Erectile dysfunction and cardiovascular-kidney-metabolic syndrome: Insights from the all of us research program

Erectile dysfunction (ED) is associated with cardiovascular disease (CVD) risk factors and is a potential indicator for future CVD events, but ED's association with cardiovascular-kidney-metabolic (CKM) syndrome has not been systematically studied.

This study used data from the All of Us Research Program covering 2017 to 2023. The primary exposure was prevalence of electronic health record-diagnosed ED with cross-sectional analyses measuring the association between prevalent ED and prevalent CKM conditions. In participants without CKM conditions at baseline, we performed survival analyses to evaluate the association between prevalent ED and the development of future CKM conditions with a follow up period ranging from a median of 2.1-4.0 years.

Of the 97,475 male participants in this study, 5,575 (5.7 %) had a documented baseline ED diagnosis. The highest prevalence by race was white individuals (7.2 %) and by age range was 75-80 (12.7 %). Participants with ED versus those without ED had a higher rate of CKM conditions including diabetes mellitus (T2DM) (19.3 % vs 7.3 %), hypertension (HTN) (47.6 % vs 18.8 %), chronic kidney disease (CKD) (10.3 % vs 2.8 %), heart failure (HF) (5.7 % vs 2.0 %), atherosclerotic cardiovascular disease (ASCVD) (3.0 % vs 1.3 %), and atrial fibrillation (AF) (7.3 % vs 2.5 %). Baseline prevalent ED was associated with higher risks of developing CKM conditions of CKD, HF, AF, ASCVD, and HTN but not the development of T2DM.

A diagnosis of ED was significantly associated with both the prevalence and future development of cardiovascular and metabolic conditions, suggesting that ED assessment should be incorporated into routine cardiometabolic risk evaluation.