Self-reported erectile dysfunction tied to increased CVD risk
Older men who report erectile dysfunction (ED) may be at greater risk of cardiovascular disease (CVD) independent of other risk factors such as LDL cholesterol, smoking and high blood pressure.
In a recent analysis based on data from the ongoing MESA* prospective cohort study, researchers found that men between ages 60 to 78 who self-reported ED were up to two times as likely to experience heart attacks, cardiac arrests, sudden cardiac death and fatal or non-fatal strokes over a 4-year period. [Circulation 2018; doi:10.1161/CIRCULATIONAHA.118.0339]
"Our results reveal that erectile dysfunction is, in and of itself, a potent predictor of cardiovascular risk," says study senior investigator Dr Michael Blaha, associate professor of medicine at the Johns Hopkins School of Medicine in Baltimore, Maryland, USA. "Our findings suggest that clinicians should perform further targeted screening in men with erectile dysfunction regardless of other cardiac risk factors and should consider managing [the risk factors] that much more aggressively."
For an average of 3.8 years, Blaha’s team followed a subset of 1,757 male participants in the MESA study who were of mean age 69±9.2 years, had submitted an answer to the Massachusetts Male Aging Study (MMAS), and were free of CVD events at baseline. The cohort was an ethnically mixed group consisting of 42.3% white, 24.2 percent African American, 10.5 percent Chinese American, and 22.9 percent Hispanic individuals. ED symptoms were reported by 877 (45.8 percent) participants.
Of the participants, 877 had self-reported ED (based on a reply of “never able” or “sometimes able” to the MMAS assessment).
Blaha’s team aimed to investigate the value of self-reported ED as a predictor of incident coronary heart disease (CHD) and CVD. Outcomes of hard CVD events were assessed, which included all hard CHD events (myocardial infarction, resuscitated cardiac arrest, and CHD death), plus stroke and stroke death.
During the 4-year follow-up, a total of 75 hard CVD events were observed among the cohort, with a significantly greater proportion of participants with self-reported ED experiencing them than those without ED (6.3% versus 2.6%, p<0.001).
Analysis through Cox proportional hazard models showed that ED was a significant predictor of hard CVD events (hazard ratio, 1.9; 95% confidence interval, 1.1–3.4), even when the data was adjusted for smoking status, diabetes mellitus, family history of CHD, total/high-density lipoprotein cholesterol ratio, systolic blood pressure, antihypertensive medication use, lipid-lowering medication use, β-blocker use and depression.
ED, defined as the inability to achieve or maintain an erection for satisfactory sexual intercourse, affects nearly 20 percent of men over 20 years of age. CVD and ED share common risk factors including obesity, hypertension, smoking, diabetes and metabolic syndrome.
While limited evidence of a link between ED and CVD has emerged in recent years, the results of this latest study may provide the strongest indication to date that sexual dysfunction indicates heightened cardiovascular risk, the researchers said.
“Our study had certain limitations. Although similar to the primary care assessment of ED, the single Massachusetts Male Aging Study question does not distinguish between vascular and nonvascular types of ED, which may have attenuated the association between ED and CVD,” wrote the researchers. “In addition, because our follow-up was just 3.8 years, additional 10-year data on the risk predictive value of ED are needed.”