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Erectile Dysfunction as Predictor of Future CVD Events
Study Questions:
Is erectile dysfunction (ED) an independent predictor of future cardiovascular disease (CVD) events?
Methods:
The authors utilized the MESA study (Multi-Ethnic Study of Atherosclerosis), a community-based, multisite prospective cohort study, to examine the value of self-reported ED for predicting incident coronary heart disease (CHD) and CVD in those free of these CVD events at baseline. MESA participants who answered the single Massachusetts Male Aging Study question on ED symptoms were considered for the analysis (n = 1,914). A participant was considered to have ED if he responded “never able” or “sometimes able” to the study question. A total of 1,757 participants were followed for 3.8 years (interquartile range, 3.5–4.2 years), and outcomes of hard CHD and CVD events were assessed.
Results:
The mean age was 69 ± 9.2 years and 42.3% were white, 24.2% were African American, 10.5% were Chinese American, and 22.9% were Hispanic. ED symptoms were reported by 877 (45.8%) participants. Participants with ED were more likely to have diabetes mellitus and a family history of CHD. They were also more likely to use beta-blocker, antihypertensive, lipid-lowering, and antidepressant medications. Over the 3.8-year follow-up, there were a total of 40 CHD and 75 CVD hard events. A significantly greater proportion of participants with ED experienced hard events than those without ED (CHD hard events: 3.4% vs. 1.4%, p < 0.001; CVD hard events: 6.3% vs. 2.6%, p < 0.001). In the fully adjusted model (demographics, classic risk factors, depression, and medication including beta-blockers), ED remained a significant predictor of hard CVD events (hazard ratio, 1.9; 95% confidence interval, 1.1-3.4), whereas hard CHD events became nonsignificant, albeit with a similar point estimate of risk.
Conclusions:
The findings strengthen the existing evidence for the independent association between ED and incident CVD, and could have important clinical implications for risk stratification in middle-aged men.
Perspective:
In 2017, the UK QRISK score was the first to incorporate ED as an independent risk factor (predictor) for CVD. I find it useful to discuss ED as an early sign of vascular disease, which can help getting the men and their significant others more compliant with both lifestyle and medication. Albeit, as they should, the majority are convinced it is the medication for their hypertension.
Keywords: Aging, Atherosclerosis, Antidepressive Agents, Antihypertensive Agents, Atherosclerosis, Coronary Disease, Depression, Diabetes Mellitus, Erectile Dysfunction, Geriatrics, Hypertension, Life Style, Lipids, Primary Prevention, Risk Factors, Vascular Diseases
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