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Published on: October 16, 2010
Erectile dysfunction and subsequent cardiovascular disease
Ian M Thompson1, Catherine M Tangen, Phyllis J Goodman
1Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA. thompsoni@uthscsa.edu
Insights
Erectile dysfunction (ED) is linked to a higher risk of cardiovascular events in men over 55. ED may signal underlying cardiovascular disease, warranting risk factor assessment and intervention.
Area of Science:
- Cardiology
- Urology
- Preventive Medicine
Background:
- Cardiovascular disease (CVD) and erectile dysfunction (ED) share common risk factors.
- Investigating the link between ED and subsequent CVD is crucial for early detection and prevention.
Purpose of the Study:
- To examine the association between erectile dysfunction and the occurrence of subsequent cardiovascular disease.
- To determine if ED serves as an early indicator for cardiovascular events.
Main Methods:
- A cohort of 9457 men aged 55+ from the Prostate Cancer Prevention Trial (placebo group) were monitored for CVD and ED.
- Proportional hazards regression models were employed to analyze the association, adjusting for multiple covariates.
- Data collection occurred between 1994 and 2003, with regular 3-month follow-ups.
Main Results:
- Erectile dysfunction was prevalent at study entry in 47% of men without pre-existing CVD.
- Incident ED after 5 years was associated with a 25% increased risk of subsequent cardiovascular events (HR=1.25, P=.04).
- Men with prevalent or incident ED had a 45% higher risk of cardiovascular events (HR=1.45, P<.001), comparable to risks from smoking or family history of myocardial infarction.
Conclusions:
- Erectile dysfunction can be an early warning sign for cardiovascular clinical events in men.
- The presence of ED necessitates a thorough investigation and management of cardiovascular risk factors.
Context:
The risk factors for cardiovascular disease and erectile dysfunction are similar.
Objective:
To examine the association of erectile dysfunction and subsequent cardiovascular disease.
Design, Setting, And Participants:
Men aged 55 years or older who were randomized to the placebo group (n = 9457) in the Prostate Cancer Prevention Trial at 221 US centers were evaluated every 3 months for cardiovascular disease and erectile dysfunction between 1994 and 2003. Proportional hazards regression models were used to evaluate the association of erectile dysfunction and cardiovascular disease. In an adjusted model, covariates included age, body mass index, blood pressure, serum lipids, diabetes, family history of myocardial infarction, race, smoking history, physical activity, and quality of life.
Main Outcome Measures:
Erectile dysfunction and cardiovascular disease.
Results:
Of the 9457 men randomized to placebo, 8063 (85%) had no cardiovascular disease at study entry; of these men, 3816 (47%) had erectile dysfunction at study entry. Among the 4247 men without erectile dysfunction at study entry, 2420 men (57%) reported incident erectile dysfunction after 5 years. After adjustment, incident erectile dysfunction was associated with a hazard ratio of 1.25 (95% confidence interval [CI], 1.02-1.53; P = .04) for subsequent cardiovascular events during study follow-up. For men with either incident or prevalent erectile dysfunction, the hazard ratio was 1.45 (95% CI, 1.25-1.69; P<.001). For subsequent cardiovascular events, the unadjusted risk of an incident cardiovascular event was 0.015 per person-year among men without erectile dysfunction at study entry and was 0.024 per person-year for men with erectile dysfunction at study entry. This association was in the range of risk associated with current smoking or a family history of myocardial infarction.
Conclusions:
Erectile dysfunction is a harbinger of cardiovascular clinical events in some men. Erectile dysfunction should prompt investigation and intervention for cardiovascular risk factors.
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