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Medline, Embase, and the Cochrane Library were searched for publications investigating the possible association between ED and Hcy. Results were restricted by language, but no time restriction was applied. Standardized mean difference SMD was obtained by random effect models. A total of 9 studies were included in the analysis with a total of 1, subjects subjects with ED; subjects without ED. Subgroup analysis based on prevalence of diabetes showed significantly higher SMD in subjects without diabetes 1. The authors concluded that findings from this meta-analysis suggested that increased levels of serum Hcy were more often observed in subjects with Sildenafil 100mg. They stated that based on existing literature on this topic, a causative role for hyperhomocysteinemia as an independent risk factor for ED could be postulated, although confirmation would require interventional studies aimed to decrease serum Hcy levels considering erectile function as primary outcome, reasons of ED. Sildenafil 100mg researchers stated that actually, only in rat model of hyperhomocysteinemia has been observed an improvement in erectile function after being treated with a demethylation agent. These investigators also reported significantly higher levels of Hcy in subjects without diabetes, compared to diabetic men. They noted that while one could assume that this is further proof of a multi-factorial pathogenesis for ED, it is also a clear indication that future research in this field should examine the possible association with other known risk factors such as smoking habit and obesity in order to adequately address the possible effects of different variates.

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