Folic acid deficiency linked to arteriogenic erectile dysfunction

The findings, published in Frontiers in Endocrinology, imply that folic acid deficiency should be considered an independent risk factor for arteriogenic erectile dysfunction.

Erectile dysfunction is the inability to obtain and/or maintain an erection sufficient for sexual intercourse. In men, ED is one of the most common forms of sexual dysfunction.

Folic acid is water-soluble B vitamin that may improve endothelial function by acting on the process of NO (nitric oxide) metabolism, which not only plays an essential role in but also participates in the erection process via the cyclic guanosine monophosphate (cGMP)pathway

Peak systolic velocity (PSV) is the most commonly used parameter that can be measured for direct evaluation of the penile arterial supply. Additionally, PSV has been found to correlate closely with the probability of future cardiovascular events. When PSVis <35cm/s, arterial insufficiency of the penile artery can be diagnosed. Additionally, the degree of decline in PSV is related to the severity of damage to the penile artery, mainly determined by the function of the penile endothelium.

Against the above background, Xingliang Feng, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China, and colleagues explored the correlation between serum folic acid level and penile arterial peak systolic velocity as measured via penile colour Doppler ultrasonography (PDU), which directly indicates an endothelial function in the penile artery, for the first time.

The study included 244 consecutive ED patients and 72 healthy controls. Serum folic acid was measured in ED patients and healthy controls, and for all eligible ED patients, PDU examinations were conducted. The correlation between n FA levels and PDU parameters was evaluated in ED patients using the Pearson method.

The researchers also performed a receiver operating characteristic (ROC) curve analysis to calculate the specificity and sensitivity of these parameters for the prediction of arteriogenic ED.

The study revealed the following findings:

• 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, 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.
• A positive correlation between PSV and FA levels was found among patients with arteriogenic ED (r=0.605).
• 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, for a sensitivity of 0.611 and specificity of 0.824.

"A significant association between PSV of the cavernous artery and serum FA level was found in patients with arteriogenic ED," the researchers wrote. "Specifically, there was a significant decrease in PSV as serum FA level decreases, and FA deficiency should be considered an independent risk factor for arteriogenic ED."

"It is critical to perform a large-scale cohort study in the future to explore the FA supplementation's beneficial effect for erectile function in patients with arteriogenic ED," they concluded.

Reference:

Feng X, Mei Y, Xie P, Xing Z, Wang X, Cui L, Xu R. Serum folic acid: an effective indicator for arteriogenic erectile dysfunction. Front Endocrinol (Lausanne). 2023 Jul 24;14:1080188. doi: 10.3389/fendo.2023.1080188. PMID: 37554765; PMCID: PMC10405823.