The triad of erectile dysfunction, testosterone deficiency syndrome and metabolic syndrome: findings from a multi-ethnic Asian men study (The Subang Men’s Health Study)

Figures & data

Table I.  Participants’ age, prevalence of ED, metabolic syndrome and testosterone deficiency by ethnic distribution.

	All participants (N = 1046)	Malay (N = 361)	Chinese (N = 511)	Indian (N = 155)	P value	λ^2
	N (%)	N (%)	N (%)	N (%)
Age
Mean ± SD (years)	55.8 ± 8.4	55.5 ± 7.6	55.9 ± 8.2	56.2 ± 10.1	0.644	F = 0.44
Range (years)	41–93	41–82	41–82	42–93
BMI (kg/m^2)
18.5–22.9	221 (21.6)	50 (14.5)	146 (29.3)	20 (13.6)	<0.001	67.31
23–24.9	251 (24.6)	68 (19.7)	144 (28.9)	35 (23.8)
25–29.9	421 (41.2)	165 (47.8)	175 (35.1)	75 (51.0)
≥30	114 (11.2)	62 (18.0)	33 (6.6)	17 (11.6)
ED
Not sexually active	79 (8.1)	20 (5.9)	42 (8.6)	17 (12.0)	<0.001	27.97
No ED	311 (32.0)	88 (26.0)	181 (36.9)	42 (29.6)
Mild ED	387 (39.9)	152 (44.8)	189 (38.6)	46 (32.4)
Moderate ED	119 (12.3)	53 (15.6)	46 (9.4)	20 (14.1)
Severe ED	75 (7.7)	26 (7.7)	32 (6.5)	17 (12.0)
MS
Yes	308 (31.3)	119 (35.0)	119 (23.8)	70 (48.6)	<0.001	35.1
No	675 (68.7)	221 (65.0)	380 (76.2)	74 (51.4)
Number of MS components
0	112 (12.0)	25 (8.0)	76 (15.7)	11 (7.8)	<0.001	50.37
1	254 (27.1)	75 (24.1)	152 (31.4)	27 (19.1)
2	253 (27.0)	89 (28.6)	131 (27.1)	33 (23.4)
3	214 (22.9)	80 (25.7)	94 (19.4)	40 (28.4)
4–5	103 (11.0)	42 (13.5)	31 (6.4)	30 (21.3)
Waist circumference
≥90 cm	559 (56.5)	216 (65.3)	226 (45.3)	107 (74.8)	<0.001	55.35
<90 cm	424 (43.6)	115 (34.7)	273 (54.7)	36 (25.2)
Triglyceride
≥1.7 mmol/L	381 (37.7)	135 (38.5)	175 (34.3)	71 (47.3)	0.014	8.51
<1.7 mmol/L	630 (62.3)	216 (61.5)	335 (65.7)	79 (52.7)
HDL
≤1.0 mmol/L	142 (14.0)	54 (15.4)	57 (11.2)	31 (20.7)	0.009	9.45
>1.0 mmol/L	869 (86.0)	297 (84.6)	453 (88.8)	119 (79.3)
BP
≥130/85 mm Hg	582 (60.1)	206 (61.9)	285 (58.2)	91 (62.8)	0.444	1.63
<130/85 mm Hg	286 (39.9)	127 (38.1)	205 (41.8)	54 (37.2)
Fasting plasma glucose
≥5.6 mmol/L	286 (28.3)	121 (34.3)	112 (22.1)	53 (35.3)	<0.001	19.5
<5.6 mmol/L	724 (71.7)	232 (65.7)	395 (77.9)	97 (64.7)
Testosterone deficiency
TT < 10.4 nmol/L	164 (16.1)	72 (20.5)	59 (11.5)	33 (21.3)	<0.001	15.87
TT ≥ 10.4 nmol/L	854 (83.9)	280 (79.5)	452 (88.5)	122 (78.7)

BMI, body mass index; BP, blood pressure; ED, mrectile dysfunction; HDL, high-density lipoprotein; MS, metabolic syndrome; SD, standard deviation; TT, total testosterone.

