Erectile Dysfunction and Subsequent Cardiovascular Disease

Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 01/2006; 294(23):2996-3002. DOI: 10.1001/jama.294.23.2996
Source: PubMed


The risk factors for cardiovascular disease and erectile dysfunction are similar.
To examine the association of erectile dysfunction and subsequent cardiovascular disease.
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.
Erectile dysfunction and cardiovascular disease.
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.
Erectile dysfunction is a harbinger of cardiovascular clinical events in some men. Erectile dysfunction should prompt investigation and intervention for cardiovascular risk factors.

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Available from: Catherine M Tangen, Aug 25, 2014
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    • "The correlates and consequences of a satisfying sex life are important areas of research that are gaining increasing attention in the psychological and medical literature. While it has long been assumed that sexual activity affects overall quality of life for men (Thompson et al., 2005), only recently have studies begun to report similar findings for women. For example, Davison and colleagues (2009) found that sexually satisfied women reported higher overall subjective well-being than did sexually unsatisfied women. "
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    ABSTRACT: Leaders in the field of sexuality have called for additional research examining the link between sexual well-being and life satisfaction in women in order to expand knowledge regarding the important consequences of a satisfying sex life. Participants in the present study were sexually active women reporting a wide range of sexual difficulties who completed an in-person interview, validated self-report measures, and daily online assessments for 4 weeks. Sexual well-being was related to life satisfaction both cross-sectionally and within individuals over time. In addition, high relational satisfaction and low attachment anxiety served as protective factors, decreasing the degree to which unsatisfying sexual experiences were associated with decreases in life satisfaction. These results extend previous findings by confirming a strong association between sexual well-being and overall life satisfaction within individuals over time. The strength of this association is moderated by a number of intra- and interpersonal factors. Implications for healthcare providers are discussed.
    Full-text · Article · Jan 2015 · Journal of Sex and Marital Therapy
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    • "Of the remaining 53% fully sexually–functional men, 57% will report any of the ED symptoms after the next 5 year period. A strong statistically significant correlation (with hazard ratio 1.46) of ED and cardiovascular events has been documented [12]. Moreover, endocrine disorders, which often affect elderly patients, significantly contribute to the incidence and severity of erectile dysfunction. "
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    ABSTRACT: Introduction Benign prostate hyperplasia and erectile dysfunction affect a significant subset of men. BPH and ED may have the same promoting conditions and are the strong predicting risk factors to each other. A significant number of these patients are bothered by lower urinary tract symptoms (LUTS). Direct correlation of age, sexual dysfunction and LUTS severity has been well documented. Many sexually dysfunctional patients with concomitant BPH receive alpha–adrenergic antagonists and any Phosphodiesterase–5 (PDE5) inhibitor simultaneously. PDE5 inhibitors relieve LUTS symptoms in the course of BPH and reduce independent detrusor contractions. This paper presents the results of clinical trials on the efficacy of PDE5 inhibitors on LUTS, new perspectives on its use and newly–identified side effects. Material and methods The review is based on an internet search of PubMed and Medscape databases. The search terms were as follows: LUTS and ED, BPH and phosphodiesterase–5 inhibitors, LUTS clinical trials, phosphodiesterase–5 inhibitors mechanisms. Results Clinical trials show an epidemiological and pathophysiological relationship between BPH, LUTS and ED. Numerous studies reveal the alleviating effect of phosphodiesterase–5 inhibitors on LUTS, expressed as the reduction of IPSS score, but not followed by a change in Qmax. Opponents raise a link of PDE5 inhibitors with increased risk of melanoma. New studies reveal that phosphodiesterase–5 inhibitors are effective in the treatment of neurological disorders. Conclusions Researches reveal the efficacy of phosphodiesterase–5 inhibitors in LUTS along with an improvement of erectile function. The molecular mechanism of action of such drugs suggests imminent novel applications. Potential benefits will be multidimensional. Unfortunately, interfering with particular molecular mechanisms may alleviate some diseases, but may lay groundwork for others – new and even more devastating.
    Full-text · Article · Aug 2014
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    • "ED can mark the starting point for the evaluation and prevention of significant severe diseases (such as diabetes, metabolic syndrome, dyslipidaemia, arteriosclerosis, hypertension, ischaemic cardiopathy , neuropathy, etc.) hitherto unknown by the patients. A large clinical trial has clearly shown that prevalent or incidental ED predicted the occurrence of cardiovascular events over a follow-up period of 9 years (Thompson et al., 2005). The same study demonstrated that incident ED predicted subsequent acute CAD to a degree equal to or greater than that of cigarette smoking, hyperlipidaemia or family history of AMI. "
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    ABSTRACT: Arterial erectile dysfunction (ED) is commonly associated with classic cardiovascular and metabolic risk factors, such as smoking, hypertension, diabetes mellitus, dyslipidaemia and obesity. However, some patients with arterial ED do not present any cardiovascular risk factor. As mean platelet volume (MPV) has been shown to be directly related to the cardiovascular risk and the percentage of platelets expressing the vitronectin receptor (αVβ3), involved in the early stages of platelet adhesion, is higher in patients with ED, the present study was undertaken to evaluate MPV and αVβ3 in 15 patients with arterial ED not associated with any cardiovascular risk factor. Their MPV and αVβ3 values were compared with those of men with normal penile haemodynamic. Patients with arterial ED had a mean value of MPV (11.25 vs. 9.88 fL; p < 0.001) and a percentage of platelets expressing the αVβ3 (7.39 vs. 2.07%; p < 0.001) significantly higher compared to controls. A negative correlation was observed between peak systolic velocity and MPV (r = 0.916; p < 0.001) or αVβ3 (r = 0.930; p < 0.001), whereas MPV and αVβ3 correlated positively (r = 0.908; p < 0.001). In conclusion, this study showed for the first time that MPV and the percentage of platelet expressing αVβ3 are significantly higher in patients with arterial ED compared to controls. We speculate that these parameters of platelet function may be envisaged as markers of cardiovascular risk in patients with arterial ED.
    Full-text · Article · Jul 2014 · Andrology
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