title: Erectile dysfunction severity as a risk marker for cardiovascular disease hospitalisation and all-cause mortality: a prospective cohort study.
abstract: BACKGROUND
  Erectile dysfunction is an emerging risk marker for future cardiovascular disease (CVD) events; however, evidence on dose response and specific CVD outcomes is limited. This study investigates the relationship between severity of erectile dysfunction and specific CVD outcomes.
  
  
  RESULTS
  We conducted a prospective population-based Australian study (the 45 and Up Study) linking questionnaire data from 2006-2009 with hospitalisation and death data to 30 June and 31 Dec 2010 respectively for 95,038 men aged ≥45 y. Cox proportional hazards models were used to examine the relationship of reported severity of erectile dysfunction to all-cause mortality and first CVD-related hospitalisation since baseline in men with and without previous CVD, adjusting for age, smoking, alcohol consumption, marital status, income, education, physical activity, body mass index, diabetes, and hypertension and/or hypercholesterolaemia treatment. There were 7,855 incident admissions for CVD and 2,304 deaths during follow-up (mean time from recruitment, 2.2 y for CVD admission and 2.8 y for mortality). Risks of CVD and death increased steadily with severity of erectile dysfunction. Among men without previous CVD, those with severe versus no erectile dysfunction had significantly increased risks of ischaemic heart disease (adjusted relative risk [RR] = 1.60, 95% CI 1.31-1.95), heart failure (8.00, 2.64-24.2), peripheral vascular disease (1.92, 1.12-3.29), "other" CVD (1.26, 1.05-1.51), all CVD combined (1.35, 1.19-1.53), and all-cause mortality (1.93, 1.52-2.44). For men with previous CVD, corresponding RRs (95% CI) were 1.70 (1.46-1.98), 4.40 (2.64-7.33), 2.46 (1.63-3.70), 1.40 (1.21-1.63), 1.64 (1.48-1.81), and 2.37 (1.87-3.01), respectively. Among men without previous CVD, RRs of more specific CVDs increased significantly with severe versus no erectile dysfunction, including acute myocardial infarction (1.66, 1.22-2.26), atrioventricular and left bundle branch block (6.62, 1.86-23.56), and (peripheral) atherosclerosis (2.47, 1.18-5.15), with no significant difference in risk for conditions such as primary hypertension (0.61, 0.16-2.35) and intracerebral haemorrhage (0.78, 0.20-2.97).
  
  
  CONCLUSIONS
  These findings give support for CVD risk assessment in men with erectile dysfunction who have not already undergone assessment. The utility of erectile dysfunction as a clinical risk prediction tool requires specific testing.
authors: National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia. Emily.Banks@anu.edu.au
authors: Emily
authors: E
authors: Banks
authors: Grace
authors: G
authors: Joshy
authors: Walter P
authors: WP
authors: Abhayaratna
authors: Leonard
authors: L
authors: Kritharides
authors: Peter S
authors: PS
authors: Macdonald
authors: Rosemary J
authors: RJ
authors: Korda
authors: John P
authors: JP
authors: Chalmers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality* / Q000503:physiopathology; D016001:Confidence Intervals; D007172:Erectile Dysfunction / Q000150:complications* / Q000473:pathology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers
references: Ann Intern Med. 2009 Oct 6;151(7):496-507
references: 19805772
references: JAMA. 2005 Dec 21;294(23):2996-3002
references: 16414947
references: N Engl J Med. 2000 Jun 15;342(24):1802-13
references: 10853004
references: J Sex Med. 2009 Sep;6(9):2445-54
references: 19538544
references: Aust N Z J Public Health. 2008 Oct;32(5):405-7
references: 18959540
references: Aust Fam Physician. 2009 Apr;38(4):241-5
references: 19350075
references: Aust N Z J Public Health. 2011 Dec;35(6):557-63
references: 22151163
references: Aust N Z J Med. 1995 Aug;25(4):316-23
references: 8540872
references: J Am Coll Cardiol. 2011 Sep 20;58(13):1378-85
references: 21920268
references: J Sex Med. 2012 Aug;9(8):2104-10
references: 22759697
references: J Clin Epidemiol. 2004 Apr;57(4):366-72
references: 15135837
references: Med J Aust. 2006 Feb 20;184(4):151-4
references: 16489896
references: J Sex Med. 2010 Aug;7(8):2805-16
references: 20367771
references: J Am Coll Cardiol. 2010 Nov 30;56(23):1908-13
references: 21109113
references: Int J Clin Pract. 2003 Sep;57(7):597-600
references: 14529061
references: Mayo Clin Proc. 2009 Feb;84(2):108-13
references: 19181643
references: Int J Epidemiol. 2008 Oct;37(5):941-7
references: 17881411
references: Stroke. 2002 Oct;33(10):2465-70
references: 12364739
references: Int J Impot Res. 2008 Sep-Oct;20(5):507-11
references: 18701919
references: Nat Rev Cardiol. 2010 May;7(5):241
references: 20425903
references: J Sex Med. 2006 Jan;3(1):28-36; discussion 36
references: 16409215
references: Int J Impot Res. 2000 Aug;12(4):197-204
references: 11079360
references: BMC Med Res Methodol. 2010 Apr 01;10:26
references: 20356408
references: J Am Coll Cardiol. 2010 Jan 26;55(4):350-6
references: 20117441
references: Heart. 2003 Mar;89(3):251-3
references: 12591819
references: J Sex Med. 2010 Jan;7(1 Pt 1):192-202
references: 19912508
references: Aging Male. 2003 Dec;6(4):217-21
references: 15006259
references: Lancet. 2005 Jul 16-22;366(9481):218-24
references: 16023512
references: Pharmacoepidemiol Drug Saf. 2010 Jun;19(6):579-85
references: 20131328
references: Int J Impot Res. 2008 Jan-Feb;20(1):92-9
references: 17728804
references: Stat Med. 1997 Apr 15;16(7):791-801
references: 9131766