a VD treatment regime thereafter. At the four follow up visits (3, 6, 9 and 12 months), blood was collected, and patients' erectile function was evaluated by IIEF-5 questionnaire.

MAIN OUTCOME MEASURES

During the follow up visits, all the biochemical and hormonal (TT, estradiol and luteinizing hormones, HbA1c, serum lipids profile) were assessed, and patients' erectile function was evaluated by IIEF-5 questionnaire.

RESULTS

Patients' mean age was 53.2 ± 10.4 years. Serum VD exhibited significant increments (p <0.001) from baseline (15.16 ± 4.64 ng/mL), to 3 (31.90 ± 15.99 ng/mL), 6 (37.23 ± 12.42 ng/mL), 9 (44.88 ± 14.49 ng/mL) and 12 months (48.54 ± 11.62 ng/mL), and there was significant stepladder increases in both serum TT level (12.46 ± 3.30 to 15.99 ± 1.84 nmol/L) and erectile function scores (13.88 ± 3.96 to 20.25 ± 3.24) (p <0.001 for both). We also observed significant stepladder decreases in estradiol (87.90 ± 27.16 to 69.85 ± 14.80 pmol/L, p = 0.001), PTH (from 58.52 ± 28.99 to 38.33 ± 19.44 pg/mL, p <0.001) and HbA1c levels (7.41 ± 2.85 to 6.66 ± 1.67%, p = 0.001). Mean BMI significantly decreased from 33.91 ± 6.67 to 33.14 ± 6.35 kg/m² (p = 0.001); and PSA values significantly increased from 0.59 ± 0.30 to 0.82 ± 0.39 ng/mL (p <0.001) at the end of the 12 months' follow-up. There were no changes in LH levels.

CONCLUSION

This study demonstrated that VD treatment improves testosterone levels, metabolic syndrome and erectile function in middle-aged men. More randomized placebo-controlled interventional trials of VD treatment in patients with the metabolic syndrome and low TT could assist in uncovering the putative roles of VD.

Hypovitaminosis D is associated with erectile dysfunction in type 2 diabetes

Diabetes is an established risk factor for erectile dysfunction (ED). The pathophysiology of ED in diabetic men is multifactorial, but it mainly involves a vascular disorder related to a reduction of endothelial function. Recently, several studies have correlated ED risk factors with vitamin D deficiency. In this study, we evaluate the relationship between 25-hydroxyvitamin D [25(OH)D] levels, erectile dysfunction, and vascular disease, in type 2 diabetes mellitus men (T2DM). In this observational study, 92 T2DM males (58.83 ± 9.73 years) underwent medical history collection, International Index of Erectile Function (IIEF-5) questionnaire, that allows the identification and grading of DE, physical examination, biochemical/hormonal blood tests, and penile echo-color Doppler ultrasonography. T2DM patients with lower 25(OH)D levels (<25 nmol/l) showed higher penile IMT (p < 0.05), waist circonference (p < 0.05), glucose concentrations (p < 0.05), and lower IIEF-5 score (p < 0.005), testosterone concentrations (p < 0.05), and cavernous peak systolic velocity (PSV) (p < 0.05), compared to patients with 25(OH)D >50 nmol/l. 25(OH)D levels were directly correlated with IIEF-5 (R = 0.39; p = 0.0001), testosterone (R = 0.24; p = 0.02), and PSV (R = 0.24; p = 0.04) and inversely with waist (R = -0.33; p = 0.002), HbA1c (R = -0.22; p = 0.03), triglyceride (R = -0.21; p = 0.06), and penile IMT (R = -0.30; p = 0.009). At multivariate analysis, 25(OH)D deficiency remained an independent predictor of DE. We demonstrate a significant association between 25(OH)D deficiency and erectile dysfunction in T2DM men. This association may be due to the influence of 25(OH)D deficiency on cardiovascular risk factor (glycaemia, HDL cholesterol, and triglycerides), testosterone plasma levels and endothelial dysfunction.

Vitamin D deficiency is independently associated with greater prevalence of erectile dysfunction: The National Health and Nutrition Examination Survey (NHANES) 2001-2004

BACKGROUND AND AIMS

Erectile dysfunction (ED) and atherosclerotic cardiovascular disease (ASCVD) share many common risk factors, and vascular ED is a marker for increased ASCVD risk. Low 25-hydroxyvitamin D [25(OH)D] concentrations have been associated with increased ASCVD risk, but less is known regarding the relationship of low 25(OH)D with ED. We determined whether 25(OH)D deficiency is associated with ED independent of ASCVD risk factors.

