ED predicts future CVD but doesn't add beyond traditional risk factors

January 19, 2010

Watertown, MA - Men with erectile dysfunction (ED) are at a significantly greater risk of developing cardiovascular disease, and this association is maintained after adjustment for traditional risk factors, including the Framingham Risk Score (FRS), research shows[1].

After adjustment for these conventional risk factors, men with ED are at a 40% greater risk of developing cardiovascular disease than men without ED. Still, despite the statistical significance of the association between ED and cardiovascular disease, ED did not improve the prediction of cardiovascular-disease incidence in men beyond that of traditional risk factors.

The results, according to investigators, have mixed implications for clinical practice.

"While we show that erectile dysfunction is indeed a warning signal for future cardiovascular events, that it independently predicts cardiovascular disease beyond the Framingham score, it doesn't quite meet the high watermark for saying that it should be added to the Framingham risk score," lead investigator Dr Andre Araujo (New England Research Institutes, Watertown, MA) told heartwire .

The results of the study are published in the January 26, 2010 issue of the Journal of the American College of Cardiology.

Confirm hypothesis and reclassifying patients

ED is thought to be a harbinger of future cardiovascular disease, and this has been confirmed in studies published in recent years. As the researchers point out in their paper, the diseases share physiological mechanisms—endothelial dysfunction, arterial occlusion, and systemic inflammation—as well as risk factors. Also, progressive diseases such as atherosclerosis that result in occluded arteries would be expected to show up earlier in the microvasculature than in the larger vessels.

Still unknown, however, is whether ED improves the prediction of cardiovascular disease beyond traditional risk factors, said Araujo.

In this prospective, population-based study, the group analyzed data from 1057 men aged 40 to 70 years with complete risk-factor data participating in the Massachusetts Male Aging Study (MMAS), one of the first studies to document the incidence of ED in this population. All ED data were self-reported, and patients were followed for an average of 12 years.

During follow-up, there were 261 new cases of cardiovascular disease. Adjusted for age, ED was significantly associated with cardiovascular-disease incidence, with men with ED having a 42% higher risk of developing disease than those without ED. When adjusted for age and the FRS, men with ED remained at significantly greater risk of developing cardiovascular disease than men without ED.

Relationship between ED and cardiovascular disease

Model Hazard ratio (95% CI)
Age-adjusted 1.42 (1.05-1.90)
Multivariate-adjusted 1.41 (1.05-1.90)
Adjusted for age and continuous Framingham Risk Score 1.40 (1.04-1.88)

In an evaluation of the discriminatory capability of ED beyond traditional risk factors, however, ED did not significantly improve the prediction of cardiovascular-disease incidence beyond traditional risk factors. The addition of ED to the multivariate model and the age-plus-FRS models only slightly improved the C statistic.

Discrimination of CVD in various multivariate models

Model C statistic (95% CI)
Multivariate 0.7068 (0.6769-0.7366)
Multivariate and ED 0.7106 (0.6804-7408)
Age and continuous Framingham Risk Score 0.6919 (0.6604-0.7216)
Age and continuous Framingham Risk Score and ED 0.6953 (0.6645-0.7261)

Despite not improving the prediction of cardiovascular disease, Araujo said the results confirm the hypothesis that ED is a sentinel marker for cardiovascular disease, and these data should help put ED on the minds of physicians and patients.

"I think the results could have some implications by putting ED on the radar of physicians who are seeing middle-aged men and men experiencing erectile difficulties," he said. "The fact is that you can assess ED with a single question, a simple question that costs no money and doesn't put the patient at risk."


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