Association between serum homocysteine and erectile dysfunction: a systematic review and meta-analysis

The aim of this meta-analysis was to determine the relationship between erectile dysfunction (ED) and serum homocysteine (Hcy) levels. A comprehensive search was performed using databases such as Web of Science, PubMed, and the Cochrane Library to identify suitable studies published by July 2023. The statistical analysis involved calculating the standardized mean differences (SMDs) and 95% confidence intervals (CIs) using STATA software. Twelve studies with 1766 ED patients and 2340 non-ED control participants were included in this meta-analysis. The pooled results indicated that the Hcy levels of ED patients were obviously greater than those of control participants (SMD (95% CI) = 0.97 (0.51,1.43), p < 0.001). Subgroup analysis revealed a greater SMD in ED patients aged>40 years, overweight status, those with a mild-moderate International Index of Erectile function (IIEF) score, and those living in Mediterranean countries, (1.18 (0.61, 1.75), p < 0.001; 1.27 (0.72, 1.82), p < 0.001;1.63 (1.04, 2.22), p < 0.001; 1.18 (0.61, 1.75), p < 0.001, respectively). Our meta-analysis indicated that subjects with ED exhibit higher levels of serum Hcy. However, due to the existence of publication bias, more rigorous and large-sample studies are needed.