Serum Folic Acid: an Effective Indicator for Arteriogenic Erectile Dysfunction

Overview

Journal Front Endocrinol (Lausanne)

Specialty Endocrinology

Date 2023 Aug 9

PMID 37554765

Authors

Xingliang Feng

Yangyang Mei

Pinpeng Xie

Zhaoyu Xing

Xiaogang Wang

Li Cui

Renfang Xu

Affiliations

Soon will be listed here.

Abstract

Background: The present study is the first to explore the correlation between serum folic acid (FA) level and penile arterial peak systolic velocity (PSV) as measured via penile color Doppler ultrasonography (PDU), which directly reflects endothelial function in the penile artery.

Materials And Methods: A total of 244 consecutive erectile dysfunction (ED) patients and 72 healthy controls, recruited from the Andrology department and the Healthy Physical Examination Center of our hospital, respectively, from June 2020 to April 2022, were included in the study. Serum FA was measured in ED patients and healthy controls, and PDU examinations were conducted for all eligible ED patients. The Pearson method was used to evaluate the correlation between FA levels and PDU parameters in ED patients. A receiver operating characteristic (ROC) curve analysis was also performed to calculate the sensitivity and specificity of these parameters for prediction of arteriogenic ED.

Results: After the PDU test, the average serum FA level among patients diagnosed with arteriogenic ED was 8.08 ± 2.64 ng/ml, lower than the average of 10.78 ± 2.87 ng/ml among healthy controls. There were no statistically significant inter-group differences on any basic parameters, including age, body mass index, fasting blood glucose, total cholesterol, and triglyceride. For further analysis, we divided the arteriogenic ED group into three subgroups by PSV range to compare serum FA levels among these subgroups. The mean FA levels in each of these groups were 5.97 ± 1.51ng/ml, and 8.21 ± 2.37ng/ml, and 10.55 ± 2.56ng/ml, while the corresponding PSV values were 15.75 ± 2.39cm/s, 23.53 ± 2.19cm/s, and 32.72 ± 1.64cm/s. Overall, a positive correlation between PSV and FA level was found among patients with arteriogenic ED (r=0.605, P<0.001). Furthermore, when FA level was used, with a cut-off value of 10.045 ng/ml, as a criterion to distinguish patients with arteriogenic ED from healthy controls, the area under the curve (AUC) was 0.772 (95% confidential interval: [0.696, 0.848]), for a sensitivity of 0.611 and specificity of 0.824.

Conclusion: Serum FA level is positively correlated with PSV in ED patients, and has the ability to distinguish patients with arteriogenic ED from healthy controls. Taking these findings together, FA deficiency should be regarded as an independent risk factor for arteriogenic ED.

References

Zhang Y, Zhang W, Dai Y, Jiang H, Zhang X . Serum Folic Acid and Erectile Dysfunction: A Systematic Review and Meta-Analysis. Sex Med. 2021; 9(3):100356. PMC: 8240352. DOI: 10.1016/j.esxm.2021.100356. View

Lue T, Hricak H, Marich K, Tanagho E . Vasculogenic impotence evaluated by high-resolution ultrasonography and pulsed Doppler spectrum analysis. Radiology. 1985; 155(3):777-81. DOI: 10.1148/radiology.155.3.3890009. View

Alkaitis M, Crabtree M . Recoupling the cardiac nitric oxide synthases: tetrahydrobiopterin synthesis and recycling. Curr Heart Fail Rep. 2012; 9(3):200-10. PMC: 3406312. DOI: 10.1007/s11897-012-0097-5. View

Uddin S, Mirbolouk M, Dardari Z, Feldman D, Cainzos-Achirica M, DeFilippis A . Erectile Dysfunction as an Independent Predictor of Future Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis. Circulation. 2018; 138(5):540-542. PMC: 6289871. DOI: 10.1161/CIRCULATIONAHA.118.033990. View

Guo L, Liu Y, Sun W, Yuan M, Xiao Z, Song H . Significance of platelet distribution width as a severity marker of erectile dysfunction. Andrologia. 2016; 49(3). DOI: 10.1111/and.12628. View

