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A Population-Based, Longitudinal Study of Erectile Dysfunction and Future Coronary Artery Disease

      OBJECTIVE

      To assess the association between erectile dysfunction (ED) and the long-term risk of coronary artery disease (CAD) and the role of age as a modifier of this association.

      PARTICIPANTS AND METHODS

      From January 1, 1996, to December 31, 2005, we biennially screened a random sample of 1402 community-dwelling men with regular sexual partners and without known CAD for the presence of ED. Incidence densities of CAD were calculated after age stratification and adjusted for potential confounders by time-dependent Cox proportional hazards models.

      RESULTS

      The prevalence of ED was 2% for men aged 40 to 49 years, 6% for men aged 50 to 59 years, 17% for men aged 60 to 69 years, and 39% for men aged 70 years or older. The CAD incidence densities per 1000 person-years for men without ED in each age group were 0.94 (40-49 years), 5.09 (50-59 years), 10.72 (60-69 years), and 23.30 (≥70 years). For men with ED, the incidence densities of CAD for each age group were 48.52 (40-49 years), 27.15 (50-59 years), 23.97 (60-69 years), and 29.63 (≥70 years).

      CONCLUSION

      ED and CAD may be differing manifestations of a common underlying vascular pathology. When ED occurs in a younger man, it is associated with a marked increase in the risk of future cardiac events, whereas in older men, ED appears to be of little prognostic importance. Young men with ED may be ideal candidates for cardiovascular risk factor screening and medical intervention.
      BMI (body mass index), BMSFI (Brief Male Sexual Function Inventory), CAD (coronary artery disease), CI (confidence interval), ED (erectile dysfunction), HR (hazard ratio)
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      REFERENCES

