Study Confirms Heart Risk of Erectile Dysfunction


As the severity of erectile dysfunction increases, so do the risks of cardiovascular disease and mortality among men both with and without a history of heart disease, researchers found.

Men with severe dysfunction in particular had significantly elevated risks of ischemic heart disease, heart failure, peripheral vascular disease, "other" cardiovascular disease, all cardiovascular diseases combined, and all-cause mortality (RRs 1.26 to 8.00), according to Emily Banks, MBBS, PhD, of Australian National University in Canberra, and colleagues.

The relationships were generally stronger among men with previously recorded cardiovascular disease, the researchers reported online in PLOS Medicine; they noted that the erectile dysfunction should be considered a marker for heart disease rather than a risk factor.

"The findings provide general support for the Princeton consensus that men with erectile dysfunction require assessment for cardiovascular disease risk," the authors wrote, "while the quantitative ability of erectile dysfunction to predict risk in the clinical setting, over and above clinically measured risk factors, requires specific testing."

The researchers examined data from the 45 and Up Study, a prospective, population-based investigation of both men and women 45 and older living in New South Wales, Australia. The current analysis included 95,038 men (mean age 62) who provided postal questionnaire data from 2006 to 2009 and were followed for hospitalizations and deaths using government databases.

Erectile dysfunction was assessed using a single question about how often the men were able to get and keep an erection firm enough for satisfactory sexual activity. Severe dysfunction – defined as an answer of "never" to that question – occurred in 2.2% of those ages 45 to 54, 6.8% of those ages 55 to 64, 20.2% of those ages 65 to 74, 50% of those ages 75 to 84, and 75.4% of those ages 85 and older.

There were 7,855 hospitalizations for cardiovascular disease through an average follow-up of 2.2 years, and 2,304 deaths through an average follow-up of 2.8 years.

Risks of both outcomes increased along with the severity of erectile dysfunction after adjustment for age, smoking, alcohol consumption, marital status, income, education, physical activity, body mass index, diabetes, and treatment for hypertension or hypercholesterolemia.

Among men with no prior cardiovascular disease, severe erectile dysfunction was associated with significantly greater risks of the following specific outcomes:

Heart failure (RR 8.00, 95% CI 2.64 to 24.20)
Atrioventricular and left bundle branch block (RR 6.62, 95% CI 1.86 to 23.56)
Peripheral atherosclerosis (RR 2.47, 95% CI 1.18 to 5.15)
All-cause mortality (RR 1.93, 95% CI 1.52 to 2.44)
Peripheral vascular disease (RR 1.92, 95% CI 1.12 to 3.29)
Acute myocardial infarction (RR 1.66, 95% CI 1.22 to 2.26)
Ischemic heart disease (RR 1.60, 95% CI 1.31 to 1.95)
All cardiovascular diseases combined (RR 1.35, 95% CI 1.19 to 1.53)
"Other" cardiovascular disease (RR 1.26, 95% CI 1.05 to 1.51)

Generally similar relationships were observed among men with a history of known cardiovascular disease, although the findings "should be interpreted with caution, since a number of treatments for cardiovascular disease increase the risk of erectile dysfunction," according to Banks and colleagues.

Erectile dysfunction is likely a "biomarker ... of the severity of underlying pathological processes such as atherosclerosis and endothelial dysfunction," they wrote.

"Although the pathophysiology of erectile dysfunction is multifactorial and includes arterial, neurogenic, hormonal, cavernosal, iatrogenic, and psychogenic causes, it is now widely accepted that erectile dysfunction is predominantly due to underlying vascular causes, particularly atherosclerosis," they wrote.

The researchers acknowledged that the study was limited by the lack of information on the duration of erectile dysfunction, on certain risk factors like blood pressure and lipids, and on medication use.

In addition, the study relied on self-reported data for most of the potential confounders and on administrative data for cardiovascular hospitalization endpoints. Unmeasured confounding was a possibility.


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