Erectile Dysfunction with Cardiovascular Disease
Strong Predictor of Death, Heart Attack, Stroke
Treatments effective in reducing cardiovascular
disease had no effect on ED
March 16, 2010 - Erectile dysfunction (ED) is a
strong predictor of death from all causes and of heart attack, stroke
and heart failure in men with cardiovascular disease (CVD), German
researchers reported in Circulation: Journal of the American Heart
In the first study to show that ED is predictive of
death and cardiovascular outcomes, researchers found that men with CVD
and ED (compared to those without ED) were twice as likely to suffer
death from all causes and 1.6 times more likely to suffer the composite
of cardiovascular death, heart attack, stroke and heart failure
hospitalization. More specifically, they were:
● 1.9 times more likely to die from cardiovascular disease;
● twice as likely to have a heart attack;
● 1.2 times more likely to be hospitalized for heart failure; and
● 1.1 times more likely to have a stroke.
The researchers also found that, though ACE
inhibitors, angiotensin receptor blockers or a combination of the two,
can reduce cardiovascular events in high-risk patients, the medications
didn’t influence the course nor the development of ED.
“Erectile dysfunction is something that regularly
should be addressed in the medical history of patients; it might be a
symptom of early atherosclerosis,” said Michael Böhm, M.D., lead author
of the study and chairman of internal medicine in the Department of
Cardiology and Intensive Care at the University of Saarland, Germany.
The worldwide study included 1,519 men from 13
countries in a substudy of the ONTARGET and TRANSCEND trials of
cardiovascular patients. The men answered a questionnaire to determine
whether they had ED. Men with ED were then categorized as having mild,
mild-to-moderate, moderate or severe ED. The questionnaires were given
at the initial visit, after two years or at the final visit after an
average follow-up of five years.
ONTARGET patients were either randomly assigned to
the ACE inhibitor drug ramipril (400 patients), telmisartan (395
patients) or a combination (381 patients). In TRANSCEND, researchers
randomized ACE inhibitor-intolerant patients to placebo (202 patients)
or telmisartan (171 patients).
The researchers found that patients with ED were
older, and had a higher prevalence of hypertension, stroke, diabetes and
lower urinary tract surgery than those without ED. Furthermore, 55
percent of the men had ED at entry in the trials.
Deaths from all causes occurred in 11.3 percent of
the patients who reported ED at baseline, but in only 5.6 percent of
those with no or mild ED at the start of the study. The composite
primary outcome of cardiovascular death, heart attack, stroke and heart
failure hospitalization occurred in 16.2 percent of ED patients compared
to 10.3 percent of patients with no or mild ED.
The risks of death from all causes and composite
outcome increased in a stepwise manner with the progression of ED,
“It is likely that the presence of ED identified individuals whose
cardiovascular disease might be far more advanced than when evaluated
with other clinical parameters alone,” Böhm said.
ED is closely associated with the endothelial
dysfunction that occurs in atherosclerosis and the vascular disturbances
such as the build-up of plaque that precedes events such as heart attack
and stroke, Böhm said.
“Men with ED going to a general practitioner or a
urologist need to be referred for a cardiology workup to determine
existing cardiovascular disease and proper treatment,” Böhm said. “ED is
an early predictor of cardiovascular disease.”
Many men with ED see a general practitioner or a
urologist to get medication for ED, he said.
“The medication works and the patient doesn’t show
up anymore,” Böhm said. “These men are being treated for the ED, but not
the underlying cardiovascular disease. A whole segment of men is being
placed at risk.”
Men need to consider ED as a risk factor for
cardiovascular disease just as high blood pressure and cholesterol are,
Böhm said. “If a man has erectile dysfunction, then he needs to ask his
physician to check for other risk factors of cardiovascular disease.”
Co-authors are: Magnus Baumhakel, M.D.; Koon Teo,
M.B., Ph.D.; Peter Sleight, M.D.; Jeffrey Probstfield, M.D.; Peggy Gao,
M.Sc.; Johannes F. Mann, M.D.; Rafael Diaz, M.D.; Gilles R. Dagenais,
M.D.; Garry L.R. Jennings, M.D.; Lisheng Liu, M.D.; Petr Jansky, M.D.
and Salim Yusuf, M.B., B.S. Author disclosures are on the manuscript.
Boehringer-Ingelheim, Germany funded the substudy.