Association between visceral adiposity index and arteriogenic erectile dysfunction: a multicenter cross-sectional...

Arteriogenic erectile dysfunction (AED) is a common form of erectile dysfunction (ED) associated with vascular dysfunction. Visceral adiposity, reflected by the Visceral Adiposity Index (VAI), is a known risk factor for metabolic disorders, but its role in AED remains unclear.

This study aimed to explore the association between VAI and AED and investigate whether total testosterone (TT) mediates this relationship.

A total of 216 men, including 111 patients with AED and 105 controls, were enrolled from 3 hospitals. AED was diagnosed using a stepwise approach, including abnormal nocturnal penile tumescence and rigidity testing (NPTR) and confirmatory penile color Doppler duplex ultrasonography (CDDU). Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic performance of VAI for identifying AED. Multivariate logistic regression was used to identify independent risk factors for AED. A multiple mediation analysis was performed to evaluate the indirect effect of TT in the VAI-erectile function relationship using the PROCESS macro in SPSS.

VAI was calculated using a formula: VAI (men) = [waist circumference (WC)/(39.68 + (1.88 × body mass index (BMI))] × (triglycerides (TG)/1.03) × (1.31/high-density lipoprotein cholesterol (HDL-C)). Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5).

The AED group had significantly higher VAI values than controls (1.92 [0.72-3.11] vs 1.37 [0.79-1.95], P < .001). Multivariate logistic regression analysis identified VAI as an independent predictor of AED (OR = 2.548, 95% CI, 1.892-4.017, P < .001). ROC analysis demonstrated that VAI had good diagnostic performance for identifying AED, with an area under the curve (AUC) of 0.704 (95% CI, 0.635-0.774, P < .001). Mediation analysis showed that TT partially mediated the relationship between VAI and erectile function, explaining approximately 23% of the total effect.

These findings highlight the importance of visceral adiposity and TT levels in the pathophysiology of AED, providing insights for potential therapeutic interventions.

This multicenter study used standardized NPTR followed by penile CDDU to objectively define AED. VAI provided an integrated measure of visceral adiposity beyond BMI or WC. Limitations include the cross-sectional design (precluding causal inference), possible residual confounding, and a relatively limited sample size.

This study suggests that VAI is independently associated with AED and that testosterone reduction partially mediates this relationship.