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Erectile dysfunction (ED) significantly increases the risk of cardiovascular disease (CVD), coronary heart disease (CHD), stroke, and all-cause mortality, according to a meta-analysis conducted by a Chinese research team and published in the Journal of the American College of Cardiology (JACC). Sensitivity analysis suggests that the association is independent of conventional cardiovascular risk factors, a finding that may help to answer a pivotal question regarding the relationship of these two conditions.
Noting the “rapidly growing interest in the association between ED and risk of CVD,” a research team from Soochow University in Suzhou, China conducted a meta-analysis of prospective cohort studies to better understand the relationship between the two conditions. Specifically, while it is well accepted that CVD predicts the incidence of ED (largely because both conditions share the same risk factors), it is unknown whether ED is a marker of further cardiovascular events and if ED is independently associated with an increased risk of CVD.
Conducting a PubMed literature search, the research team retrieved 12 prospective cohort studies published between 2005 and 2011 and involving 36,744 participants. Five of the studies were conducted in the United States, four were European, two were Chinese, and 1 was a multicountry study. Each study examined the effect of ED on CVD, CHD, stroke, or all-cause mortality. The mean length of follow-up ranged from 4 to 16.2 years.
After extracting data from all 12 studies, the research team found a significant association between ED and an increased risk of CVD, CHD, stroke, and all-cause mortality. Specifically, men with ED had an increased risk of 48 percent for CVD (95% confidence interval [CI]; 1.25 to 1.74), 46 percent for CHD (95% CI; 1.31 to 1.63), 35 percent for stroke (95% CI; 1.19 to 1.54), and 19 percent for all-cause mortality (95% CI; 1.05 to 1.34), compared with men in the control group.
In addition, after conducting a sensitivity analysis (which was restricted to studies that controlled for conventional cardiovascular risk factors—such as age, body mass index, blood pressure, diabetes, cholesterol, and smoking), the researchers still found an increased risk of CVD of 54 percent (95% CI, 1.20 to 1.78), leading them to determine that ED “is probably an independent risk factor for CVD.” They added that the studies’ long follow-up range supported the idea that ED is an independent risk factor and not just an early marker for CVD, as cardiovascular events came as late as 16 years after ED in some studies, instead of occurring around the time of onset.
According to the research team, while the underlying mechanisms involved in the association between ED and CVD are still uncertain, the findings from the meta-analysis provide a better understanding of their association, which “may have important public health and clinical implications.” Specifically, study author Li-Qiang Qin, MD, PhD, notes “ED may not only contribute to cardiovascular risk prediction but also serve as a potential target for CVD prevention.” Currently, approximately 18 million men in the United States experience ED and CVD is the country’s leading cause of death.
The American College of Cardiology is transforming cardiovascular care and improving heart health through continuous quality improvement, patient-centered care, payment innovation and professionalism. The College is a 39,000-member nonprofit medical society comprised of physicians, surgeons, nurses, physician assistants, pharmacists and practice managers, and bestows credentials upon cardiovascular specialists 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 at http://www.cardiosource.org/ACC.