Men with erectile dysfunction prone to heart disease, stroke

Men who struggle with erectile dysfunction (ED)—especially more severe cases—are at an increased risk of coronary heart disease (CHD), total heart disease, stroke and all-cause mortality, according to research published in the Journal of Sexual Medicine.

ED and CVD intersect in a number of ways, first author Binghao Zhao, MD, PhD, of Peking Union Medical College Hospital in Beijing, China, and co-authors wrote in the journal. They share common risk factors like hypertension, smoking, diabetes, dyslipidemia, obesity and metabolic syndrome, and the authors said it’s been “long acknowledged” that pre-existing CVD can contribute to sexual dysfunction.

Despite that acknowledgement, though, the researchers said experts and society guidelines have failed to address ED as a component of early CVD detection, intervention and prevention.

“Screening and diagnosis of ED could be of great importance for secondary CVD prevention, because ED assessment offers an easy, low-cost alternative to several investigational cardiovascular biomarkers and describes the risk more exactly than common risk factors, particularly for patients at intermediate risk of CVD,” Zhao et al. wrote.

The authors combed five major medical databases for studies assessing ED’s role in CVD, including 25 studies of 154,794 total subjects in their meta-analysis. The team considered primary outcomes of CVD, CHD, stroke and all-cause death.

Compared with men with no ED, those with the condition saw:

  • A 43% increased risk of heart disease
  • A 59% increased risk of CHD
  • A 34% increased risk of stroke
  • A 33% increased risk of all-cause mortality

Zhao and colleagues said ED patients who were older (55 years of age and up), had experienced ED for less than seven years, and had higher rates of smoking and diabetes were most prone to develop CVD. Severe ED predicted even higher CVD and all-cause mortality rates.

“Most of the results were robust across the sensitivity and subgroup analyses,” the authors wrote. “In addition, a pronounced and positive dose-response relationship was observed between CVD and all-cause mortality. Although the results are limited by the considerable, but unmeasured, heterogeneity in the CVD analysis, the evidence should be promptly translated into practice.”

The team said the large number of patients in their analysis made it a strong effort, but noted not all studies they considered were randomized controlled trials, potentially “downgrading” the evidence. Still, their results are enough to inform some changes in day-to-day practice.

“The diligent observation of at-risk elderly patients and young men should be routinely included to determine the need for pharmacologic or lifestyle interventions addressing cardiovascular risk factors,” Zhao and co-authors wrote. “Importantly, early detection and treatments for CVD in the valuable time window in which risk factors can be modified at an early stage will effectively reduce fatal CV events in male patients with ED.”