Canadian Journal of Cardiology

Long-term Effects of Statins, Blood Pressure-Lowering, and Both on Erectile Function in Persons at Intermediate Risk for Cardiovascular Disease: A Substudy of the Heart Outcomes Prevention Evaluation-3 (HOPE-3) Randomized Controlled Trial



      It is unclear whether modifying cholesterol, blood pressure, or both affect erectile dysfunction. Also, there are concerns that erectile dysfunction is worsened by common medications used to treat these risk factors. In this study, we evaluated the effect of: (1) cholesterol-lowering with a statin; (2) pharmacologic blood pressure reduction; and (3) their combination, on erectile function.


      A priori, this was a secondary analysis of the Heart Outcomes Prevention Evaluation-3 (HOPE-3) randomized controlled trial. Men were 55 years of age or older with at least 1 cardiovascular risk factor. Erectile function was measured using the erectile function domain of the International Index of Erectile Function (IIEF-EF) score. Men with incomplete scores, or who did not engage in sexual activity, were excluded. Using a 2 × 2 factorial design, participants were randomized to rosuvastatin (10 mg/d) or placebo, and to candesartan with hydrochlorothiazide (HCTZ; 16 mg/12.5 mg/d; Cand+HCTZ) or placebo. Primary outcome was change in IIEF-EF from baseline to end of study follow-up.


      Two thousand one hundred fifty-three men were included; mean age was 61.5 years, and mean follow-up was 5.8 years. Mean IIEF-EF score at baseline was 23.0 (SD 5.6). Least square mean change in the IIEF-EF score did not differ with rosuvastatin compared with placebo (−1.4; standard error [SE], 0.3 vs −1.5; SE, 0.3; P = 0.74), Cand+HCTZ compared with placebo (−1.6; SE, 0.3 vs −1.3; SE, 0.3; P = 0.10), or combination therapy compared with double placebo (P = 0.35).


      Cholesterol-lowering using a statin, and blood pressure-lowering using Cand+HCTZ, either alone or in combination, do not improve or adversely affect erectile function.



      On ignore si les modifications du cholestérol ou de la pression artérielle, ou les deux, nuisent au fonctionnement érectile. Aussi, on craint que le dysfonctionnement érectile soit aggravé par les médicaments communément utilisés pour traiter ces facteurs de risques. Dans la présente étude, nous avons évalué les répercussions sur le fonctionnement érectile de : 1) la diminution du cholestérol par les statines ; 2) la réduction de la pression artérielle à l’aide de médicaments ; 3) leur combinaison.


      A priori, il s’agissait d’une analyse secondaire de l’essai contrôlé randomisé HOPE-3 (Heart Outcomes Prevention Evaluation-3. Les hommes avaient 55 ans ou plus et au moins 1 facteur de risque cardiovasculaire. Nous avons évalué le fonctionnement érectile à l’aide du domaine du fonctionnement érectile (FE) selon le score International Index of Erectile Function (IIEF). Nous avons exclu les hommes ayant des scores incomplets ou qui n’avaient pas d’activité sexuelle. Au moyen d’un plan expérimental factoriel 2 × 2, nous avons réparti de manière aléatoire les participants à la rosuvastatine (10 mg/j) ou au placebo, et au candesartan/hydrochlorothiazide (HCTZ ; 16 mg/12,5 mg/j ; Cand+HCTZ) ou au placebo. Le critère de jugement principal était la variation du FE selon l’IIEF (FE-IIEF) du début à la fin du suivi durant l’étude.


      Nous avons inclus 2153 hommes dont la moyenne d’âge était de 61,5 ans et le suivi moyen était de 5,8 ans. Le score moyen de FE-IIEF au début était de 23,0 (ÉT 5,6). La variation de la moyenne des moindres carrés du score de FE-IIEF ne différait pas entre la rosuvastatine et le placebo (−1,4 ; erreur type [ET], 0,3 vs −1,5 ; ET, 0,3 ; P = 0,74), entre le Cand+HCTZ et le placebo (−1,6 ; ET, 0,3 vs −1,3 ; ET, 0,3 ; P = 0,10) ou entre le traitement combiné et le « double placebo » (P = 0,35).


      Ni la diminution du cholestérol à l’aide des statines ni la réduction de la pression artérielle à l’aide du Cand+HCTZ (seul ou de manière combinée) n’améliorent le fonctionnement érectile ou ne lui nuisent.
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      Linked Article

      • Erratum
        Canadian Journal of CardiologyVol. 34Issue 6
        • Preview
          In the article, “Long-term Effects of Statins, Blood Pressure-Lowering, and Both on Erectile Function in Persons at Intermediate Risk for Cardiovascular Disease: A Substudy of the Heart Outcomes Prevention Evaluation-3 (HOPE-3) Randomized Controlled Trial” (Can J Cardiol 2018;34:38-44), by Joseph et al., there is an incorrect dose in the Methods section of the article. However, the correct dose is given in the abstract. The correct dose in the Methods section is “Cand + HCTZ; 16 and 12.5 mg/d”. The authors apologize for this error.
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      • Statins and Erectile Function
        Canadian Journal of CardiologyVol. 34Issue 6
        • Preview
          We read with great interest the report from Heart Outcomes Prevention Evaluation (HOPE)-3 by Joseph and associates.1 We were impressed by the size of the study and the high quality of the data. The statement in the conclusions that cholesterol lowering using a statin does not improve or adversely affect erectile function is correct when applied to HOPE-3. However, the statement may not be generalizable to the issue of the relationship between statins and erectile function. We noticed the nonsignificant decrease of 0.1 units more in placebo compared with rosuvastatin (Joseph et al.
        • Full-Text
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