Estimate CV risk even in patients with mild erectile dysfunction, GPs told
Men with mild or moderate erectile dysfunction should have their cardiovascular risk assessed, say researchers after conducting the largest trial to date looking at the issue.
Australian researchers conducted a cohort study, recruiting 95,038 participants via posted questionnaires between 2006 to 2009. The questionnaires sent to men included a question on erectile dysfunction, asking ‘How often are you able to get and keep an erection that is firm enough for satisfactory sexual activity?’ Possible responses included ‘always’, ‘usually’, ‘sometimes’ and ‘never’, with each corresponding to a definition of erectile dysfunction as none, mild, moderate and severe, respectively. This questionnaire data was then matched with hospital admission data up until December 2010.
Severe erectile dysfunction was associated with a significant 60% increase in risk of ischaemic heart disease, with moderate erectile dysfunction associated with a significant 37% increase, when both were compared to men without erectile dysfunction. Mild, moderate and severe erectile dysfunction were all linked with a significantly increased risk of heart failure, at eight-fold for the latter, and more than five-fold for mild and moderate, when compared to men without erectile dysfunction.
What does it mean for GPs?
The authors concluded that the findings ‘highlight the need to consider erectile dysfunction in relation to the risk of a wide range of cardiovascular diseases that extends beyond ischaemic heart disease and stroke.’ They added that men with ‘mild and moderate erectile dysfunction should be considered at increased risk, in addition to those with severe disease.’
Dr Geoff Hackett, GP and consultant in sexual medicine, Birmingham: ‘These findings are in line with every other study, which is reassuring. It’s generally thought there’s around a 50% increase in the risk of myocardial infarction, and this paper is in line with that. But we have to ask why this message is not getting through. Erectile dysfunction is a better predictive indicator for cardiovascular risk than chest pain or shortness of breath in the male population aged in their early 40s, and you wouldn’t ignore symptoms chest pain or shortness of breath if they presented in a patient. It should act as a prompt for further investigation for cardiovascular disease because these events are preventable.’
PLOS One 2013, available online 29 January http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001372