Erectile Dysfunction and Risk of Cardiovascular Disease: Meta-Analysis of Prospective Cohort Studies

Study Questions:

Is erectile dysfunction (ED) an independent risk factor for cardiovascular disease (CVD)?


The authors did a PubMed database search through January 2011 to identify studies that met prestated inclusion criteria. Relative risk (RR) was used as a common measure of the association between ED and risk of CVD, coronary heart disease (CHD), stroke, or all-cause mortality across studies. Either a fixed- or a random-effects model was used to calculate the overall combined risk estimates. Homogeneity of RRs across studies was tested by using the Q statistic, and the I2 statistic, which is a quantitative measure of inconsistency across studies, was calculated.


Twelve prospective cohort studies involving 36,744 participants were included in the meta-analysis. The overall combined RRs (95% confidence intervals) for men with ED compared with the reference group were 1.48 (1.25-1.74) for CVD, 1.46 (1.31-1.63) for CHD, 1.35 (1.19-1.54) for stroke, and 1.19 (1.05-1.34) for all-cause mortality. Sensitivity analysis restricted to studies with control for conventional CV risk factors yielded similar results. No evidence of publication bias was observed.


This meta-analysis of prospective cohort studies suggests that ED significantly increases the risk of CVD, CHD, stroke, and all-cause mortality, and the increase is probably independent of conventional CV risk factors.


ED can be considered a marker of risk for CVD, but is not necessarily a risk factor, which implies a causal relationship. While ED had no relationship with classic risk factors in this meta-analysis, the relationship of ED with other factors associated with CVD and particularly myocardial infarction (as in INTERHEART)—including psychological distress/depression, physical inactivity, and nutritional factors—were not considered.

Clinical Topics: Atherosclerotic Disease (CAD/PAD)

Keywords: Coronary Artery Disease, Myocardial Infarction, Depressive Disorder, Stroke, Limb Deformities, Congenital, Biological Markers, Erectile Dysfunction, Cell Transformation, Neoplastic, Cardiovascular Diseases, Risk Factors, Maxillofacial Abnormalities

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