Erectile dysfunction (ED) shares modifiable risks factors with atherosclerosis and coronary artery disease (CAD), has a high prevalence in individuals with multiple cardiovascular (CV) risk factors, and is an independent predictor of CV events. Evidence supporting a link between ED and CV disease has accumulated in recent years. Lifestyle factor modification has been shown to improvement ED as had cardiovascular risk factor reduction with pharmacotherapy. However, most of the studies on ED are limited by small sample size, being single-centre studies in 1 geographical location, Furthermore, the effect of both lifestyle interventions and pharmacotherapy for CV risk factors on ED improvement has never been extensively studied. This systematic review and meta-analysis was conducted to evaluate the effect of lifestyle interventions and pharmacotherapy for cardiovascular (CV) risk factors on the severity of ED.

A literature search up to August 2010 was conducted for RCTs with follow-up of at least 6 weeks of lifestyle modification intervention or pharmacotherapy for CV risk factor reduction. The main outcome measure was the weighted mean differences in the International Index of Erectile Dysfunction (IIEF-5) score.

Six studies published between 2004 and 2010 were identified, involving 740 participants (374 intervention and 366 control arms). The mean age of the patients was 55.4 years, and study duration ranged from 12 to 104 weeks. All studies demonstrated improvement in ED with lifestyle changes and improvement in lipid parameters. Meta-analysis of the 6 trials demonstrated that:

• The improvement in CV risk factors was associated with statistically significant improvement in sexual function (IIEF-5 score): weighted mean difference (WMD) 2.66 (95% CI, 1.86 to 3.47).

• When the clinical trials evaluating pharmacotherapy for CV risk factors were excluded, the improvement in sexual function was also statistically significant (WMD 2.40; 1.19 to 3.61).

• Pharmacotherapy targeting CV risk factors also demonstrated improvement in sexual function, with a statistically significant WMD of 3.07 (1.84 to 4.30).
The researchers conclude that these findings “further strengthen the evidence that lifestyle modification and pharmacotherapy for CV risk factors are effective in improving sexual function in men with ED.”