title: Does erectile dysfunction contribute to cardiovascular disease risk prediction beyond the Framingham risk score?
abstract: OBJECTIVE
  This study was designed to determine whether erectile dysfunction (ED) predicts cardiovascular disease (CVD) beyond traditional risk factors.
  
  
  BACKGROUND
  Both ED and CVD share pathophysiological mechanisms and often co-occur. It is unknown whether ED improves the prediction of CVD beyond traditional risk factors.
  
  
  METHODS
  This was a prospective, population-based study of 1,709 men (of 3,258 eligible) age 40 to 70 years. The ED data were measured by self-report. Subjects were followed for CVD for an average follow-up of 11.7 years. The association between ED and CVD was examined using the Cox proportional hazards regression model. The discriminatory capability of ED was examined using C statistics. The reclassification of CVD risk associated with ED was assessed using a method that quantifies net reclassification improvement.
  
  
  RESULTS
  Of the prospective population, 1,057 men with complete risk factor data who were free of CVD and diabetes at baseline were included. During follow-up, 261 new cases of CVD occurred. We found ED was associated with CVD incidence controlling for age (hazard ratio [HR]: 1.42, 95% confidence interval [CI]: 1.05 to 1.90), age and traditional CVD risk factors (HR: 1.41, 95% CI: 1.05 to 1.90), as well as age and Framingham risk score (HR: 1.40, 95% CI: 1.04 to 1.88). Despite these significant findings, ED did not significantly improve the prediction of CVD incidence beyond traditional risk factors.
  
  
  CONCLUSIONS
  Independent of established CVD risk factors, ED is significantly associated with increased CVD incidence. Nonetheless, ED does not improve the prediction of who will and will not develop CVD beyond that offered by traditional risk factors.
authors.affiliation: New England Research Institutes, Watertown, Massachusetts, USA. aaraujo@neriscience.com
authors.forename: Andre B
authors.initials: AB
authors.lastname: Araujo
authors.forename: Susan A
authors.initials: SA
authors.lastname: Hall
authors.forename: Peter
authors.initials: P
authors.lastname: Ganz
authors.forename: Gretchen R
authors.initials: GR
authors.lastname: Chiu
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Rosen
authors.forename: Varant
authors.initials: V
authors.lastname: Kupelian
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Travison
authors.forename: John B
authors.initials: JB
authors.lastname: McKinlay
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications* / Q000209:etiology; D007172:Erectile Dysfunction / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors