Prognostic Utility of Erectile Dysfunction for Cardiovascular Disease
Prognostic Utility of Erectile Dysfunction for Cardiovascular Disease
The ability of ED to improve CVD prediction beyond traditional risk factors is a topic of debate. In a population-based study of 1248 men (mean age, 61 y) who were free from CVD at baseline, Schouten et al used a single, multiple-choice question to determine presence and severity of ED. Their data revealed that 22.8% had reduced erectile rigidity and 8.7% had severely reduced erectile rigidity. During an average of 6.3 years of follow-up, reduced erectile rigidity (compared with normal erections) was associated with a HR of 1.6 for cardiovascular events (acute myocardial infarction, stroke, or sudden death), after adjustment for age and Framingham Risk Score (FRS). Severely reduced erectile rigidity was associated with a HR of 2.6. Thus, in this population-based study, the presence of ED was a predictor of cardiovascular events independent of Framingham risk factors.
In a recent, prospective, population-based study of 1,709 men followed for a mean of 15 years, Araujo et al examined the association of ED with all-cause mortality and cause-specific mortality. After adjustment for age; body mass index; alcohol consumption; physical activity; cigarette smoking; self-assessed health; and self-reported heart disease, hypertension, and diabetes, ED was associated with hazard ratios of 1.26 and 1.43 for all-cause and CVD mortality, respectively. These findings suggest that the association between ED and all-cause mortality is primarily driven by CVD mortality. In a subsequent analysis of the 1,057 men with complete risk factor data who were free of CVD and diabetes at baseline, Araujo et al evaluated whether ED predicts CVD beyond traditional risk factors. After adjustment for age and traditional CVD risk factors, ED was associated with increased incidence of CVD events (HR, 1.41). Addition of ED to the FRS, after adjustment for age, yielded a reclassification of 17 (11%) of 155 men who had CVD events within 10 years (Table II).
In sum, the evidence strongly suggests that vasculogenic ED is a sign of future CVD events and has potential to alter the 10-year predictive capacity of the FRS. This may be especially true in the younger population, in whom the FRS is traditionally under-predictive of both 10-year and lifetime risk.
Does Addition of ED to Traditional Cardiovascular Risk Factors Improve CVD Prediction?
The ability of ED to improve CVD prediction beyond traditional risk factors is a topic of debate. In a population-based study of 1248 men (mean age, 61 y) who were free from CVD at baseline, Schouten et al used a single, multiple-choice question to determine presence and severity of ED. Their data revealed that 22.8% had reduced erectile rigidity and 8.7% had severely reduced erectile rigidity. During an average of 6.3 years of follow-up, reduced erectile rigidity (compared with normal erections) was associated with a HR of 1.6 for cardiovascular events (acute myocardial infarction, stroke, or sudden death), after adjustment for age and Framingham Risk Score (FRS). Severely reduced erectile rigidity was associated with a HR of 2.6. Thus, in this population-based study, the presence of ED was a predictor of cardiovascular events independent of Framingham risk factors.
In a recent, prospective, population-based study of 1,709 men followed for a mean of 15 years, Araujo et al examined the association of ED with all-cause mortality and cause-specific mortality. After adjustment for age; body mass index; alcohol consumption; physical activity; cigarette smoking; self-assessed health; and self-reported heart disease, hypertension, and diabetes, ED was associated with hazard ratios of 1.26 and 1.43 for all-cause and CVD mortality, respectively. These findings suggest that the association between ED and all-cause mortality is primarily driven by CVD mortality. In a subsequent analysis of the 1,057 men with complete risk factor data who were free of CVD and diabetes at baseline, Araujo et al evaluated whether ED predicts CVD beyond traditional risk factors. After adjustment for age and traditional CVD risk factors, ED was associated with increased incidence of CVD events (HR, 1.41). Addition of ED to the FRS, after adjustment for age, yielded a reclassification of 17 (11%) of 155 men who had CVD events within 10 years (Table II).
In sum, the evidence strongly suggests that vasculogenic ED is a sign of future CVD events and has potential to alter the 10-year predictive capacity of the FRS. This may be especially true in the younger population, in whom the FRS is traditionally under-predictive of both 10-year and lifetime risk.
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