Longitudinal study offers good news on natural history of ED

Remission of erectile dysfunction may be more common than previously believed, according to results from the Massachusetts Male Aging Study (MMAS).

The MMAS is a prospective cohort study of community-dwelling aging men. ED was assessed at baseline (1987-'89) and at the first follow-up visit (1995-'97, predating widespread use of phosphodiesterase type-5 inhibitors) through self-reports using a four-point scale (none, mild, moderate, complete). Remission and progression were respectively defined as lower and higher severity at follow-up compared with the baseline visit.

At baseline, 401 men reported ED, including 78 complete, 77 moderate, and 246 minimal. At the follow-up visit, progression had occurred in 33% of the men with moderate or minimal ED, while 35% of those with any ED experienced remission.Further analyses showed initial ED severity had prognostic value. Total remission occurred significantly more often among men with mild ED at baseline than among those reporting moderate or complete ED (32% vs. 23%, p=.04), while total progression to complete ED was significantly more common among men with moderate ED relative to those with mild ED (32% vs. 20%, p=.02). Other factors found to have prognostic significance through regression analyses included age, smoking, and obesity.

"These findings are good news for urologists and their patients with ED because, until recently, it was thought that progression of ED was inevitable with aging. Furthermore, they suggest that intervention to reduce modifiable risk factors such as smoking and obesity offers great potential for slowing ED progression and enhancing remission," said John B. McKinlay, PhD, of New England Research Institutes, Watertown, MA, and principal investigator of the MMAS.