| Summary: | Erectile dysfunction (ED) is a highly prevalent disorder reported in men worldwide.
ED is commonly associated with aging as well as with several other factors including
demographic, clinical and lifestyle factors. However, scarce studies were reported on
the combined association of demographic, clinical and lifestyle factors with worsening
of severity of ED. Besides, few biomarkers too were proved to be significantly
associated with ED and it is believed that demographic, clinical and lifestyle factors
may have been one of the reasons which influence changes of biomarker levels in ED
patients. However, these factors have not been studied extensively. Hence, this study
was conducted to investigate the association of demographic, clinical and lifestyle
factors with severity of ED and biomarker levels, namely total testosterone (TT) and
asymmetric dimethylarginine (ADMA), and build the predictor models for severity of
ED and related biomarkers.
This cross sectional study involved 276 patients. Data were recruited from patients
attending ED and medical clinics in University Malaya Medical Centre, a tertiary
teaching hospital in Malaysia. The demographic, clinical, lifestyle factors and severity
of ED were assessed using questionnaire included with the International Index of
Erectile Function (IIEF-5). Meanwhile, TT and ADMA levels were determined using
the enzyme-linked immunosorbant assay (ELISA). Binary logistic regression test was
used to demonstrate the predictors of severity of ED, TT and ADMA levels.
Significant predictors for worsening of severity of ED are [presented as adjusted
odds ratio (95% confidence interval), p value] self-employed [10.55 (0.43 – 257.06),
p=0.004], pensioner [8.07 (0.19 – 352.45), p=0.026], non-government employee [1.16
(0.05 – 26.26), p=0.04] and TT [0.41 (0.25 – 0.69), p=0.001]. Nevertheless,
demographic and lifestyle factors were found to be the significant predictors for both
TT and ADMA levels. Pensioner [0.08 (0.01 – 0.87), p=0.038] and unemployed [0.04
iv
(0.01 –0.42), p=0.007], are the predictors which may predict the changes of TT levels.
On the other hand, academic qualification (secondary) [4.51 (0.48 – 42.83), p=0.014]
and intensity of physical activities (< 1 hour/day) [2.61 (0.65 – 10.48), p=0.008] were
the predictors which more likely influence the changes of ADMA levels in ED patients.
In conclusion, demographic and lifestyle factors predominate clinical factors in
influencing TT and ADMA levels. Demographic and clinical factors predict the
worsening of severity of ED in Malaysian ED population. Identification of these
predictors influencing severity of ED, TT and ADMA may help to upgrade our
knowledge on risk factors of ED. Thus, these predictive models may serve as new
indicators in providing primarily guidance to physicians and ensuring ED can be
managed and treated more effectively.
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