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Impotence predicts heart problems years early

Erectile dysfunction predicts cardiovascular events up to five years in advance and should be added to the risk factors assessed under the quality and outcomes framework, experts say.

A UK study of 372 men found two-thirds with cadiovascular disease had erectile dysfunction but only 53% had discussed the problem with their GP.

Only 37% of those with erectile dysfunction did not have any signs of coronary heart disease, reported the study published online by the International Journal of Clinical Practice.

Erectile dysfunction preceded a cardiovascular event by up to five years rather than the three-year window reported previously.

Professor Mike Kirby, professor of health and human sciences at the University of Hertfordshire and a GP in Radlett, said the cardiovascular risk of a man with erectile dysfunction was similar to that of a current smoker or someone with a family history of heart disease.

It was therefore ‘absolutely critical' GPs were warned early about erectile dysfunction so they had time to treat underly-ing cardiovascular risk factors.

Professor Kirby said: ‘There is between a three to five year opportunity to reduce their risk and prevent an event.'

Professor Kirby said GPs' reluctance to broach the subject was partly to blame.

Erectile dysfunction is identified as a marker of cardiovascular risk for patients with diabetes in the current Joint British Society guidelines.

But Professor Kirby wants to go further and has submit-ted a recommendation to the QOF review that routine enquiries about erectile function should be included as specific indicators in the diabetes and CVD domains.

However, he admitted the chances of its inclusion this time around were ‘very slim'.

Dr Terry McCormack, a GP in Whitby, North Yorshire and executive director of the Primary Care Cardiovascular Society, said, if the evidence was strong enough, ‘it should be part of routine follow-up for anybody who has hypertension or diabetes'.

But he pointed out the anomaly that GPs were not able to prescribe drug treatment for patients with erectile dysfunction unless they had prostate cancer or diabetes.

‘It's completely unfair that patients with erectile dysfunction should have to pay for their own medication,' he said.

Evidence builds for QOF inclusionEvidence builds for QOF inclusion Evidence builds for QOF inclusion

Erectile dysfunction is a marker of cardiovascular risk in patients with diabetes - Joint British Guidelines
Men with diabetes who have erectile dysfunction have a 10-year cardiovascular risk 5.5 percentage points higher than those not affected. - A Dutch study in 2006
All patients with erectile dysfunction should be ‘care-fully assessed for the presence of cardiovascular risk factors' - The US Princeton Consensus Conference in 2006

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