Erectile dysfunction predicts greater CV risk, regardless of other risk factors

By John Murphy, MDLinx
Published June 13, 2018

Key Takeaways

Erectile dysfunction (ED) predicts a greater risk for cardiac events, even after adjustment for traditional risk factors such as cholesterol, smoking, and high blood pressure, according to new research published in Circulation.

“Our results reveal that erectile dysfunction is, in and of itself, a potent predictor of cardiovascular risk,” said study senior investigator Michael Blaha, MD, MPH, associate professor of medicine and director of clinical research, Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, MD.

The researchers included 1,757 men (average age: 69 years) who participated in the Multi-Ethnic Study of Atherosclerosis (MESA). Of these, nearly 46% reported ED symptoms. After about 4 years of follow up, those who reported ED were more than twice as likely (6.3% vs 2.6%) to experience cardiac events such as heart attack, cardiac arrest, sudden cardiac death, and fatal or non-fatal stroke compared with those who did not.

After adjusting for smoking, diabetes, family history of heart disease, cholesterol, high blood pressure, and use of blood pressure and cholesterol medications, those who reported ED still had nearly double the risk for cardiac events.

The results of the study add to the evidence of an independent association between ED and cardiovascular disease (CVD), and could have important clinical implications for risk stratification in middle-aged men, the researchers noted.

“Our findings suggest that clinicians should perform further targeted screening in men with erectile dysfunction, regardless of other cardiac risk factors and should consider managing any other risk factors—such as high blood pressure or cholesterol—that much more aggressively,” Dr. Blaha said.

The results may justify more aggressive preventive therapy in ED patients, the researchers wrote. They pointed to the QRISK algorithm used in the UK for predicting CVD. In 2017, QRISK was updated to include ED as an independent risk factor for CVD.

ED and cardiovascular disease are known to share common risk factors, such as obesity, hypertension, metabolic syndrome, diabetes mellitus, and smoking. ED and CVD also have common underlying pathological mechanisms, including endothelial dysfunction, inflammation, and atherosclerosis. But the results of this latest study provide the strongest indication to date that sexual dysfunction indicates heightened cardiovascular risk, the researchers noted.

Men who present for ED treatment should receive a comprehensive cardiovascular evaluation, Dr. Blaha advised. Additionally, men should be informed that ED places them at elevated risk for CVD.

“The onset of ED should prompt men to seek comprehensive cardiovascular risk evaluation from a preventive cardiologist,” Dr. Blaha said. “It is incredible how many men avoid the doctor and ignore early signs of cardiovascular disease, but present for the first time with a chief complaint of ED. This is a wonderful opportunity to identify otherwise undetected high-risk cases.”

This research was funded by the National Heart, Lung, and Blood Institute and by the National Center for Research Resources, with additional support from the US Environmental Protection Agency.

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