Erectile dysfunction linked with 43% higher risk of cardiovascular disease-related death

Erectile dysfunction increased the risk of cardiovascular death by 43% compared with men who had normal erectile function, reported Andre B. Araujo, PhD, director of epidemiology at the New England Research Institutes in Watertown, MA.

The finding provides support for an association between CVD and erectile dysfunction, including the possibility of shared pathophysiologic mechanisms.

"In this study, ED is as strongly associated with CVD mortality as some prominent risk factors for CVD. Thus, our data are consistent with current recommendations that patients who present with ED should potentially be screened and possibly treated for CVD."

The authors initiated their study based on previous observations that ED and CVD share common risk factors and often occur together. However, whether ED increases the risk of mortality from CVD or other causes has not been clearly determined.

To assess the impact of ED on mortality risk, Dr. Araujo and colleagues analyzed data on 1,655 men ages 40 to 70, followed for approximately 15 years through 2004 in the Massachusetts Male Aging Study. As part of the study, the men completed a 23-item questionnaire about sexual activity. On the basis of their responses, the men were classified as having no ED or having minimal, moderate, or complete ED.

Responses to the questionnaire showed a 20% prevalence of ED. Comparing men with and without ED, investigators found that men with ED were older and had higher rates of CVD and cardiovascular risk factors, including hypertension, diabetes, and physical inactivity.

Comparison of men with no or minimal ED versus moderate or complete ED showed that all-cause and cardiovascular mortality increased with severity of ED. Among men with moderate/severe ED, total mortality was 36.8 deaths per 1,000 person-years versus 10.5 deaths per 1,000 person-years among men with no or minimal ED. Cardiovascular mortality among men with moderate/severe ED was 12.4 per 1,000 person-years versus 3.6 per 1,000 person-years among men with minimal or no ED.

In a multivariate analysis, significant predictors of all-cause mortality were moderate/complete ED, older age, increased alcohol consumption, smoking, fair or poor self-rated health, heart disease, hypertension, and diabetes.

ED was associated with an adjusted hazard ratio (HR) of 1.43, the same as hypertension and only slightly lower than the risk associated with diabetes (HR 1.62).

Study results were presented at the 2009 AUA annual meeting and later published in the Journal of Sexual Medicine (2009; 6:2445-54).