Central Bringing Excellence in Open Access   Annals of Mens Health and Wellness Cite this article: Schlesinger N, Lu N, Choi HK (2017) Gout and the Risk of Incident Erectile Dysfunction: A Body Mass Index-Matched Matched Population- Based Study. Ann Mens Health Wellness 1(1): 1003. *Corresponding author Na o mi Sc hle sing e r, De p a rtme nt o f Me d ic ine , Rutg e rs - Ro b e rt Wo o d Jo hnso n Me d ic a l Sc ho o l, MEB 468, Rutg e rs RWJMS, Ne w Brunswic k, NJ 08901, USA, Te l: 732 3258378; Email: Submitte d: 13 January 2017 Accepted: 15 Marc h 2017 Publishe d: 16 Marc h 2017 Copyright © 2017 Sc hle sing e r e t a l. OPEN ACCESS Ke ywo rds • Gout • Ere c tile d ysfunc tio n Original Research Gout and the Risk of Incident Erectile Dysfunction: A Body Mass Index-Matched Matched Population-Based Study Naomi Schlesinger 1 *, Na Lu 2 , and Hyon K. Choi 2 1 Department of Medicine, Rutgers - Robert Wood Johnson Medical School, USA 2 Department of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, USA Abstract Purpose: Gout is the most common infammatory arthritis. Erectile dysfunction is common in the general population; however, evidence regarding erectile dysfunction among gout patients is limited. Our goal was to study the risk of incident erectile dysfunction in gout patients as compared with the general population. Materials and methods: We conducted a cohort study using The Health Improvement Network, an electronic medical record database in the United Kingdom. Up to fve individuals without gout were matched to each case of incident gout by age, enrolment time, and body mass index. Multivariate Hazard Ratios for erectile dysfunction were calculated after adjusting for smoking, alcohol consumption, comorbidities and medication use. Results: We identifed 2290 new cases of erectile dysfunction among 38,438 patients with gout (mean age 63.6 years) and 8447 cases among 154,332 individuals in the comparison cohort over a 5-year median follow up (11.9 vs. 10.5 per 1000 person-years, respectively). Univariate (age, entry time and body mass index-matched) and multivariate Hazard Ratios for erectile dysfunction among patients with gout were 1.13 (95% CI, 1.08 to 1.19) and 1.15 (95% CI, 1.09 to 1.21), respectively. In our sensitivity analysis, restricting gout cases to those receiving anti-gout treatment (n=31,227) the magnitude of relative risk was stronger than the primary analysis; (multivariate Hazard Ratios = 1.29; 95% CI, 1.22 to 1.37). Conclusions: This population-based study suggests that gout is associated with an increased risk of developing erectile dysfunction, supporting a possible role for hyperuricemia and infammation as independent risk factors for erectile dysfunction. ABBREVIATIONS UK: United Kingdom; MSU: Monosodium Urate; CKD- Chronic Kidney Disease DM: Diabetes Mellitus; ED: Erectile Dysfunction; CVD: Cardiovascular Disease; CAD: Coronary Artery Disease; GP: General Practitioner; THIN: The Health Improvement Network; BMI: Body Mass Index; Hrs: Hazard Ratios; IIEF: International Index of Erectile Function; IL: Interleukin; SU: Serum Urate INTRODUCTION Gout is the most common inflammatory arthritis in humans, affecting an estimated 8.3 million Americans [1]. The prevalence of gout has increased significantly in many western countries, including in the United Kingdom (UK) [2]. Gout is frequently perceived as an acute arthritis of the big toe; however, it is a chronic metabolic condition resulting from hyperuricemia leading to deposition of monosodium urate (MSU) crystals in joints and soft issues as well as acute attacks. Gout is frequently associated with a number of comorbidities, including hypertension, hyperlipidemia, obesity, chronic kidney disease (CKD), diabetes mellitus (DM), as well as a combination of these conditions known as the metabolic syndrome [3]. Erectile dysfunction (ED) defined as the “the inability to achieve or maintain an erection sufficient for satisfactory sexual performance” [4], and is common in the general population. An association between ED and cardiovascular disease (CVD) has long been recognized and studies suggest that ED is an independent marker of CVD risk [5]. CVD and ED share mutual risk factors and comorbidities such as DM, obesity, hypertension, advanced age, hyperlipidemia, metabolic syndrome, certain medications and tobacco abuse [5]. It has been suggested that there is an increased risk of coronary artery disease (CAD) and peripheral vascular disease associated with gout independent of traditional CVD risk factors [6]. As the number of CVD risk factors increase, so does the incidence of both CAD and ED [7]. We have previously reported an increased odds of ED in gout patients a in a cross-sectional study of arthritis patients (N=201) from a University Hospital Rheumatology clinic [8].While common risk factors for and comorbidities of gout [9,10], and ED may explain the link between ED and gout, chronic inflammation as well as hyperuricemia contribute to an increased risk of ED among gout patients. Our objective in this study was to confirm the independent association between gout and the risk of incident ED in a general population context.