Cheng Z, Yang X, Wang H . Hyperhomocysteinemia and Endothelial Dysfunction. Curr Hypertens Rev. 2010; 5(2):158-165. PMC: 2873778. DOI: 10.2174/157340209788166940. View

Montorsi P, Ravagnani P, Galli S, Rotatori F, Briganti A, Salonia A . The artery size hypothesis: a macrovascular link between erectile dysfunction and coronary artery disease. Am J Cardiol. 2006; 96(12B):19M-23M. DOI: 10.1016/j.amjcard.2005.07.006. View

Pagidipati N, Gaziano T . Estimating deaths from cardiovascular disease: a review of global methodologies of mortality measurement. Circulation. 2013; 127(6):749-56. PMC: 3712514. DOI: 10.1161/CIRCULATIONAHA.112.128413. View

Sabatini S, Sgro P, Duranti G, Ceci R, Di Luigi L . Tadalafil alters energy metabolism in C2C12 skeletal muscle cells. Acta Biochim Pol. 2011; 58(2):237-41. View

10.

Ayta I, McKinlay J, Krane R . The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. BJU Int. 1999; 84(1):50-6. DOI: 10.1046/j.1464-410x.1999.00142.x. View

11.

Miner M, Rosenberg M, Barkin J . Erectile dysfunction in primary care: a focus on cardiometabolic risk evaluation and stratification for future cardiovascular events. Can J Urol. 2014; 21 Suppl 2:25-38. View

12.

Kuo Y, Liu S, Chen J, Chang H, Tsai V, Hsieh J . Feasability of a novel audio-video sexual stimulation system: an adjunct to the use of penile duplex Doppler ultrasonography for the investigation of erectile dysfunction. J Sex Med. 2009; 7(12):3979-83. DOI: 10.1111/j.1743-6109.2009.01583.x. View

13.

Bivalacqua T, Usta M, Champion H, Kadowitz P, Hellstrom W . Endothelial dysfunction in erectile dysfunction: role of the endothelium in erectile physiology and disease. J Androl. 2003; 24(6 Suppl):S17-37. DOI: 10.1002/j.1939-4640.2003.tb02743.x. View

14.

Wierzbicki A, Jackson G . NO problem: arterial and venous endothelial function and erectile dysfunction. Eur Urol. 2011; 59(6):956-8. DOI: 10.1016/j.eururo.2011.02.019. View

15.

Caretta N, De Rocco Ponce M, Minicuci N, Palego P, Valente U, Garolla A . Penile doppler ultrasound predicts cardiovascular events in men with erectile dysfunction. Andrology. 2018; 7(1):82-87. DOI: 10.1111/andr.12561. View

16.

Pezzoni F, Scroppo F . Penile vascular diagnostic categorization using penile duplex Doppler ultrasound: Differences in vascular hemodynamics parameters by differences in anatomic sampling location. Arch Ital Urol Androl. 2016; 88(3):183-185. DOI: 10.4081/aiua.2016.3.183. View

17.

Wang X, Guo L, Xiao Z, Guan Y, Zhang J, Li M . Mean platelet volume might be an effective indicator of arterial erectile dysfunction. Asian J Androl. 2018; 21(1):62-66. PMC: 6337960. DOI: 10.4103/aja.aja_74_18. View

18.

Katsiki N, Wierzbicki A, Mikhailidis D . Erectile dysfunction and coronary heart disease. Curr Opin Cardiol. 2015; 30(4):416-21. DOI: 10.1097/HCO.0000000000000174. View

19.

Karabakan M, Erkmen A, Guzel O, Aktas B, Bozkurt A, Akdemir S . Association between serum folic acid level and erectile dysfunction. Andrologia. 2015; 48(5):532-5. DOI: 10.1111/and.12474. View

20.

Selhub J, Miller J . The pathogenesis of homocysteinemia: interruption of the coordinate regulation by S-adenosylmethionine of the remethylation and transsulfuration of homocysteine. Am J Clin Nutr. 1992; 55(1):131-8. DOI: 10.1093/ajcn/55.1.131. View