title: Smoking causes erectile dysfunction through vascular disease.
abstract: OBJECTIVE
  To investigate whether smoking either directly or through vascular disease causes erectile dysfunction (ED) and to determine whether ED is an early marker of vascular disease in smokers.
  
  
  METHODS
  The target population consisted of all men 50, 60, or 70 years old who resided in the study areas in Finland in 1994. Questionnaires were mailed to 3143 men in 1994, to 2837 men in 1999, and to 2510 men in 2004. A total of 1368 men (55% of those alive) responded to the three surveys.
  
  
  RESULTS
  Men who smoked in 1994 and developed a vascular disease during 1994 to 1999 had a three times (adjusted incidence density ratio [IDR] 3.1, 95% confidence interval [CI] 1.3 to 7.5) greater risk of ED during 1999 to 2004 compared with those who had never smoked who did not develop vascular disease. In contrast, smokers without episodes of vascular disease were not at an increased risk of ED (adjusted IDR 1.0, 95% CI 0.5 to 1.8). Among men who were exsmokers and had ED in 1994, the incidence of vascular disease was greater than among those who had never smoked who were free of ED at entry (IDR 1.5, 95% CI 1.0 to 2.2). No greater risk of vascular disease owing to ED was found in smokers (IDR 1.1, 95% CI 0.6 to 2.0) or those who had never smoked (IDR 1.1, 95% CI 0.6 to 1.9) at entry.
  
  
  CONCLUSIONS
  The results of this study have shown that smoking may cause ED because it can cause vascular disease, and ED may be a marker of silent vascular disease in exsmokers.
authors.affiliation: University of Tampere School of Public Health, Tampere, Finland. r_shiri@yahoo.com
authors.forename: Rahman
authors.initials: R
authors.lastname: Shiri
authors.forename: Jukka
authors.initials: J
authors.lastname: Häkkinen
authors.forename: Juha
authors.initials: J
authors.lastname: Koskimäki
authors.forename: Teuvo L J
authors.initials: TL
authors.lastname: Tammela
authors.forename: Anssi
authors.initials: A
authors.lastname: Auvinen
authors.forename: Matti
authors.initials: M
authors.lastname: Hakama
mesh_terms: D000368:Aged; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D018783:Impotence, Vasculogenic / Q000453:epidemiology / Q000209:etiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014652:Vascular Diseases / Q000150:complications*