title: Changes in erectile dysfunction over time in relation to Framingham cardiovascular risk in the Boston Area Community Health (BACH) Survey.
abstract: BACKGROUND
  Erectile dysfunction (ED) is associated with cardiovascular disease (CVD); however, the association between change in ED status over time and future underlying CVD risk is unclear.
  
  
  OBJECTIVE
  The aim of this study was to investigate the association between change in ED status and Framingham CVD risk, as well change in Framingham risk.
  
  
  METHODS
  We studied 965 men free of CVD in the Boston Area Community Health (BACH) Survey, a longitudinal cohort study with three assessments. ED was assessed with the five-item International Index of Erectile Function at BACH I (2002-2005) and BACH II (2007-2010) and classified as no ED/transient ED/persistent ED. CVD risk was assessed with 10-year Framingham CVD risk algorithm at BACH I and BACH III (2010-2012). Linear regression models controlled for baseline age, socio-demographic and lifestyle factors, as well as baseline Framingham risk. Models were also stratified by age (≥/< 50 years).
  
  
  METHODS
  Framingham CVD risk and change in Framingham CVD risk were the main outcome measures.
  
  
  RESULTS
  Transient and persistent ED was significantly associated with increased Framingham risk and change in risk over time in univariate and age-adjusted models. In younger men, persistent ED was associated with a Framingham risk that was 1.58 percentage points higher (95% confidence interval [CI]: 0.11, 3.06) and in older men, a Framingham risk that was 2.54 percentage points higher (95% CI: -1.5, 6.59), compared with those without ED. Change in Framingham risk over time was also associated with transient and persistent ED in men <50 years, but not in older men.
  
  
  CONCLUSIONS
  Data suggest that even after taking into account other CVD risk factors, transient and persistent ED is associated with Framingham CVD risk and a greater increase in Framingham risk over time, particularly in younger men. Findings further support clinical assessment of CVD risk in men presenting with ED, especially those under 50 years.
authors.affiliation: Division of Epidemiology, New England Research Institutes, Inc., Watertown, MA, USA; Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Shona C
authors.initials: SC
authors.lastname: Fang
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Rosen
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Vita
authors.forename: Peter
authors.initials: P
authors.lastname: Ganz
authors.forename: Varant
authors.initials: V
authors.lastname: Kupelian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001900:Boston / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000150:complications* / Q000453:epidemiology; D007172:Erectile Dysfunction / Q000453:epidemiology / Q000209:etiology*; D006306:Health Surveys; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011634:Public Health; D012307:Risk Factors; D013997:Time Factors
keywords: Changes in Erectile Function; Male; Prospective Cohort; Sexual Dysfunction