Erectile Dysfunction Linked With Increased Risk of CV Events

January 10, 2013

ATHENS, Greece — A new review combining data on more than 90 000 patients is reinforcing the link between erectile dysfunction (ED) and increased cardiovascular events and death [1]. A key point, say the authors, is that the magnitude of risk conferred by ED is equivalent to that of other modifiable risk factors discussed much more frequently by cardiologists.

Researchers report that patients with ED had a significant 44% increased risk of cardiovascular events and a significant 25% increased risk of all-cause mortality when compared with individuals without ED. ED was also associated with a significant 62% increased risk of MI and a 39% increased risk of cerebrovascular events. The researchers, led by Dr Charalambos Vlachopoulos (Athens Medical School, Greece), say the findings support the inclusion of ED in the European guidelines for cardiovascular disease prevention.

"Our analysis showed that the risk conferred by ED on events is of a magnitude similar to that of the risk conferred on events by established risk predictors such as hypertension and dyslipidemia commonly encountered in clinical practice," they write in the report, published online January 8, 2013 in Circulation: Cardiovascular Quality and Outcomes. "Thus, our results stress the importance of early diagnosis of ED and the meticulous CV investigation that is required in specific groups of ED patients."

In total, 14 studies with more than 92 000 participants followed for 6.1 years were included in the analysis. Of these studies, 13 reported cardiovascular outcomes, four reported cardiovascular mortality data, four reported rates of MI, six reported cerebrovascular outcomes, and five reported cardiovascular mortality data.

Relative Risk for ED and Clinical Events

Outcome Relative risk (95% CI)
Cardiovascular events 1.44 (1.27–1.63)
Cardiovascular mortality 1.19 (0.97–1.46)
MI 1.62 (1.34–1.96)
Cerebrovascular events 1.39 (1.23–1.57)
All-cause mortality 1.25 (1.12–1.39)

"Improvement of ED by lifestyle interventions per se might be beneficial in terms of prognosis, and our results highlight the role of ED as a potential low-cost biomarker that would call for more aggressive cardiovascular-risk-factor modification," write the authors. "Of special interest is the effect of pharmacological treatment of ED, because it seems that this may also have a beneficial impact on risk."

The relative risk of cardiovascular events was highest in younger patients and patients with intermediate baseline cardiovascular risk compared with individuals at high or low cardiovascular risk. "This is particularly important because this intermediate-risk group is in need of further risk reclassification with a predictor such as ED," add Vlachopoulos and colleagues. In addition, the risk of clinical events in ED patients was higher in those who smoked and those with dyslipidemia.