Moderate ED may signal heart disease, early death

Even relatively minor erectile dysfunction may signal "silent" heart disease and may indicate an increased risk of dying early from any cause, according to Australian researchers, who say they’ve conducted the world’s largest study on the link between erectile dysfunction and heart disease.

A separate study from Greece found that patients with ED have a 44% increased risk of cardiovascular events.

The Australian study found that men with erectile dysfunction have a higher risk of hospital admission for heart disease, even if they have no history of heart problems. They are also at greater risk of premature death from any cause.

The research, published online in PLOS Medicine (Jan. 29, 2013), is the first to show a direct link between how severe a man’s erection problem is and his risk of dying early or being treated in hospital for heart disease, according to lead author Emily Banks MBBS, PhD, of the Sax Institute, Haymarket, New South Wales.

"The risks of future heart disease and premature death increased steadily with severity of erectile dysfunction, both in men with and without a history of cardiovascular disease," Dr. Banks said.

She and colleagues examined hospital and death records for 95,000 men from the 45 and Up Study, a large study of healthy aging. Men provided information about health and lifestyle factors and were followed for a 2 to 3-year period, recording 7,855 hospital admissions related to cardiovascular disease and 2,304 deaths.

Risks of cardiovascular disease (CVD) and death increased steadily with severity of erectile dysfunction. Among men without previous CVD, those with severe versus no erectile dysfunction had significantly increased risks of ischemic heart disease (adjusted relative risk [RR]: 1.60, 95% CI: 1.31–1.95), heart failure (8.00, 2.64–24.2), peripheral vascular disease (1.92, 1.12–3.29), “other” CVD (1.26, 1.05–1.51), all CVD combined (1.35, 1.19–1.53), and all-cause mortality (1.93, 1.52–2.44). For men with previous CVD, corresponding RRs (95% CI) were 1.70 (1.46–1.98), 4.40 (2.64–7.33), 2.46 (1.63–3.70), 1.40 (1.21–1.63), 1.64 (1.48–1.81), and 2.37 (1.87–3.01), respectively.

Among men without previous CVD, RRs of more specific CVDs increased significantly with severe versus no erectile dysfunction, including acute myocardial infarction (1.66, 1.22–2.26), atrioventricular and left bundle branch block (6.62, 1.86–23.56), and (peripheral) atherosclerosis (2.47, 1.18–5.15).

The Greek study, from Athens Medical School, found ED patients have a 25% increased risk of all-cause mortality, a 62% increased risk of myocardial infarction, and a 39% increased risk of cerebrovascular events, compared to patients without ED. That study was published in Circulation: Cardiovascular Quality and Outcomes (2013; 6:99-109).