title: The effects of statin treatment on adrenal and sexual function and nitric oxide levels in hypercholesterolemic male patients treated with a statin.
abstract: Erectile dysfunction complaints among men treated with a statin are not uncommon.
  
  
  
  To evaluate the effect of lowering low-density lipoprotein cholesterol (LDL-C) to target levels using varying doses of atorvastatin therapy in hypercholesterolemic male patients on adrenocortical hormones, sexual functions, and serum nitric oxide (NO) levels.
  
  
  
  Eleven hypercholesterolemic male patients who had LDL-C levels greater than 160 mg/dL were included in the study and 11 healthy male individuals served as controls. Following basal hormone measurements, 1-and 250-mcg adrenocorticotropic hormone stimulation tests were performed in both groups, and blood sampling was performed at 0, 30, and 60 minutes for the determination of blood levels of cortisol, total testosterone (TT), free testosterone (FT), 11-deoxycortisol, and dehydroepiandrostenedione. Depending on baseline LDL-C concentrations, atorvastatin therapy was given to patients with daily doses of 5 or 10 mg and the study procedures were repeated once patients reached risk stratified goal LDL-C levels. LDL-C values after treatment were classified into 3 groups as LDL-C > 160 mg/dL, LDL-C 100 to 130 mg/dL and LDL-C < 100 mg/dL. NO levels were measured at baseline and after statin therapy. Erectile function was assessed both objectively and subjectively by using penile somatosensory evoked potential (SEP) and the International Index of Erectile Function-5 Questionnaire, respectively, at 3 different LDL-C levels.
  
  
  
  With regard to adrenocorticotropic hormone stimulation test (1 or 250 mcg) results, peak cortisol levels before and after statin treatment among 3 LDL-C groups and among controls did not differ significantly. However, peak TT and FT hormone levels decreased in conjunction with decreasing levels of LDL-C among the statin-treated patients, whereas dehydroepiandrostenedione and 11-11-deoxycortisol peak values did not change. N1 latency obtained during SEP, which is the first negative deflection, was prolonged with decreasing levels of LDL-C and a significant decrease in International Index of Erectile Function-5 scores were observed. When LDL-C levels of ≥ 160 mg/dl was reduced to 100 to 130 mg/dl, maximal NO elevations were noted.
  
  
  
  Our results suggest that decreased LDL-C levels caused by different doses of atorvastatin treatment did not associate with significant changes in adrenal hormone levels. In contrast, there was a significant relationship between attained LDL-C on statin therapy and TT and FT levels. Electrophysiologically, abnormal SEP responses obtained in the patient group with LDL-C levels below 100 indicate a negative impact on the integrity of the somatosensory pathway, which plays a role in erectile function. Reducing LDL-C with a statin was associated with both decreased testosterone levels and erectile dysfunction.
authors.affiliation: Department of Internal Medicine, Erciyes University Medical School, Kayseri, Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Baspınar
authors.affiliation: Department of Endocrinology and Metabolism, Erciyes University Medical School, Kayseri, Turkey.
authors.forename: Fahri
authors.initials: F
authors.lastname: Bayram
authors.affiliation: Department of Neurology, Acıbadem University Medical Faculty, Acibadem Kayseri Hospital, Kayseri, Turkey.
authors.forename: Selda
authors.initials: S
authors.lastname: Korkmaz
authors.affiliation: Department of Neurology, Erciyes University Medical School, Kayseri, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Aksu
authors.affiliation: Department of Biochemistry, Kayseri Training and Research Hospital, Kayseri, Turkey.
authors.forename: Derya
authors.initials: D
authors.lastname: Kocer
authors.affiliation: Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey.
authors.forename: Oğuzhan Sıtkı
authors.initials: OS
authors.lastname: Dizdar
authors.affiliation: Department of Endocrinology and Metabolism, Erciyes University Medical School, Kayseri, Turkey.
authors.forename: Yasin
authors.initials: Y
authors.lastname: Simsek
authors.affiliation: Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, USA; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: peter.toth@cghmc.com.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Toth
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage; D000328:Adult; D000069059:Atorvastatin / Q000627:therapeutic use; D016022:Case-Control Studies; D008078:Cholesterol, LDL / Q000097:blood; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000032:analysis*; D010410:Penile Erection / Q000502:physiology*; D013739:Testosterone / Q000097:blood
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D009569:Nitric Oxide; D013739:Testosterone; D000324:Adrenocorticotropic Hormone; D000069059:Atorvastatin; D006854:Hydrocortisone
keywords: ACTH; Cortisol; Erectile dysfunction; Hypercholesterolemia; Somatosensory evoked potential; Statin; Testosterone