Erectile Dysfunction and Subsequent Cardiovascular Disease | Cardiology | JAMA | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.170.64.36. Please contact the publisher to request reinstatement.
1.
NIH Consensus Development Panel on Impotence.  Impotence.  JAMA. 1993;270:83-908510302Google ScholarCrossref
2.
Zusman RM, Morales A, Glasser DB, Osterloh IH. Overall cardiovascular profile of sildenafil citrate.  Am J Cardiol. 1999;83:35C-44C10078541Google ScholarCrossref
3.
Johannes CB, Araujo AB, Feldman HA, Derby CA, Kleinman KP, McKinlay JB. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts Male Aging Study.  J Urol. 2000;163:460-46310647654Google ScholarCrossref
4.
Moinpour CM, Lovato LC, Thompson IM Jr.  et al.  Profile of men randomized to the prostate cancer prevention trial: baseline health-related quality of life, urinary and sexual functioning, and health behaviors.  J Clin Oncol. 2000;18:1942-195310784636Google Scholar
5.
Le NA. Inflammation, oxidative stress, and atherosclerosis.  Curr Opin Lipidol. 2004;15:227-22915017368Google ScholarCrossref
6.
Thompson IM, Goodman PJ, Tangen CM.  et al.  The influence of finasteride on the development of prostate cancer.  N Engl J Med. 2003;349:215-22412824459Google ScholarCrossref
7.
American Heart Association.  Heart Disease and Stroke Statistics: 2004 UpdateDallas, Tex: American Heart Association; 2003
8.
Yusuf S, Hawken S, Ounpuu S.  et al. INTERHEART Study Investigators.  Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study.  Lancet. 2004;364:937-95215364185Google ScholarCrossref
9.
Rosengren A, Hawken S, Ounpuu S.  et al. INTERHEART Investigators.  Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): case-control study.  Lancet. 2004;364:953-96215364186Google ScholarCrossref
10.
Blood Pressure Lowering Trialists' Collaboration.  Effects of different blood pressure lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomized trials.  Lancet. 2003;362:1527-153514615107Google ScholarCrossref
11.
Collins R, Armitage J, Parish S, Sleigh P, Peto R.Heart Protection Study Collaborative Group.  MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomized placebo-controlled trial.  Lancet. 2003;361:2005-201612814710Google ScholarCrossref
12.
de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study.  Circulation. 1999;99:779-7859989963Google ScholarCrossref
13.
Parish S, Collins R, Peto R.  et al.  Cigarette smoking, tar yields, and non-fatal myocardial: 14 000 cases and 32 000 controls in the United Kingdom.  BMJ. 1995;311:471-4777647641Google ScholarCrossref
14.
Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years' observation on male British doctors.  BMJ. 2004;328:1519-152815213107Google ScholarCrossref
15.
Katz DL. Lifestyle and dietary modification for prevention of heart failure.  Med Clin North Am. 2004;88:1295-132015331318Google ScholarCrossref
16.
Bai Q, Xu QQ, Jiang H, Zhang WL, Wang XH, Zhu JC. Prevalence and risk factors of erectile dysfunction in 3 cities of China: a community-based study.  Asian J Androl. 2004;6:343-34815546027Google Scholar
17.
Montorsi F, Briganti A, Salonia A.  et al.  Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease.  Eur Urol. 2003;44:360-36412932937Google ScholarCrossref
18.
Ponholzer A, Temml C, Mock K, Marszalek M, Obermayr R, Madersbacher S. Prevalence and risk factors for erectile dysfunction in 2869 men using a validated questionnaire.  Eur Urol. 2005;47:80-8615582253Google ScholarCrossref
19.
DeBusk R. Sexual activity in patients with angina.  JAMA. 2003;290:3129-313314679276Google ScholarCrossref
20.
Fung MM, Bettencourt R, Barrett-Connor E. Heart disease risk factors predict erectile dysfunction 25 years later: the Rancho Bernardo study.  J Am Coll Cardiol. 2004;43:1405-141115093875Google ScholarCrossref
21.
Speel TG, van Langen H, Meuleman EJ. The risk of coronary heart disease in men with erectile dysfunction.  Eur Urol. 2003;44:366-37012932938Google ScholarCrossref
22.
Liu PY, Death AK, Handelsman DJ. Androgens and cardiovascular disease.  Endocr Rev. 2003;24:313-34012788802Google ScholarCrossref
23.
Gazzaruso C, Giordanetti S, De Amici E.  et al.  Relationship between erectile dysfunction and silent myocardial ischemia in apparently uncomplicated type 2 diabetic patients.  Circulation. 2004;110:22-2615210604Google ScholarCrossref
24.
Blumentals WA, Gomez-Caminero A, Joo S, Vannappagari V. Is erectile dysfunction predictive of peripheral vascular disease?  Aging Male. 2003;6:217-22115006259Google ScholarCrossref
25.
Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study.  J Urol. 1994;151:54-618254833Google Scholar
26.
Sherbourne CD. Social functioning: sexual problems measures. In: AL Stewart, JE Ware Jr, eds. Measuring Functioning and Well-being: The Medical Outcomes Study Approach. Durham, NC: Duke University Press; 1991:194-204
27.
Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction.  Urology. 1997;49:822-8309187685Google ScholarCrossref
28.
Rosen RC, Cappelleri JC, Smith MD, Kipsky J, Pena BM. Development and evaluation of an abridged 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction.  Int J Impot Res. 1999;11:319-32610637462Google ScholarCrossref
29.
Derby CA, Araujo AB, Johannes CB, Feldman HA, McKinlay JB. Measurement of erectile dysfunction in population-based studies: the use of a single question self-assessment in the Massachusetts Male Aging Study.  Int J Impot Res. 2000;12:197-20411079360Google ScholarCrossref
30.
Mittleman MA, Glasser DB, Orazem J. Clinical trials of sildenafil citrate (Viagra) demonstrate no increase in risk of myocardial infarction and cardiovascular death compared with placebo.  Int J Clin Pract. 2003;57:597-60014529061Google Scholar
31.
DeBusk R, Drory Y, Goldstein I.  et al.  Management of sexual dysfunction in patients with cardiovascular disease: recommendations of the Princeton Consensus Panel.  Am J Cardiol. 2000;86:175-18110913479Google ScholarCrossref
Original Contribution
December 21, 2005

