Erectile dysfunction is sentinel of CV events, mortality

In a meta-analysis of 16 recent studies of patients diagnosed with erectile dysfunction (ED), researchers found that the condition heralds a significantly higher risk of total cardiovascular (CV) events, MI, cerebrovascular events and all-cause mortality. These findings were published online Jan. 8 in Circulation: Cardiovascular Quality and Outcomes.

Charalambos V. Vlachopoulos, MD, of the Cardiovascular Disease and Sexual Health Unit of Athens Medical School in Greece, and colleagues analyzed data from 16 longitudinal studies published after 2003 that intended to quantify the value of ED as a predictor of CV events and mortality. They selected only full-length longitudinal studies (either prospective or retrospective) that had appeared in peer-reviewed journals, evaluated both ED and at least one CV outcome, and had a follow-up period of at least one year. They conducted a meta-analysis of the data from 16 studies meeting these criteria, which included 92,757 study subjects.

Vlachopoulos et al analyzed the data according to whether the subjects were at low risk of developing cardiovascular disease over the next 10 years (less than 10 percent based on Framingham Risk Score), intermediate risk (between 10 and 20 percent) or high risk (subjects with diabetes mellitus, CV disease (CVD), or greater than 20 percent on the Framingham Risk Score). They also stratified data based on whether ED was diagnosed through a questionnaire or a single question.

The pooled risk ratio (RR) for individuals with ED was 1.44 for total CV events. This number was highest for subjects in the intermediate risk group (RR 1.51, compared to 1.3 for high-risk subjects and 0.93 for low-risk subjects). For subjects diagnosed with ED by questionnaire, RR was 1.61 vs. 1.27 among subjects diagnosed with a single question.

The researchers conducted a sensitivity analysis of only those studies that had adjusted for age, smoking, diabetes mellitus, cholesterol and hypertension, and determined the RR for total CV events was 1.41, similar to their findings when analyzing all studies. Young age at enrollment was the strongest predictor of CV events in this analysis, as in others.    

When the researchers looked at individual endpoints, they found that the higher risk among ED patients persisted. The RR for CV mortality was 1.19; for MI, 1.62; and for cerebrovascular events, 1.39. They found all-cause mortality for subjects with ED carried an RR of 1.25.

The researchers concluded that ED is a “potential low-cost biomarker” of future cardiovascular events and all-cause mortality, “that would call for more aggressive CV risk factor modification.” They also noted that the highest increased risk was among those patients who were designated as at intermediate risk of CVD according to the Framingham Risk Score. “ED as a predictor may be particularly useful in these young patients in whom the Framingham Risk Score may underestimate risk by examining forward only 10 years,” they wrote.

For more information on ED and its CV implications, please read "ED as a Vascular Disease: Stents and Interventions," in the January 2012 issue of Cardiovascular Business.