PARIS — Erectile dysfunction may be an independent risk factor for heart disease, according to investigators from two studies who gave poster presentations at the annual meeting of the European Association of Urology.
Dr. Francis Dubosq reported that myocardial scintography revealed coronary artery disease in 9 (29%) of 31 men who sought treatment for erectile dysfunction (ED) from urologists at Hôpital Foch in Suresnes, France. The investigators excluded patients with known coronary artery disease or two or more cardiovascular risk factors from the population referred to cardiology for screening.
Dr. Arthur Bohnen reported that ED was an independent risk factor for acute myocardial infarction and stroke in a longitudinal, population-based study that followed 1,248 men for an average of 6.5 years in Krimpen, Netherlands.
His group found that older men with severe ED were 2.5 times more likely to have a cardiovascular event than men with no ED; the odds were 1.5 times higher for those with moderate ED. Both investigators said the results from the ongoing studies were preliminary. Although they stopped short of drawing definitive conclusions, each saw immediate implications for physicians.
Dr. Dubosq, a urologist at Hôpital Foch, said physicians should view men with ED as being at high risk for coronary artery disease. “You have to be very careful because these patients are going to be candidates for artery involvements,” he said, emphasizing that the patients screened had no symptoms of coronary artery disease.
Dr. Bohnen, a general practitioner at Erasmus Medical Center, Rotterdam, Netherlands, said physicians should consider ED when estimating a patient's cardiovascular risk. “They should ask a question about ED and not only ask about smoking,” he said. “It shows here [ED] is an independent risk factor, independent of the other risk factors.”
The French study looked at a younger population, aged 45–70 years, chosen from 153 men seeking treatment for ED. The 20% sample selected for cardiology screening had a median age of 58 years.
Scores on the International Index of Erectile Dysfunction showed that 2 of the men had severe ED, 10 had moderate ED, and 19 had mild ED.
Blood tests showed no evidence of diabetes, dyslipidemia, or androgen deficiency, and Doppler ultrasound did not detect peripheral artery disease in any of the subjects screened for heart disease in the French study. Using Laurier scores, described as “an estimation adapted to [the] European population of the 10-year risk for 'hard' CAD,” the investigators found that the median score was significantly different from “the ideal index of people the same age without CAD risk factors”: 6.84 for the ED population vs. 5.32.
The Dutch study enrolled men aged 50–78 years at baseline without regard to whether they presented with ED.
Patients with a radical prostatectomy, prostate or bladder cancer, or neurogenic disease were excluded.
Of 1,248 men enrolled, 856 had no ED, 284 had moderate ED, and 108 had severe ED based on responses to the International Continence Society male sex questionnaire. During the follow-up period, 4.6% of the men had cardiovascular events. Within the population of men who had a cardiovascular event, 20% had severe ED and 31% had moderate ED.
The investigators defined cardiovascular disease as “acute myocardial infarction, stroke, or sudden death determined by an expert panel based on general practitioner data and hospital discharge letters.”
Risk associated with ED was independent of cardiovascular risk factors such as cholesterol, blood pressure, body mass index, Framingham risk scores, family history, and smoking status.