title: Erectile dysfunction and cardiovascular events in diabetic men: a meta-analysis of observational studies.
abstract: BACKGROUND
  Several studies have shown that erectile dysfunction (ED) influences the risk of cardiovascular events (CV events). However, a meta-analysis of the overall risk of CV events associated with ED in patients with diabetes has not been performed.
  
  
  RESULTS
  We searched MEDLINE and the Cochrane Library for pertinent articles (including references) published between 1951 and April 22, 2012. English language reports of original observational cohort studies and cross-sectional studies were included. Pooled effect estimates were obtained by random effects meta-analysis. A total of 3,791 CV events were reported in 3 cohort studies and 9 cross-sectional studies (covering 22,586 subjects). Across the cohort studies, the overall odds ratio (OR) of diabetic men with ED versus those without ED was 1.74 (95% confidence interval [CI]: 1.34-2.27; P<0.001) for CV events and 1.72 (95% CI: 1.5-1.98; P<0.001) for coronary heart disease (CHD). The funnel plot, Begg's test, and Egger's test did not show evidence of publication bias (all P>0.05). Moreover, meta-regression analysis found no relationship between the method used to assess ED (questionnaire or interview), mean age, mean hemoglobin A(1c), mean body mass index, or mean duration of diabetes and the risk of CV events or CHD. In the cross-sectional studies, the OR of diabetic men with ED versus those without ED was 3.39 (95% CI: 2.58-4.44; P<0.001) for CV events (N = 9), 3.43 (95% CI: 2.46-4.77; P<0.001) for CHD (N = 7), and 2.63 (95% CI: 1.41-4.91; P = 0.002) for peripheral vascular disease (N = 5).
  
  
  CONCLUSIONS
  ED was associated with an increased risk of CV events in diabetic patients. Prevention and early detection of cardiovascular disease are important in the management of diabetes, especially in view of the rapid increase in its prevalence.
authors.affiliation: Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Tomohide
authors.initials: T
authors.lastname: Yamada
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hara
authors.forename: Hitomi
authors.initials: H
authors.lastname: Umematsu
authors.forename: Ryo
authors.initials: R
authors.lastname: Suzuki
authors.forename: Takashi
authors.initials: T
authors.lastname: Kadowaki
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D016206:Databases, Bibliographic; D048909:Diabetes Complications / Q000453:epidemiology* / Q000503:physiopathology; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000503:physiopathology; D007172:Erectile Dysfunction / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires