Increasing severity of erectile dysfunction is a marker for increasing risk of cardiovascular disease and death

A large study published in PLOS Medicine on January 29, 2013, shows that the risk of future cardiovascular disease and death increased with severity of erectile dysfunction in men both with and without a history of cardiovascular disease. While previous studies have shown an association between ED and CVD risk, this study finds that the severity of ED corresponds to the increased risk of CVD hospitalization and all-cause mortality.

The study authors, Emily Banks (from the Australian National University) and colleagues, analyzed data from the Australian prospective cohort 45 and Up Study. The authors examined the association between severity of self-reported ED and CVD hospitalization and mortality in 95,038 men aged 45 years and older, after adjusting for a number of potential confounding factors. The study included more than 65,000 men without known CVD at baseline and more than 29,000 men with known CVD. There were 7855 incident admissions for CVD during an average 2.2 years of follow-up ending in June 2010, and 2304 deaths during an average of 2.8 years of follow-up, ending in December 2010.

The authors found that, among men without known CVD, those with severe versus no ED had a relative 35% increase in risk of hospitalization for all CVDs, and a relative 93% increased risk of all-cause mortality. Among men with known CVD at baseline and severe ED, their increased risk of hospitalization for all CVDs combined was a relative 64% and for all-cause mortality, 137%.

The researchers say: "The findings of this study highlight the need to consider ED in relation to the risk of a wide range of CVDs". They also stress that it is unlikely that ED causes CVD; rather both are caused by similar underlying causes such as atherosclerosis. As a result, ED could serve as a useful marker to identify men who should undergo further testing to assess their risk for CVD.

Funding: This specific project was supported by a development grant from the National Heart Foundation, NSW Cardiovascular Research Network, made available through the 45 and Up Study Cardiovascular Research Collaboration. EB is supported by the Australian National Health and Medical Research Council. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: JC has received research grants from Servier, administered through the University of Sydney and The George Institute, as principal investigator for the ADVANCE trial and ADVANCE-ON post trial follow-up study, and have received honoraria from Servier for speaking about ADVANCE at Scientific meetings. PM has received payment from Pfizer for giving a lecture on the treatment of pulmonary hypertension. All other authors have declared that no competing interests exist.

Citation: Banks E, Joshy G, Abhayaratna WP, Kritharides L, Macdonald PS, et al. (2013) Erectile Dysfunction Severity as a Risk Marker for Cardiovascular Disease Hospitalisation and All-Cause Mortality: A Prospective Cohort Study. PLoS Med 10(1): e1001372. doi:10.1371/journal.pmed.1001372