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WASHINGTON -- Statins appeared to improved erectile function to a clinically meaningful degree, according to a meta-analysis.
Across 11 randomized trials, the average gain in subjective score on the International Inventory of Erectile Function (IIEF) was 3.4 points versus placebo or other controls (P=0.0001).
The effect "was clinically relevant," , of Rutgers Robert Wood Johnson Medical School in New Brunswick, N.J., told reporters at a press telebriefing in advance of presentation at the American College of Cardiology meeting here.
"It was about one-third of what to you achieve with PDE5 [phosphodiesterase] inhibitors and slightly bigger than what you see with of nonpharmacological lifestyle therapy," he said, noting that the study was also scheduled for release online today in the .
He chalked the improved performance up to a net benefit of lipid lowering and pleiotropic effects of statins, such as endothelial function improvement, against the reduction in testosterone reported with the drugs because that hormone is made from cholesterol.
"This may effect an improvement in adherence to statin therapy," Kostis suggested, noting that at least half of patients stopped or took much less than prescribed in prior large primary prevention studies.
But he recommended against using statins for sexual health effects in men without high cholesterol.
Rather, needing erectile dysfunction treatment may be a sign to look for cardiovascular risk factors like high cholesterol, Kostis noted.
"Over the years it's become apparent that erectile dysfunction is an indication of decreased vascular health in men, and it's considered by many to be a significant cardiovascular risk factor," agreed , of Tufts Medical Center in Boston and vice-chair of the program committee for the ACC conference.
Kostis cautioned that the meta-analysis was small, with just 647 patients across 11 randomized trials (an average of 53 per study), and combined a variety of statins and durations of treatment (averaging 3 months).
Erectile function was the primary endpoint in all the trials, but not all had the more objective measures available for meta-analysis.
But the effect of statins remained statistically significant through sensitivity analyses for publication bias and with each study omitted sequentially.
"A big study that is well-powered, placebo-controlled, and probably factorial design to look at statins as well as PDE5 inhibitors and testosterone may clarify this question once and for all," Kostis noted.
Disclosures
Kostis disclosed no relevant financial relationships with industry, though he has been an investigator on statin trials.
Primary Source
American College of Cardiology
Source Reference: Kostis JB, Dobrzynski JM "Effect of statins on erectile function" ACC 2014.