Abstract
BACKGROUND: The monocyte-to-high-density lipoprotein cholesterol ratio (MHR) has become a novel inflammation marker with a possible association with erectile dysfunction (ED); however, there are fewer studies exploring the association between MHR and ED. AIM: This study sought to explore the association between MHR and ED. METHODS: This study population was drawn from participants in two 2-year cycles of the National Health and Nutrition Examination Survey (2001-2002 and 2003-2004). MHR was calculated as the ratio of monocyte count (10(3) cells/μL) to high-density lipoprotein cholesterol (mg/dL). The relationship between MHR and ED was explored using survey-weighted logistic regression models with MHR as a continuous variable and divided into tertiles (tertile 1 [T1]: <0.01; T2: 0.01-0.014; T3: >0.014). We also used a smooth curve fit (penalized spline method) to characterize the dose-response relationship between MHR and ED. In addition, subgroup analyses based on age, body mass index, smoking, hypertension, diabetes mellitus, and cardiovascular disease were performed to further analyze the data. Sensitivity analyses were also conducted to further assess the stability of the results. OUTCOMES: The main outcome measure was the difference in ED prevalence between MHR levels. RESULTS: A total of 1361 participants were enrolled, with 513 (T1), 438 (T2), and 410 (T3) participants in the 3 MHR groups. After adjusting for all potential covariates, survey-weighted logistic regression analyses showed a significant association between MHR and ED (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.26-3.05). When MHR was used as a categorical variable, the adjusted OR for ED prevalence increased significantly with increasing MHR after adjusting for all potential covariates (T3 vs T1: OR, 2.14; 95% CI, 1.29-3.55). The dose-response curves showed that the prevalence of ED increased with increasing MHR. CLINICAL IMPLICATIONS: Easy to access and low cost, MHR is a convenient clinical tool that helps clinicians in the prevention and treatment of ED. STRENGTHS AND LIMITATIONS: The present study is the first to examine the association between MHR and ED nationally representative data. However, the study population was derived from a U.S. database, so the findings are limited to the U.S. population. CONCLUSION: Our study demonstrated that MHR levels were independently associated with ED and that ED patients had higher MHR levels, suggesting that MHR may be a valuable predictor for identifying people at higher risk for ED.