Figure 1.  Prevalence of ED severity based on age groups. (p < 0.001).

Figure 2.  Prevalence of MS based on age groups (p = 0.013).

Table II.  Prevalence of comorbidities in ED and non-ED populations.

Comorbidities	ED (moderate–severe) N (%)	Insignificant ED (no-mild) N (%)	Crude OROR (95% CI)	Adjusted OR (logistic regression) OR (95% CI)
Metabolic syndrome (APC):	84 (43.8)	192 (28.0)	2.0 (1.4,2.8)**	0.9 (0.5,1.6)
Waist circumference (>90 cm)	128 (66.0)	373 (54.6)	1.6 (1.2,2.2)*	1.2 (0.7,1.9)
Blood pressure (≥130/85 mm Hg)	132 (69.8)	383 (56.6)	1.8 (1.3,2.5)*	1.6 (1.1,2.5)*
Fasting blood glucose (≥5.6 mmol/L)	79 (40.5)	176 (25.0)	2.0 (1.5,2.8)**	1.8 (1.2,2.8)*
Triglycerides (≥1.7 mmol/L)	81 (41.5)	260 (36.9)	1.2 (0.9,1.7)	N/A
HDL (≤1.0 mmol/L)	43 (22.1)	79 (11.2)	2.2 (1.5,3.4)**	2.0 (1.3,3.3)*
Coronary heart disease (self-reported)	37 (20.6)	55 (8.3)	2.9 (1.8,4.5)**	2.6 (1.6,4.3)*
Testosterone (<10.4 nmol/L)	40 (20.4)	102 (14.5)	1.5 (1.0,2.3)*	1.0 (0.6,1.6)
Morbid obesity (BMI ≥ 30 kg/m^2)	31 (15.8)	68 (9.8)	1.7 (1.1,2.7)*	1.3 (0.7,2.2)

APC, asia-pacific criteria; BMI, body mass index; CI, confidence interval; ED, erectile dysfunction; HDL, highdensity lipoprotein; OR, odds ratio; ^* p < 0.05; ^**p < 0.01.

Table III.  Prevalence of comorbidities in TDS and non-TDS populations.

Comorbidities	TDS (TT<10.4 nmol/L) N (%)	Non-TDS (TT ≥ 10.4 nmol/L) N (%)	Crude OROR (95% CI)	Adjusted OR (logistic regression) OR (95% CI)
Metabolic syndrome (APC)	83 (51.8)	233 (27.9)	2.7 (1.9,3.9)**	1.9 (1.0,3.8)*
Waist circumference (≥90 cm)	120 (77.4)	435 (52.5)	3.1 (2.1,4.6)**	2.6 (1.5,4.6)*
Blood pressure (≥130/85 mm Hg)	112 (71.8)	478 (58.4)	1.8 (1.2,2.6)*	1.8 (1.2,2.8)*
Blood glucose (≥5.6 mmol/L)	74 (44.6)	222 (25.8)	2.3 (1.6,3.3)**	2.4 (1.5,3.7)**
Triglycerides (≥1.7 mmol/L)	80 (48.2)	312 (36.2)	1.6 (1.2,2.3)*	1.8 (1.2,2.8)*
HDL (≤1.0 mmol/L)	39 (23.5)	104 (12.1)	2.3 (1.5,3.4)**	2.2 (1.3,3.6)*
Overweight (BMI > 30)	38 (24.2)	69 (8.1)	3.6 (2.3,5.6)**	2.3 (1.4,3.8)*

APC, Asia-pacific criteria; BMI, body mass index; CI, confidence interval; HDL, highdensity lipoprotein; OR, odds ratio; TDS, testosterone deficiency syndrome; TT, total testosterone; p < 0.01; p < 0.05.