What is the rate of erectile dysfunction (ED) associated with statin use?

Rate of Erectile Dysfunction with Statin Use

The rate of new-onset erectile dysfunction (ED) with statin use is approximately 22% after 6 months of therapy, according to the most recent high-quality evidence. 1

Evidence on Statin-Associated ED

• The most direct evidence comes from a prospective observational study that found 22% of men experienced new-onset ED after 6 months of statin therapy, with median International Index of Erectile Function (IIEF) scores decreasing significantly from 21 to 6.5 (p<0.001) 1
• This finding is consistent with earlier evidence from the Princeton III Consensus, which cited a study reporting new-onset ED in 22% of 93 high-risk men after 6 months of statin use 2
• ED following statin therapy appears more likely in patients with severe endothelial dysfunction due to established cardiovascular risk factors including age, smoking, and diabetes 1

Contradictory Evidence

• Some studies suggest statins may actually improve erectile function:
  • A nationwide propensity-matched cohort study in Taiwan found statin users had a significantly lower risk of incident ED compared to non-users (HR 0.75; 95% CI 0.63-0.90) 3
  • This protective effect was more pronounced in middle-aged men (40-49 years) and those taking high-potency statins 3
  • A small clinical study showed improvement in erectile function in men with hypercholesterolemia as their only ED risk factor when treated with atorvastatin 4

Mechanisms and Risk Factors

• The relationship between statins and ED is complex and may involve:
  • Potential reduction in testosterone levels 5
  • Improvement in endothelial function, which could theoretically benefit erectile function 5
  • Interaction with existing cardiovascular risk factors 1
• After statin therapy, lower IIEF scores correlate with:
  • Advanced age 1
  • Presence of diabetes 1
  • History of smoking 1

Clinical Implications

• When prescribing statins, clinicians should be aware of the potential risk of ED, particularly in men with existing cardiovascular risk factors 1
• For patients experiencing statin-associated ED, consider:
  • Evaluating for other causes of ED 2
  • Potentially using PDE5 inhibitors like sildenafil, which have been shown to be effective for ED of various etiologies including cardiovascular disease 6, 7
  • In some cases, combination therapy with sildenafil plus atorvastatin may provide greater improvements than sildenafil alone in men with poor initial response to sildenafil 8

Monitoring Recommendations

• Assess erectile function before initiating statin therapy to establish baseline 1
• Monitor for changes in erectile function, particularly during the first 6 months of therapy 1
• For patients with new-onset ED while on statins, evaluate the risk-benefit ratio of continuing statin therapy versus the impact on quality of life 2

Key Considerations

• The decision to continue or discontinue statin therapy in patients experiencing ED should weigh cardiovascular benefits against quality of life impacts 2
• If ED appears after institution of statin therapy and significantly impacts quality of life, consider switching to another agent 2