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Dear Editor,

I read with great interest the article by Jamaluddin et al1 about evaluating the relationship among High-Sensitivity C-Reactive Protein (hs-CRP) level, mechanism and severity of erectile dysfunction (ED), and response to tadalafil in a recent issue of the journal. Hs-CRP level is a marker of inflammation, and has been shown to be a strong predictor of future risk for adverse cardiovascular events.1 In their study, Jamaluddin et al1 observed that the baseline hs-CRP level was more higher in the vasculogenic ED group. Following tadalafil treatment, a reduction in hs-CRP levels was detected in all patients, but this decrease was more significant in the nonvasculogenic ED group. Their findings showed that hs-CRP level of ≥2.35 mg/L was associated with poorer response to tadalafil (with 39.5% sensitivity and 75.4% specificity).Based on their multivariate analysis, shorter duration of ED, nonvasculogenic origin, and higher baseline erectile function scores were found to be significant predictors of the response to tadalafil. However, the significant effect of hs-CRP level on predicting improvement in ED was not shown in the multivariate analysis. As mentioned by the authors, the predictive accuracy of hs-CRP level was modest and it was not found to be an independent determinant of therapeutic responsiveness to tadalafil.1

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