Elsevier

Annals of Epidemiology

Volume 16, Issue 2, February 2006, Pages 85-90
Annals of Epidemiology

Cardiovascular Risk Among Men Seeking Help for Erectile Dysfunction

https://doi.org/10.1016/j.annepidem.2005.06.047Get rights and content

Purpose

The introduction of sildenafil put the risk of cardiovascular disease (CVD) among men with erectile dysfunction (ED) on the agenda of physicians. The question arose, Is EDsentinel to CVD? We sought to answer this question in the present study.

Methods

A historical cohort study was set up using medical records of general practices all over the Netherlands. Incident cases of ED were selected before and after the introduction of sildenafil using a catchment population of 60,000 men aged 35 to 74 years. Two to three men without ED (controls) were, subsequently, matched to each case. Incidence of CVD was determined for cases and controls, respectively.

Results

Overall, incidence of ED doubled from 5.3 per 1000 men-years in the period before introduction of sildenafil to 10.1 after the introduction. The relative risk of incident CVD among men with ED compared to controls was 1.7 [95%-CI 0.9–3.3] before the introduction and 1.1 [95%-CI 0.6–1.8] afterwards.

Conclusions

While ED could be seen as a marker for CVD before the introduction of sildenafil, it was clearly not afterwards.

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

References (19)

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    Erectile dysfunction (ED) is fairly common, especially among elderly men, and is associated with coronary artery disease (CAD) [1-4].

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This study was supported by an unrestricted grant from Pfizer International, New York.

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