Association between homocysteine, vitamin B₁₂, folic acid and erectile dysfunction: a cross-sectional study in China

Abstract

ObjectivesErectile dysfunction (ED) affects up to 53.4% of men aged 30–80 years. In this study, we aimed to examine the association between homocysteine (HCY), vitamin B12 (B12), folic acid (FA) and ED.DesignCross-sectional study.SettingGuangxi, China.ParticipantsA total of 1381 participants who completed questionnaires were included, between September 2009 and December 2009.MeasuresED was evaluated by the International Index of Erectile Function scores. Also, the values of HCY, B12 and FA were acquired. Then, regression and between-group analyses were performed.ResultsNo association between FA and ED was found. Significant correlations between HCY and ED were found—the relationships between these two parameters were most notable in men aged over 60 years and in men living alone (bachelors or bachelorhood). B12 levels were higher in men with ED (718.53±234.37 pg/mL vs 688.74±229.68, p=0.015). Using multinomial logistic regression analyses, B12 levels were related to mild ED (multivariate adjusted analysis: OR 1.620, 95% CI 1.141 to 2.300, p=0.007), especially among men aged 40–49 years (OR 2.907, 95% CI 1.402 to 6.026, p=0.004).ConclusionsWe report, for the first time, a relationship between B12 levels and ED. We also found specific cohorts of men for whom the relationship between HCY levels and ED is most prominent. Further studies are required to elucidate the mechanisms underlying these relationships—these may ultimately result in new therapies for ED.

Serum folic acid levels and erectile dysfunction: A meta‐analysis and systematic review

“…According to the established retrieval formula, we searched a total of 1,341 related studies, deleted duplicates and made preliminary screening according to titles and abstracts, and the remaining 21 literatures entered the full‐text reading stage. After reading through the full text of 21 articles, a total of six studies (Attia et al., 2019; Chen et al., 2019; Gupta et al., 2020; Karabakan et al., 2016; Sansone et al., 2018; Yan et al., 2014) including 1,842 participants were finally included in our meta‐analysis. Among the six studies, five are case–control studies and one is cross‐sectional.…”

“…Six studies reporting the FA levels in the ED group and non‐ED group were included in the meta‐analysis(Attia et al., 2019; Chen et al., 2019; Gupta et al., 2020; Karabakan et al., 2016; Sansone et al., 2018; Yan et al., 2014). The pooled MD revealed that individuals without ED had about 3.37 ng/ml higher of FA levels than those with ED (MD = 3.37, 95% CI 1.49–5.52, p = 0.004), with severe heterogeneity existed ( I 2 = 86%) (Figure 2).…”

“…Several subsequent studies reported similar results and further suggested that the degree of FA deficiency was related to the severity of ED (Attia et al., 2019; Gupta et al., 2020; Karabakan et al., 2016). But recent cross‐sectional study of 1,381 participants found no significant difference in FA levels between ED patients and controls (Chen et al., 2019). Due to the small sample size and controversial results in previous studies, we intend to further clarify the relationship between FA levels and ED through meta‐analysis and systematically elaborate its potential mechanism, so as to provide basis for future large‐scale prospective clinical studies and guide clinical practice.…”

Hyperhomocysteinemia: Focus on Endothelial Damage as a Cause of Erectile Dysfunction

“…In a large study, Hcys, FA and B12 levels were recently assessed on a total of 1381 patients (688 ED and 693 non-ED). The authors reported a significant association between Hcys and erectile function, especially in older men (age ≥ 60), with a larger proportion of HHcys in the ED group than the non-ED group (43.02% versus 37.52%, p = 0.037) [ 21 ]. In particular, Demir et al demonstrated that HHcys increases more than three times the risk of ED [ 22 ].…”

“…It has been hypothesized that FA deficiency could play a central role in ED development both by directly interfering with the NO metabolism and by favoring the development of HHcys. Some authors [ 3 , 28 , 29 , 30 ] consider low serum FA levels as a risk factor for ED whereas others do not agree [ 21 ]. Sansone et al reported significant lower serum FA levels and higher serum Hcys levels in ED patients compared to non-ED patients, even if, surprisingly, these authors did not find a significant correlation between Hcys and FA levels [ 28 ].…”