The role of the atherogenic index of plasma in response to once-daily tadalafil in men with erectile dysfunction.

BACKGROUND

Erectile dysfunction (ED) significantly affects quality of life, and phosphodiesterase type 5 inhibitors, including tadalafil, are main treatment options. Treatment response varies, and vasculometabolic disturbances may reduce responsiveness.

METHODS

In this prospective single-centre cohort study, men aged ≥40 years with ED initiating tadalafil 5 mg once daily were followed for 12 weeks. AIP was calculated as log₁₀(triglycerides/HDL-C) after conversion to mmol/L. The primary outcome was a ≥4-point increase in IIEF-EF. Firth penalised logistic regression and ROC analyses were performed.

RESULTS

Among 134 men, the response rate was 73.1%. Nonresponders had higher baseline AIP (0.196 ± 0.271 vs 0.070 ± 0.224, p = 0.008), higher BMI (28.8 ± 4.19 vs 27.4 ± 3.28 kg/m², p = 0.042), and higher prevalence of DM (30.6% vs 12.2%, p = 0.013). Each 0.1-unit AIP increase was independently associated with nonresponse (adjusted OR 1.20, 95% CI 1.01-1.44, p = 0.036), as was DM (adjusted OR 3.39, 95% CI 1.15-10.45, p = 0.027). ROC analysis yielded an AUC of 0.650 (95% CI 0.540-0.760, p = 0.008), with an optimal cutoff of 0.130.

CONCLUSION

Higher baseline AIP was independently associated with nonresponse to once-daily tadalafil in men with ED, suggesting AIP may offer additional prognostic information, though further validation is needed.