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Those With Erectile Dysfunction Should Also Be Tested for Serum 25-Hydroxyvitamin D Concentration

      To the Editor:
      The recent report by the Princeton Consensus Conference recommended that men with a diagnosis of erectile dysfunction (ED) be evaluated for cardiovascular disease (CVD).
      • Nehra A.
      • Jackson G.
      • Miner M.
      • et al.
      The Princeton III Consensus Recommendations for the management of erectile dysfunction and cardiovascular disease.
      Vascular problems underlie most ED not associated with prostatectomy or psychological problems because erections are controlled by the spongy tissue, which can clamp down and restrict blood flow from the penis. We fully agree with the Consensus recommendations that men with ED should be evaluated for CVD.
      However, we would like to add that they also be checked for vitamin D deficiency. In a recent article, the case was made that vitamin D deficiency may contribute to risk of ED on the basis of the link between ED and CVD.
      • Sorenson M.
      • Grant W.B.
      Does vitamin D deficiency contribute to erectile dysfunction?.
      A growing body of research reports that vitamin D deficiency is a risk factor for CVD.
      • Parker J.
      • Hashmi O.
      • Dutton D.
      • et al.
      Levels of vitamin D and cardiometabolic disorders: systematic review and meta-analysis.
      • Anderson J.L.
      • May H.T.
      • Horne B.D.
      • et al.
      Intermountain Heart Collaborative (IHC) Study Group
      Relation of vitamin D deficiency to cardiovascular risk factors, disease status, and incident events in a general healthcare population.
      • Vacek J.L.
      • Vanga S.R.
      • Good M.
      • Lai S.M.
      • Lakkireddy D.
      • Howard P.A.
      Vitamin D deficiency and supplementation and relation to cardiovascular health.
      In addition, vitamin D deficiency has been linked to 2 features of CVD: arterial stiffness
      • Zagura M.
      • Serg M.
      • Kampus P.
      • et al.
      Aortic stiffness and vitamin D are independent markers of aortic calcification in patients with peripheral arterial disease and in healthy subjects.
      • Giallauria F.
      • Milaneschi Y.
      • Tanaka T.
      • et al.
      Arterial stiffness and vitamin D levels: the Baltimore Longitudinal Study of Aging.
      and elevated C-reactive protein concentration.
      • van de Luijtgaarden K.M.
      • Voûte M.T.
      • Hoeks S.E.
      • et al.
      Vitamin D deficiency may be an independent risk factor for arterial disease.
      There is no evidence yet that increasing serum 25-hydroxyvitamin D concentration will reduce the symptoms or progression of ED. However, it seems likely that many men with ED have vitamin D deficiency. In addition, there are many other health benefits of vitamin D.
      • Holick M.F.
      • Binkley N.C.
      • Bischoff-Ferrari H.A.
      • et al.
      Endocrine Society
      Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline.
      For optimal nonskeletal benefits, serum 25-hydroxyvitamin D concentrations should be greater than 30 ng/mL (75 nmol/L).
      • Holick M.F.
      • Binkley N.C.
      • Bischoff-Ferrari H.A.
      • et al.
      Endocrine Society
      Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline.

      References

        • Nehra A.
        • Jackson G.
        • Miner M.
        • et al.
        The Princeton III Consensus Recommendations for the management of erectile dysfunction and cardiovascular disease.
        Mayo Clin Proc. 2012; 87: 766-778
        • Sorenson M.
        • Grant W.B.
        Does vitamin D deficiency contribute to erectile dysfunction?.
        Dermatoendocrinol. 2012; 4: 128-136
        • Parker J.
        • Hashmi O.
        • Dutton D.
        • et al.
        Levels of vitamin D and cardiometabolic disorders: systematic review and meta-analysis.
        Maturitas. 2010; 65: 225-236
        • Anderson J.L.
        • May H.T.
        • Horne B.D.
        • et al.
        • Intermountain Heart Collaborative (IHC) Study Group
        Relation of vitamin D deficiency to cardiovascular risk factors, disease status, and incident events in a general healthcare population.
        Am J Cardiol. 2010; 106: 963-968
        • Vacek J.L.
        • Vanga S.R.
        • Good M.
        • Lai S.M.
        • Lakkireddy D.
        • Howard P.A.
        Vitamin D deficiency and supplementation and relation to cardiovascular health.
        Am J Cardiol. 2012; 109: 359-363
        • Zagura M.
        • Serg M.
        • Kampus P.
        • et al.
        Aortic stiffness and vitamin D are independent markers of aortic calcification in patients with peripheral arterial disease and in healthy subjects.
        Eur J Vasc Endovasc Surg. 2011; 42: 689-695
        • Giallauria F.
        • Milaneschi Y.
        • Tanaka T.
        • et al.
        Arterial stiffness and vitamin D levels: the Baltimore Longitudinal Study of Aging.
        J Clin Endocrinol Metab. 2012; 97: 3717-3723
        • van de Luijtgaarden K.M.
        • Voûte M.T.
        • Hoeks S.E.
        • et al.
        Vitamin D deficiency may be an independent risk factor for arterial disease.
        Eur J Vasc Endovasc Surg. 2012; 44: 301-306
        • Holick M.F.
        • Binkley N.C.
        • Bischoff-Ferrari H.A.
        • et al.
        • Endocrine Society
        Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline.
        J Clin Endocrinol Metab. 2011; 96: 1911-1930

      Linked Article

      • The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease
        Mayo Clinic ProceedingsVol. 87Issue 8
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          The Princeton Consensus (Expert Panel) Conference is a multispecialty collaborative tradition dedicated to optimizing sexual function and preserving cardiovascular health. The third Princeton Consensus met November 8 to 10, 2010, and had 2 primary objectives. The first objective focused on the evaluation and management of cardiovascular risk in men with erectile dysfunction (ED) and no known cardiovascular disease (CVD), with particular emphasis on identification of men with ED who may require additional cardiologic work-up.
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