METHODS

We performed cross-sectional analyses of 3390 men aged ≥20 years free of ASCVD who participated in NHANES 2001-2004. Serum 25(OH)D was measured by the DiaSorin radioimmunoassay; deficiency was defined as levels <20 ng/ml (<50 nmol/L). Self-reported ED, assessed by a single validated question, was defined as men who reported being "never" or "sometimes able" to maintain an erection. We assessed the relationship between 25(OH)D deficiency and ED prevalence using adjusted Poisson regression methods.

RESULTS

After accounting for NHANES sampling, the weighted prevalence of 25(OH)D deficiency and of ED were 30% and 15.2%, respectively. 25(OH)D levels were lower in men with vs. those without ED (mean 22.8 vs 24.3 ng/mL, respectively; p = 0.0005). After adjusting for lifestyle variables, comorbidities, and medication use, men with 25(OH)D deficiency had a higher prevalence of ED compared to those with levels ≥30 ng/ml (Prevalence Ratio 1.30, 95% CI 1.08-1.57).

CONCLUSION

In this cross-sectional analysis of a representative sample of U.S. men, vitamin D deficiency was associated with an increased prevalence of ED independent of ASCVD risk factors. Additional research is needed to evaluate whether treating vitamin D deficiency improves erectile function.

Association between serum fetuin-A level and erectile function

Recent studies have shown that ED is an early symptom of atherosclerosis. Fetuin-A, a glycoprotein secreted by the liver, kidneys and choroid plexus, has been linked to systemic fibrosis and calcification in human and rat studies. Deficiency of this compound may play a role in atherosclerosis and cardiovascular disease progression. The aim of the study was to examine whether serum fetuin-A level is related to erectile function or severity of ED. Sixty ED patients without cardiovascular disease were assigned to one of the three groups (mild, moderate or severe ED) depending on ED severity. Twenty healthy volunteers were included as the control group. The International Index of Erectile Function-5 questionnaire was used to measure erection quality in all four groups. Mean age, body mass index, total testosterone, low- and high-density lipoprotein cholesterol, and triglyceride levels did not significantly differ between the three erectile dysfunction and control groups (P > 0.05). The group with severe ED had a significantly lower mean fetuin-A level than the mild ED and control groups. For both mild and moderate ED groups, the mean serum fetuin-A level was significantly lower in comparison with the control group (P < 0.001). Serum fetuin-A level may be used as a supplemental biochemical parameter in preliminary evaluation of ED.

Type 2 diabetes and cardiovascular disease: Have all risk factors the same strength?

Diabetes mellitus is a chronic condition that occurs when the body cannot produce enough or effectively use of insulin. Compared with individuals without diabetes, patients with type 2 diabetes mellitus have a considerably higher risk of cardiovascular morbidity and mortality, and are disproportionately affected by cardiovascular disease. Most of this excess risk is it associated with an augmented prevalence of well-known risk factors such as hypertension, dyslipidaemia and obesity in these patients. However the improved cardiovascular disease in type 2 diabetes mellitus patients can not be attributed solely to the higher prevalence of traditional risk factors. Therefore other non-traditional risk factors may be important in people with type 2 diabetes mellitus. Cardiovascular disease is increased in type 2 diabetes mellitus subjects due to a complex combination of various traditional and non-traditional risk factors that have an important role to play in the beginning and the evolution of atherosclerosis over its long natural history from endothelial function to clinical events. Many of these risk factors could be common history for both diabetes mellitus and cardiovascular disease, reinforcing the postulate that both disorders come independently from “common soil”. The objective of this review is to highlight the weight of traditional and non-traditional risk factors for cardiovascular disease in the setting of type 2 diabetes mellitus and discuss their position in the pathogenesis of the excess cardiovascular disease mortality and morbidity in these patients.

Mean platelet volume and vitamin D level

BACKGROUND

Vitamin D deficiency and a high mean platelet volume (MPV) are related to cardiovascular disease. We investigated whether vitamin D deficiency is associated with high MPV.

