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Erectile dysfunction is not independently associated with cardiovascular death: data from the vitamins and lifestyle
James M Hotaling1, Thomas J Walsh, Liam Connor Macleod
1Department of Urology, University of Washington, Seattle, WA 98195, USA.
Insights
Erectile dysfunction (ED) in men is not an independent predictor of cardiovascular death. Once other cardiovascular disease risk factors are accounted for, ED does not increase the risk of dying from heart disease.
Area of Science:
- Cardiology
- Urology
- Public Health
Background:
- Erectile dysfunction (ED) is a common issue in aging men and is linked to cardiovascular (CV) events.
- Existing research shows an association between ED and CV events like heart attack and stroke.
Purpose of the Study:
- To investigate whether ED is associated with an increased risk of cardiovascular death.
- To determine if ED independently predicts CV mortality in men.
Main Methods:
- A cohort of 31,296 men aged 50-76 in Washington State completed a health questionnaire, including an ED assessment.
- Participants were tracked for CV death through the Washington State Death Certificate System from 2000-2008.
- Multivariate Cox proportional hazard regression was used to analyze the risk of CV death, adjusting for numerous CV risk factors.
Main Results:
- Approximately 7,762 men reported ED, and 486 experienced CV death during an average follow-up of 7.8 years.
- Initially, ED was associated with a 23% increased risk of CV death (HR 1.23, 95% CI 1.01, 1.49).
- After adjusting for established CV disease risk factors, ED was no longer a significant predictor of CV death (HR 0.93, 95% CI 0.76, 1.15).
Conclusions:
- In this cohort, ED was not independently associated with an increased risk of cardiovascular death.
- The findings suggest that ED may be a symptom reflecting underlying, known risk factors for cardiovascular disease rather than an independent risk factor itself.
Introduction:
Erectile dysfunction (ED) is a significant problem among aging men. ED is independently associated with cardiovascular (CV) events (angina, myocardial infarction, and stroke).
Aim:
We sought to determine if ED was associated with CV death.
Main Outcome Measures:
Risk of CV death in men with ED.
Methods:
Exactly 31,296 men in Washington aged 50-76 completed a questionnaire in 2000-2002 on supplements, diet, exercise, personal health, and ED. ED was determined by one question: "Have you experienced impotence in the last year?" We excluded patients with a history of coronary artery disease or stroke. Participants linked yearly through 2008 to the Washington State Death Certificate System. CV death was defined by death certificates listing CV-related deaths (International Classification of Diseases 10th Revision [ICD-10] codes: I00-I15, I20-I52, and I60-I99). We performed multivariate Cox proportional hazard regression adjusting for age, marital status, race, education, self-rating of health, body mass index (BMI), antihypertensive/lipid-lowering drug use, diabetes, family history of CV disease, smoking, and exercise.
Results:
About 7,762 men had ED and there were 486 CV deaths over 7.8-year average follow-up. The typical man who suffered CV death was older, single, reporting poor health, taking antihypertensives, higher BMI, a smoker, a diabetic, and had a family history of CV disease. When adjusting for age, marital status, and education only, men with ED had a 23% increased risk of CV death (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.01, 1.49). With further adjustment for known risk factors for CV disease (diabetes, treatment for hypertension or hyperlipidemia, family history of myocardial infarction/stroke, BMI, and exercise), ED no longer predicted CV death (HR 0.93, 95% CI 0.76, 1.15).
Conclusions:
In this community-based cohort, ED was not independently associated with an elevated risk of CV death. These data do not contradict prior data associating ED and CV events but rather suggest that ED may be a manifestation of other known risk factors for CV disease.
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