Cardiovascular Risk Among Men Seeking Help for Erectile Dysfunction
Introduction
Erectile dysfunction (ED) is a multifactorial disease of the aging male affecting millions of men worldwide. In the Netherlands, on average 13% of men aged 40 years and older are affected (1). The prevalence increases with age: 6% of men aged 40–49 years, compared to 38% of men aged 70–79 years.
The introduction of oral sildenafil was a landmark in the treatment of erectile dysfunction. A considerable progress in understanding and treatment of erectile dysfunction in the 80s (2) paved the way to the introduction of sildenafil at the end of the 90s (3). This PDE5-inhibitor is a patient-friendly medication with a relatively high efficacy. The availability of it did increase the public interest in the subject of erectile dysfunction.
Warranty about the cardiovascular safety of sildenafil 4, 5 put the association between ED and cardiovascular disease (CVD) prominent on the agenda of physicians. It was already known that men with erectile dysfunction are more likely to have cardiovascular disease in their history (6). However, is erectile dysfunction also a sentinel to cardiovascular disease 6, 7, 8, 9? Answering this question is of clinical importance. A positive answer to this question implies men with erectile dysfunction are of special interest with respect to primary prevention of cardiovascular disease.
We aimed at quantifying the cardiovascular risk of men with erectile dysfunction in the population-based study presented here. We restricted the study to men seeking help for their complaints of erectile dysfunction. These men are relatively easily accessible for cardiovascular disease prevention, if required. We also took into account the introduction of sildenafil, as this might have changed both the population of men seeking help and the attitude of physicians towards men suffering from ED.
Section snippets
Methods
All 16 million Dutch citizens are registered with a general practitioner. The Integrated Primary Care Information is a Dutch database with longitudinal medical records (10). The database contains identification information; notes; prescriptions; and indications for therapy, physical findings, referrals, hospitalisations, and laboratory values. Seventeen general practitioners delivered medical files to Integrated Primary Care Information at the start of 1992. This number increased to 150 general
Erectile Dysfunction
Records of nearly 60,000 men were available to determine incidence of ED at the general practice (Fig. 1). The number of men consulting a general practitioner for ED increased with age and levelled off at older age (Table 1). The age effect was similar for the periods before and after the introduction of sildenafil in the Netherlands. The number of men consulting a general practitioner for ED was significantly higher in the period after than before the introduction. Depending on age category,
Discussion
The number of men consulting a general practitioner for ED increased tremendously after the introduction of sildenafil. Concomitantly, the cardiovascular risk decreased among men seeking help. The odds ratio of having a history of CVD decreased significantly even as the relative risk tended to be lower. Whereas ED seemed a marker for CVD before the introduction of sildenafil, it was clearly not afterwards.
Demonstrating ED as a sentinel to CVD would end a long-standing discussion. Erectile
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Cited by (31)
Improvement in Endothelial Function in Men Taking Phosphodiesterase Type 5 Inhibitors for Erectile Dysfunction
2023, American Journal of MedicineAssociation of Phosphodiesterase-5 Inhibitors Versus Alprostadil With Survival in Men With Coronary Artery Disease
2021, Journal of the American College of CardiologyErectile Dysfunction Predicts Cardiovascular Events as an Independent Risk Factor: A Systematic Review and Meta-Analysis
2019, Journal of Sexual MedicineCitation Excerpt :Vlachopoulos et al55 conducted a meta-analysis and meta-regression to confirm the positive associations between ED and CVD and between ED and all-cause mortality. However, less-strict selection criteria were set because one unadjusted study56 with confounders was included and because comprehensive stratified analyses remained lacking. Terentes-Printzios et al57 provided only a short report, including 5 studies supporting our results, and further details that would reveal useful information were unavailable.
Erectile dysfunction in primary care: Sexual health inquiry and cardiovascular risk factors among patients with no previous cardiovascular events
2016, Revista Portuguesa de Saude PublicaThe Circle of Lifestyle and Erectile Dysfunction
2015, Sexual Medicine ReviewsUric Acid Level and Erectile Dysfunction in Patients with Coronary Artery Disease
2014, Journal of Sexual MedicineCitation Excerpt :Erectile dysfunction (ED) is fairly common, especially among elderly men, and is associated with coronary artery disease (CAD) [1-4].
This study was supported by an unrestricted grant from Pfizer International, New York.