[Hyperhomocysteinemia and erectile dysfunction: an update].

Hyperhomocysteinemia (HHcy) is considered to be one of the most important cardiovascular risk factors. Epidemiological studies conducted on erectile dysfunction (ED) have demonstrated its close correlation with cardiovascular disease, and therefore HHcy might be a novel risk factor of ED. However, the mechanism of ED resulting from HHcy is not precisely known, but may relate to increased damage of vascular endothelial cells, reactive oxygen species (ROS), and atherosclerosis. Although further studies are needed on this association between HHcy and ED, the measurement of plasma Hcy and folic acid levels and molecular analysis of the MTHFR genotype might be added to the ED diagnostic procedure, especially in young patients or in those with a family history of cardiovascular disease. Treatment of ED patients with HHcy should first aim to reduce the Hcy level through administration of folic acid, alone or in combination with vitamin B6 or B12, and then proceed to treatment with PDE5i. This paper offers an overview on the advances in the studies of the correlation between HHcy and ED.