        • McKinlay JB
        The worldwide prevalence and epidemiology of erectile dysfunction.
        Int J Impot Res. 2000; 12: S6-S11
        • Feldman HA
        • Goldstein I
        • Hatzichristou DG
        • Krane RJ
        • McKinlay JB
        Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study.
        J Urol. 1994; 151: 54-61
        • Bacon CG
        • Mittleman MA
        • Kawachi I
        • Giovannucci E
        • Glasser DB
        • Rimm EB
        Sexual function in men older than 50 years of age: results from the health professionals follow-up study.
        Ann Intern Med. 2003; 139: 161-168
        • Burke JP
        • Jacobson DJ
        • McGree ME
        • et al.
        Diabetes and sexual dysfunction: results from the Olmsted County Study of Urinary Symptoms and Health Status Among Men.
        J Urol. 2007; 177: 1438-1442
        • Giuliano FA
        • Leriche A
        • Jaudinot EO
        • de Gendre AS
        Prevalence of erectile dysfunction among 7689 patients with diabetes or hypertension, or both.
        Urology. 2004; 64: 1196-1201
        • Saigal CS
        • Wessells H
        • Pace J
        • Schonlau M
        • Wilt TJ
        Predictors and prevalence of erectile dysfunction in a racially diverse population.
        Arch Intern Med. 2006; 166: 207-212
        • Nikoobakht M
        • Nasseh H
        • Pourkasmaee M
        The relationship between lipid profile and erectile dysfunction.
        Int J Impot Res. 2005; 17: 523-526
        • Gades NM
        • Nehra A
        • Jacobson DJ
        • et al.
        Association between smoking and erectile dysfunction: a population-based study.
        Am J Epidemiol. 2005; 161: 346-351
        • Bal K
        • Oder M
        • Sahin AS
        • et al.
        Prevalence of metabolic syndrome and its association with erectile dysfunction among urologic patients: metabolic backgrounds of erectile dysfunction.
        Urology. 2007 Feb; 69 (Epub 2007 Jan 31.): 356-360
        • Ponholzer A
        • Temml C
        • Obermayr R
        • Wehrberger C
        • Madersbacher S
        Is erectile dysfunction an indicator for increased risk of coronary heart disease and stroke?.
        Eur Urol. 2005; 48: 512-518
        • Thompson IM
        • Tangen CM
        • Goodman PJ
        • Probstfield JL
        • Moinpour CM
        • Coltman CA
        Erectile dysfunction and subsequent cardiovascular disease.
        JAMA. 2005; 294: 2996-3002
        • Bolona ER
        • Uraga MV
        • Haddad RM
        • et al.
        Testosterone use in men with sexual dysfunction: a systematic review and meta-analysis of randomized placebo-controlled trials.
        Mayo Clin Proc. 2007; 82: 20-28
        • Elesber AA
        • Solomon H
        • Lennon RJ
        • et al.
        Coronary endothelial dysfunction is associated with erectile dysfunction and elevated asymmetric dimethylarginine in patients with early atherosclerosis.
        Eur Heart J. 2006 Apr; 27 (Epub 2006 Jan 24.): 824-831
        • Keating NL
        • O'Malley AJ
        • Smith MR
        Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer.
        J Clin Oncol. 2006; 24: 4448-4456
        • Liu PY
        • Death AK
        • Handelsman DJ
        Androgens and cardiovascular disease.
        Endocr Rev. 2003; 24: 313-340
        • Montorsi P
        • Ravagnani PM
        • Galli S
        • et al.
        The artery size hypothesis: a macrovascular link between erectile dysfunction and coronary artery disease.
        Am J Cardiol. 2005 Dec; 96 (Epub 2005 Nov 4.): 19M-23M
        • Rodriguez JJ
        • Al Dashti R
        • Schwarz ER
        Linking erectile dysfunction and coronary artery disease.
        Int J Impot Res. 2005; 17: S12-S18
        • Spark RF
        • White RA
        • Connolly PB
        Impotence is not always psychogenic. Newer insights into hypothalamic-pituitary-gonadal dysfunction.
        JAMA. 1980; 243: 750-755
        • Vlachopoulos C
        • Aznaouridis K
        • Ioakeimidis N
        • et al.
        Unfavourable endothelial and inflammatory state in erectile dysfunction patients with or without coronary artery disease.
        Eur Heart J. 2006 Nov; 27 (Epub 2006 Oct 20.): 2640-2648
        • Chute CG
        • Panser LA
        • Girman CJ
        • et al.
        The prevalence of prostatism: a population-based survey of urinary symptoms.
        J Urol. 1993; 150: 85-89
        • Jacobsen SJ
        • Girman CJ
        • Guess HA
        • et al.
        Natural history of prostatism: factors associated with discordance between frequency and bother of urinary symptoms.
        Urology. 1993; 42: 663-671
        • Melton III, LJ
        History of the Rochester Epidemiology Project.
        Mayo Clin Proc. 1996; 71: 266-274
        • O'Leary MP
        • Fowler FJ
        • Lenderking WR
        • et al.
        A brief male sexual function inventory for urology.
        Urology. 1995; 46: 697-706
        • Mykletun A
        • Dahl AA
        • O'Leary MP
        • Fosså SD
        Assessment of male sexual function by the Brief Sexual Function Inventory.
        BJU Int. 2006; 97: 316-323
        • O'Leary MP
        • Rhodes T
        • Girman CJ
        • et al.
        Distribution of the Brief Male Sexual Inventory in community men.
        Int J Impot Res. 2003; 15: 185-191
        • Roger VL
        • Jacobsen SJ
        • Weston SA
        • et al.
        Trends in the incidence and survival of patients with hospitalized myocardial infarction, Olmsted County, Minnesota, 1979 to 1994.
        Ann Intern Med. 2002; 136: 341-348
        • Roger VL
        • Killian J
        • Henkel M
        • et al.
        Coronary disease surveillance in Olmsted County objectives and methodology.
        J Clin Epidemiol. 2002; 55: 593-601
        • Arciero TJ
        • Jacobsen SJ
        • Reeder GS
        • et al.
        Temporal trends in the incidence of coronary disease.
        Am J Med. 2004; 117: 228-233
        • Goraya TY
        • Jacobsen SJ
        • Belau PG
        • Weston SA
        • Kottke TE
        • Roger VL
        Validation of death certificate diagnosis of out-of-hospital coronary heart disease deaths in Olmsted County, Minnesota.
        Mayo Clin Proc. 2000; 75: 681-687
        • Therneau TM
        • Grambsch PM
        Modeling Survival Data: Extending the Cox Model. Springer-Verlag, New York, NY2000
        • Jackson G
        • Rosen RC
        • Kloner RA
        • Kostis JB
        The second Princeton consensus on sexual dysfunction and cardiac risk: new guidelines for sexual medicine.
        J Sex Med. 2006; 3: 28-36
        • Feldman HA
        • Johannes CB
        • Derby CA
        • et al.
        Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts Male Aging Study.
        Prev Med. 2000; 30: 328-338
        • O'Rourke MF
        • Hashimoto J
        Mechanical factors in arterial aging: a clinical perspective.
        J Am Coll Cardiol. 2007 Jul 3; 50 (Epub 2007 Jun 18.): 1-13
        • Eaton CB
        • Liu YL
        • Mittleman MA
        • Miner M
        • Glasser DB
        • Rimm EB
        A retrospective study of the relationship between biomarkers of atherosclerosis and erectile dysfunction in 988 men.
        Int J Impot Res. 2007 Mar-Apr; 19 (Epub 2006 Aug 17.): 218-225
        • Pourmand G
        • Alidaee MR
        • Rasuli S
        • Maleki A
        • Mehrsai A
        Do cigarette smokers with erectile dysfunction benefit from stopping?: a prospective study.
        BJU Int. 2004; 94: 1310-1313
        • Sighinolfi MC
        • Mofferdin A
        • De Stefani S
        • Micali S
        • Cicero AF
        • Bianchi G
        Immediate improvement in penile hemodynamics after cessation of smoking: previous results.
        Urology. 2007; 69: 163-165
        • Esposito K
        • Giugliano F
        • Di Palo C
        • et al.
        Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial.
        JAMA. 2004; 291: 2978-2984
        • Llisterri JL
        • Lozano Vidal JV
        • Aznar Vicente J
        • et al.
        Sexual dysfunction in hypertensive patients treated with losartan.
        Am J Med Sci. 2001; 321: 336-341
        • Kupelian V
        • Shabsigh R
        • Araujo AB
        • O'Donnell AB
        • McKinlay JB
        Erectile dysfunction as a predictor of the metabolic syndrome in aging men: results from the Massachusetts Male Aging Study.
        J Urol. 2006; 176: 222-226

      Linked Article

      • Erectile Dysfunction and the “Window of Curability”: A Harbinger of Cardiovascular Events
        Mayo Clinic ProceedingsVol. 84Issue 2
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          In their landmark 2005 report of more than 9400 men, Thompson et al1 posed the following questions: “With the high prevalence of erectile dysfunction in aging men, do pharmacologic, lifestyle, or behavioral interventions that are cardioprotective also reduce or delay onset of erectile dysfunction? Could erectile dysfunction serve as a surrogate measure of treatment efficacy in preventive interventions for cardiac disease?” Today, 4 years later, these questions remain unanswered.
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