Erectile dysfunction (ED)—the repeated inability to get or maintain an erection for sexual intercourse or activity—appears to increase a man’s risk of future heart attack or stroke, and may be an important early warning sign of cardiovascular problems. Independent of established risk factors, men with ED have a 40 percent higher risk of developing cardiovascular disease (CVD) than those without ED, according to research published in the January 26, 2010, issue of the Journal of the American College of Cardiology.
This prospective study—the first to explicitly test whether ED can be used to reclassify patients according to their future risk of developing CVD beyond the Framingham risk score, which is the standard predictive tool used to assess heart attack risk—followed 1,057 men ages 40 to 70 years old for approximately 12 years. Although ED is significantly associated with CVD, it was not found to improve the prediction of who will or will not develop CVD beyond that offered by traditional risk factors.
“This is not necessarily surprising given that the Framingham risk score is very strongly linked with CVD and has been extensively validated. Thus, the bar for improving risk prediction is set fairly high,” said Andre Araujo, Ph.D., director of Epidemiology at New England Research Institutes, Inc., Watertown, Mass. “In addition, the factors that make up the Framingham risk score—age, high-density lipoprotein cholesterol, and total cholesterol, smoking and high blood pressure—are all very strongly associated with ED.”
Still, the data indicate that ED, which affects an estimated 18 million men in the U.S., is as strongly related to the development of CVD as the Framingham risk score. Overall, 37 percent of men with ED were in the high risk category for Framingham risk score compared with 17 percent of men without ED.
In addition to shared risk factors (for example, smoking, obesity and high blood pressure), the link between ED and CVD can also be explained by the fact that the penis is a vascular organ— just like the heart.
“Since atherosclerosis is generally considered a disease that affects the entire body, then it makes sense that the small arteries in the penis would become blocked sooner than the larger arteries in the heart,” said Dr. Araujo. “Blocked arteries reduce blood flow, and this results in a reduced ability to have an erection. Since some risk factors for cardiovascular disease are ‘silent,’ men may be more likely to notice ED than high blood pressure or high cholesterol.”
For this reason, the authors believe health professionals should consider asking about ED in their older male patients and assess cardiovascular risk in those with ED.
“Once ED is noticed, there may be a window of opportunity for men to improve their health before a cardiovascular event occurs,” said Dr. Araujo.
Dr. Araujo adds that ED assessment can be done easily, at very low cost with a simple single question that correlates well with an independent physician’s assessment, and presents no risk to patients; whereas the Framingham risk score takes more time and requires a blood sample, with associated wait times for test results.
This study drew from the Massachusetts Male Aging Study, a prospective, observational cohort study of aging, health and endocrine and sexual function in a population-based random sample of men between the ages of 40 and 70 years. Of the 1,057 men included in this study, 25 percent developed CVD.
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The American College of Cardiology is leading the way to optimal cardiovascular care and disease prevention. The College is a 37,000-member nonprofit medical society and bestows the credential Fellow of the American College of Cardiology upon physicians who meet its stringent qualifications. The College is a leader in the formulation of health policy, standards and guidelines, and is a staunch supporter of cardiovascular research. The ACC provides professional education and operates national registries for the measurement and improvement of quality care. More information about the association is available online atwww.acc.org .