The role of statins in erectile dysfunction: a systematic review and meta-analysis

Abstract

To evaluate the effect of statins for erectile dysfunction (ED), a systematic review of the literature was conducted in the Cochrane Library, Embase and PubMed from the inception of each database to June 2013. Only randomized controlled trials (RCTs) comparing treatment for ED with statins were identified. Placebo RCTs with the International Index of Erectile Function (IIEF) as the outcome measure were eligible for meta-analysis. A total of seven RCTs including two statins with a total of 586 patients strictly met our criteria for systematic review and five of them qualified for the meta-analysis. A meta-analysis using a random effects model showed that statins were associated with a significant increase in IIEF-5 scores (mean difference (MD): 3.27; 95% confidential interval (CI):1.51 to 5.02; P < 0.01) and an overall improvement of lipid profiles including total cholesterol (MD: -1.08; 95% CI: -1.68 to -0.48; P < 0.01), low-density lipoprotein (LDL) cholesterol (MD: -1.43; 95% CI: -2.07 to -0.79; P < 0.01), high-density lipoprotein (HDL) cholesterol (MD: 0.24; 95% CI: 0.13 to 0.35; P < 0.01) and triglycerides (TGs) (MD: -0.55; 95% CI: -0.61 to -0.48; P < 0.01). In summary, our study revealed positive consequences of these lipid-lowering drugs on erectile function, especially for nonresponders to phosphodiesterase type 5 inhibitors (PDE5Is). However, it has been reported that statin therapy may reduce levels of testosterone and aggravate symptoms of ED. Therefore, larger, well-designed RCTs are needed to investigate the double-edged role of statins in the treatment of ED.

Figure 1

Process of study selection. ED: erectile dysfunction; RCT: randomized controlled trial.

Figure 2

Pooled estimate of IIEF-5 scores between statins and control groups. CI: confidence interval; IIEF: international index of erectile function; IV: intravenous; s.d.: standard deviation.

Figure 3

Pooled estimate of total cholesterol levels between statins and control group. CI: confidence interval; IV: intravenous; s.d.: standard deviation.

Figure 4

Pooled estimate of LDL cholesterol levels between statins and control groups. CI: confidence interval; IV: intravenous; LDL: low-density lipoprotein; s.d.: standard deviation.

Figure 5

Pooled estimate of triglycerides levels between statins and control groups. CI: confidence interval; IV: intravenous; s.d.: standard deviation.

Figure 6

Pooled estimate of HDL cholesterol levels between statins and control groups. CI: confidence interval; HDL: high-density lipoprotein; IV: intravenous; s.d.: standard deviation.