Erectile Dysfunction and Subsequent Cardiovascular Disease

Author Affiliations
 

Author Affiliations: Department of Urology, University of Texas Health Science Center at San Antonio (Dr Thompson), and Southwest Oncology Group (Dr Coltman), San Antonio; Fred Hutchinson Cancer Research Center (Drs Tangen and Moinpour and Ms Goodman) and University of Washington (Dr Probstfield), Seattle.

JAMA. 2005;294(23):2996-3002. doi:10.1001/jama.294.23.2996
Abstract

Context The risk factors for cardiovascular disease and erectile dysfunction are similar.

Objective To examine the association of erectile dysfunction and subsequent cardiovascular disease.

Design, Setting, and Participants Men aged 55 years or older who were randomized to the placebo group (n = 9457) in the Prostate Cancer Prevention Trial at 221 US centers were evaluated every 3 months for cardiovascular disease and erectile dysfunction between 1994 and 2003. Proportional hazards regression models were used to evaluate the association of erectile dysfunction and cardiovascular disease. In an adjusted model, covariates included age, body mass index, blood pressure, serum lipids, diabetes, family history of myocardial infarction, race, smoking history, physical activity, and quality of life.

Main Outcome Measures Erectile dysfunction and cardiovascular disease.

Results Of the 9457 men randomized to placebo, 8063 (85%) had no cardiovascular disease at study entry; of these men, 3816 (47%) had erectile dysfunction at study entry. Among the 4247 men without erectile dysfunction at study entry, 2420 men (57%) reported incident erectile dysfunction after 5 years. After adjustment, incident erectile dysfunction was associated with a hazard ratio of 1.25 (95% confidence interval [CI], 1.02-1.53; P = .04) for subsequent cardiovascular events during study follow-up. For men with either incident or prevalent erectile dysfunction, the hazard ratio was 1.45 (95% CI, 1.25-1.69; P<.001). For subsequent cardiovascular events, the unadjusted risk of an incident cardiovascular event was 0.015 per person-year among men without erectile dysfunction at study entry and was 0.024 per person-year for men with erectile dysfunction at study entry. This association was in the range of risk associated with current smoking or a family history of myocardial infarction.

Conclusions Erectile dysfunction is a harbinger of cardiovascular clinical events in some men. Erectile dysfunction should prompt investigation and intervention for cardiovascular risk factors.

×