Although previous studies report an association between erectile dysfunction (ED) and smoking, few have examined the impact of passive smoke exposure on ED. This analysis examines the association of active and passive smoking and ED and investigates a dose-response effect of smoking.

The Boston Area Community Heath (BACH) survey is a study of urologic symptoms in a racially and ethnically diverse population. BACH used a multistage stratified random sample to recruit 2301 men, aged 30–79 yr, from the city of Boston. ED was assessed using the five-item International Index of Erectile Function. Smoking and passive smoking were assessed by self-report. Analyses adjusted for sociodemographic and lifestyle factors and important chronic illnesses.

An association between smoking and ED was observed with a significant trend in increased risk of ED with cumulative pack-years of smoking (adjusted odds ratio [OR] = 1.68; 95% confidence interval [CI], 1.03, 2.30 for ? 20 pack-years). Compared to never smokers not exposed to passive smoking, men who never smoked but were exposed to passive smoking had a moderate, statistically nonsignificant, increase in risk of ED (adjusted OR = 1.33; 95%CI: 0.69, 2.55) comparable to the OR observed for a cumulative exposure of 10–19 pack-years of active smoking (adjusted OR = 1.25; 95%CI, 0.68, 2.30).

Erectile dysfunction (ED) is a common problem among aging men. A number of modifiable risk factors are associated with ED, including obesity, hypertension, unfavorable lipid levels, alcohol abuse, physical activity, and cigarette smoking. The association between ED and current smoking has been reported in previous cross-sectional studies. Additionally, longitudinal data from the Massachusetts Male Aging Study (MMAS) and the Health Professionals Followup Study (HPFS) have reported increased incidence of ED among smokers. Experimental studies in animal models have linked exposure to passive smoking to endothelial function in animal models, and passive smoking was associated with coronary artery disease among individuals who had never smoked but lived with a former or current smoker. Longitudinal data from the MMAS have shown a higher incidence of ED among both active smokers and those exposed to passive smoking; however, a dose-response relationship of active smoking and ED was not investigated.

The objectives of this analysis were to:
(1) to confirm the association between smoking and ED assessed using the 5-item International Index of Erectile Dysfunction (IIEF-5) scale, an internationally validated self-administered questionnaire; (2) to determine whether a dose-response effect was present between smoking and ED by quantifying smoking using pack-years of smoking exposure; and (3) to investigate the association between passive smoking and ED.

Conclusion
In summary, data from the BACH study show an association between smoking and ED and supports a dose-response relationship between cumulative pack-years of smoking and risk of ED. These results confirm previous reports from the literature supporting the association between smoking and ED. The observed dose-response pattern between duration and intensity of smoking and increased risk of ED in conjunction with previous published research indicating beneficial effects of smoking cessation,[13,31] especially at a younger age [32], highlights the importance of abstaining from or quitting smoking. Finally, a moderate, statistically nonsignificant effect of passive smoking was also observed suggesting possible effects of long-term chronic exposure on erectile function.

Conclusions
Results indicate a dose-response association between smoking and ED with a statistically significant effect observed with ≤ 20 pack-years of exposure. Passive smoking is associated with a small, statistically nonsignificant increase in risk of ED comparable to approximately 10–19 pack-years of active smoking.

Varant Kupelian, Carol L. Link, and John B. McKinlay
New England Research Institutes, Watertown, MA, USA
Varant Kupelian, Research Scientist, New England Research Institutes, 9 Galen Street, Watertown, MA 02472, USA,

 

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