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Editor's Correspondence
Feb 13, 2012

Lifestyle for Erectile Dysfunction: A Good Choice—Reply

Author Affiliations

Author Affiliations: Division of Cardiovascular, Mayo Clinic, Rochester, Minnesota.

Arch Intern Med. 2012;172(3):296-297. doi:10.1001/archinternmed.2011.805

In reply

We appreciate the excellent suggestion by Esposito and Giugliano, which is to conduct a responders' analysis (ie, to evaluate the response [International Index of Erectile Function {IIEF-5} score ≥22] to lifestyle interventions as a dichotomous outcome).

If we consider an IIEF-5 score of 22 or higher to be consistent with the achievement of normal sexual function after lifestyle intervention and cardiovascular risk factors reduction, we would have data available from 3 studies.13 A fixed-effect meta-analysis of these 3 studies revealed that lifestyle interventions reduce the odds of erectile dysfunction (ED) (odds ratio, 0.48; 95% CI, 0.26-0.89). This effect lost statistical significance under a random effects model but remained as a strong trend. The heterogeneity of this meta-analysis was likely due to differences in study populations. In contrast to the relatively younger and nondiabetic populations in the studies by Esposito et al,1,2 the study population of Wing et al3 consisted of diabetic men with average age of 60 years, explaining the irreversibility of ED.

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