Erectile Dysfunction as an Independent Predictor of Future Cardiovascular Events
Authors: S.M. Iftekhar Uddin, Mohammadhassan Mirbolouk, Zeina Dardari, David I. Feldman, Miguel Cainzos-Achirica, Andrew P. DeFilippis, Philip Greenland, Ron Blankstein, Kevin L. Billups, Martin M. Miner, Khurram Nasir, Michael J. Blaha
Journal: Circulation (2018)

coronary disease ◼ erectile dysfunction ◼ prevention and control ◼ risk factors V ascular erectile dysfunction (ED) and cardiovascular disease (CVD) share common risk factors including obesity, hypertension, metabolic syndrome, diabetes mellitus, and smoking.ED and CVD also have common underlying pathological mechanisms, including endothelial dysfunction, inflammation, and atherosclerosis. 1 Despite these close relationships, the evidence documenting ED as an independent predictor of future CVD events is limited.We therefore leveraged the MESA study (Multi-Ethnic Study of Atherosclerosis), an ethnically diverse, community-based, multisite prospective cohort study, to examine the value of self-reported ED for predicting incident coronary heart disease (CHD) and CVD in those free of these CVD events at baseline.Details of MESA have been described previously. 2 Male MESA participants who attended visit 5 and answered the single Massachusetts Male Aging Study question 3 on ED symptoms were considered for our analysis (n=1914).A participant was considered to have ED if he responded "never able" or "sometimes able" to the Massachusetts Male Aging Study question.After excluding 155 participants with a CVD event before visit 5, 1757 participants were followed for 3.8 years (interquartile range, 3.5-4.2) and outcomes of hard CHD and CVD events were assessed.Hard CVD events included all hard CHD events (myocardial infarction, resuscitated cardiac arrest, and CHD death), plus stroke and stroke death.Participants provided informed consent, and each study site obtained approval from their institutional review board.Cox proportional hazard models were developed to calculate hazard ratios for the outcomes by ED status (ED yes/no) after adjusting for age, race/ethnicity, and education (model 1); further adjusting for smoking status, diabetes mellitus, family history of CHD, total/high-density lipoprotein cholesterol ratio, systolic blood pressure, antihypertensive medication use, and lipid-lowering medication use (model 2); and further adjusting for β-blocker use and depression assessed by the Center for Epidemiological Studies Depression score (Center for Epidemiological Studies Depression score>16 versus ≤16) (model 3).To further assess the potential bidirectional relationship of prior CVD with ED, an additional shifted-time cross-sectional analysis was conducted to see if an interim CVD event before MESA visit 5 was associated with self-reported ED at visit 5.For this analysis, all 1914 participants with an ED assessment were included in a multivariable-adjusted logistic regression adjusting for the above-mentioned covariates.The mean age of the 1914 participants was 69±9.2 years and 42.3% were white, 24.2% were African American, 10.5% were Chinese American, and 22.9% were Hispanic.ED symptoms were reported by 877 (45.8%) participants.Participants with ED were more likely to have diabetes mellitus and a family history of CHD.They were also more likely to use β-blocker, antihypertensive, lipid-lowering, and antidepressant medications.Over the 3.8-year follow-up, there were a total of 40 CHD and 75 CVD hard