METHODS

This study included 434 patients without chronic disease who were not taking vitamin D or calcium supplements. Vitamin D was measured by chemiluminescent microparticle immunoassay on the Architect-I2000 system (Abbott Diagnostics, USA), and MPV was measured on the Cell-Dyn Ruby analyzer (Abbott Diagnostics). Patients were divided into Groups 1 (138 [men/women, 46/92]), 2 (148 [men/women, 54/94]), and 3 (148 [men/women, 50/98]) according to vitamin D levels of <10 ng/mL, 10-20 ng/mL, and >20 ng/mL, respectively.

RESULTS

The vitamin D level in Group 1 (7.7±1.9 ng/mL) was lower than that in Group 2 (15.1±1.6 ng/mL, P<0.001) and Group 3 (25.6±6.3 ng/mL, P<0.001). The MPV in Group 3 (7.5±1.0 fL) was lower than that in Group 1 (8.1±1.1 fL, P<0.001) and Group 2 (7.9±1.0 fL, P=0.009). Linear regression analysis showed that low levels of vitamin D (β=-0.109, P=0.019) was independently associated with increased MPV.

CONCLUSIONS

There was a strong association between a low vitamin D level and a high MPV; therefore, vitamin D deficiency may be associated with increased MPV.

Mean platelet volume and vitamin D level

BACKGROUND

Vitamin D deficiency and a high mean platelet volume (MPV) are related to cardiovascular disease. We investigated whether vitamin D deficiency is associated with high MPV.

METHODS

This study included 434 patients without chronic disease who were not taking vitamin D or calcium supplements. Vitamin D was measured by chemiluminescent microparticle immunoassay on the Architect-I2000 system (Abbott Diagnostics, USA), and MPV was measured on the Cell-Dyn Ruby analyzer (Abbott Diagnostics). Patients were divided into Groups 1 (138 [men/women, 46/92]), 2 (148 [men/women, 54/94]), and 3 (148 [men/women, 50/98]) according to vitamin D levels of <10 ng/mL, 10-20 ng/mL, and >20 ng/mL, respectively.

RESULTS

The vitamin D level in Group 1 (7.7±1.9 ng/mL) was lower than that in Group 2 (15.1±1.6 ng/mL, P<0.001) and Group 3 (25.6±6.3 ng/mL, P<0.001). The MPV in Group 3 (7.5±1.0 fL) was lower than that in Group 1 (8.1±1.1 fL, P<0.001) and Group 2 (7.9±1.0 fL, P=0.009). Linear regression analysis showed that low levels of vitamin D (β=-0.109, P=0.019) was independently associated with increased MPV.

CONCLUSIONS

There was a strong association between a low vitamin D level and a high MPV; therefore, vitamin D deficiency may be associated with increased MPV.

Vitamin D: Its role in disease prevention

Evidence that vitamin D reduces the risk of many types of disease is increasing exponentially. In 2011, 3,100 publications with "vitamin D" in the title or abstract were published, up from 2,606 in 2010, 1,303 in 2005, and 796 in 2000. A committee operating under the auspices of the Institute of Medicine (IOM) of the US National Academies reviewed the evidence for beneficial effects of vitamin D. Their report, issued at the end of 2010,(1) found what they considered to be strong evidence for only one health outcome: skeletal health. They considered beneficial evidence only from published randomized controlled trials (RCTs) focused mainly on skeletal health. In contrast, to justify concern about higher vitamin D intake and serum 25(OH)D concentrations, they used data from nested case-control studies reporting U-shaped outcomes of prediagnostic serum 25-hydroxyvitamin D [25(OH)D] for cancer and all-cause mortality rates. They set the daily recommended intake of vitamin D at 600-800 IU for most children and adults and defined vitamin D sufficiency as a serum 25(OH)D level above 20 ng/ml (50 nmol/l). They also set a daily upper intake of 4,000 IU of vitamin D(3) and called for more RCTs to determine nonskeletal health effects. As of this writing, more than 130 journal publications have criticized the IOM report as being too conservative. One summarized the problems succinctly: "The IOM recommendations for vitamin D fail in a major way on logic, on science, and on effective public health guidance. Moreover, by failing to use a physiological referent, the IOM approach constitutes precisely the wrong model for development of nutritional policy."(2).