59-fold greater likelihood (OR = 2.59) of experiencing a cardiovascular event in the next 10 years [6]. The severity of ED definitely has been associated with a higher occurrence of major cardiovascular events and an increased risk of serious cardiovascular events [7]. Some inflammatory mediators, like C-reactive protein and fibrinogen, are elevated in patients with CD, especially in those with coronary heart disease. These mediators have clinical significance and could be useful in monitoring the treatment of these patients [8], but additional studies are necessary to confirm these results. Chronic inflammation plays an important role in the development of insulin resistance, endothelial dysfunction, and cardiovascular disease.

Other studies report that plasma acute-phase protein levels are elevated in patients with ED (fibrinogen, von Willebrand factor, and interleukins) [9]. Recent studies have revealed that testosterone plays a protective role in the development of endothelial damage, and a negative linear relationship between testosterone levels and the severity of coronary disease has been found [10, 11]. Testosterone also plays an important role in erectile function and sexual desire, but it is not necessarily decreased in all patients with ED [10]. Different studies have shown that testosterone replacement therapy improves metabolic disease and central obesity [11]. The objectives of this study were to analyse the relationship between ED, MS, and systemic inflammation.

The end point of this case-control study was to investigate the prevalence of metabolic syndrome in patients with ED in comparison with control subjects and to analyse the association with acute phase reactants (CPR, ESR, fibrinogen, D-dimer) and hormone levels. 2. Material and Methods2.1. Patients and ControlsThis case-control study included 65 outpatient males, 37 with erectile dysfunction consecutively selected, according to the International Index of Erectile Function (IIEF) from the Urology Department of San Cecilio University Hospital, Granada (Spain) and 28 healthy volunteers controls without erectile dysfunction from outside of the hospital. Participants from both groups answered the IIEF test to determine the presence (or not) of ED. The IIEF is a test with 15 questions about sexual activity, sexual desire, and sexual potency.Inclusion criteria were male patients, age between 40 and 65 years with erectile dysfunction as defined by the IIEF and signing of the informed consent for GSK-3 study participation.