Affiliation:
1. Department of Urology, The Second Hospital of Shanxi Medical University , Taiyuan 030001 , China
2. Shanxi Provincial Key Laboratory of Rheumatism Immune Microecology , Taiyuan, Shanxi Province 030001 , China
3. Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education , Taiyuan, Shanxi Province 030001 , China
4. Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education , Taiyuan, Shanxi Province 030001, China
5. Department of Rheumatology, The Second Hospital of Shanxi Medical University , Taiyuan 030001 , China
Abstract
Abstract
Background
The causal relationship between certain lifestyle factors and erectile dysfunction (ED) is still uncertain.
Aim
The study sought to investigate the causal effect of 9 life factors on ED through 2-sample single-variable Mendelian randomization (SVMR) and multivariable Mendelian randomization (MVMR).
Methods
Genetic instruments to proxy 9 risk factors were identified by genome-wide association studies. The genome-wide association studies estimated the connection of these genetic variants with ED risk (n = 223 805). We conducted SVMR, inverse variance-weighting, Cochran’s Q, weighted median, MR-Egger, MR-PRESSO (Mendelian Randomization Pleiotropy RESidual Sum and Outlier), and MVMR analyses to explore the total and direct relationship between life factors and ED.
Outcomes
The primary outcome was defined as self or physician-reported ED, or using oral ED medication, or a history of surgery related to ED.
Results
In SVMR analyses, suggestive associations with increased the risk of ED were noted for ever smoked (odds ratio [OR], 5.894; 95% confidence interval [CI], 0.469 to 3.079; P = .008), alcohol consumption (OR, 1.495; 95% CI, 0.044 to 0.760; P = .028) and body mass index (BMI) (OR, 1.177; 95% CI, 0.057 to 0.268; P = .003). Earlier age at first intercourse was significantly related to reduced ED risk (OR, 0.659; 95% CI, −0.592 to −0.244; P = 2.5 × 10−6). No strong evidence was found for the effect of coffee intake, time spent driving, physical activity, and leisure sedentary behaviors on the incidence of ED (All P > .05). The result of MVMR analysis for BMI (OR, 1.13; 95% CI, 1.01 to 1.25; P = .045) and earlier age at first intercourse (OR, 0.77; 95% CI, 0.56 to 0.99; P = .018) provided suggestive evidence for the direct impact on ED, while no causal factor was detected for alcoholic drinks per week and ever smoked.
Clinical implications
This study provides evidence for the impact of certain modifiable lifestyle factors on the development of ED.
Strengths and limitations
We performed both SVMR and MVMR to strengthen the causal relationship between exposures and outcomes. However, the population in this study was limited to European ancestry.
Conclusion
Ever smoked, alcoholic drinks per week, BMI, and age first had sexual intercourse were causally related to ED, while the potential connection between coffee intake, physical activity, recreational sedentary habits, and increased risk of ED needs to be further confirmed.
Funder
National Science Foundation of China
Wu Jieping Medical Foundation
Scientific Research Grant Project for Returned Overseas Chinese Students in Shanxi Province
Publisher
Oxford University Press (OUP)