GPs should regard erectile dysfunction as an independent cardiovascular risk factor and treat even low-risk men aggressively, say the authors of a new cost-effectiveness analysis.
The researchers found treating older men with a statin was highly cost effective, even if they were at low coronary risk.
The UK study adds to the evidence base for routinely treating the cardiovascular risks of men with erectile dysfunction, and is under consideration for inclusion in national guidelines.
Erectile dysfunction is currently recognised as a marker for underlying vascular disease, and was included, for the first time this year, in the Joint European Cardiology Society guidelines on preventing cardiovascular disease.
But the authors of the study – published in BJU International this month – study say this does not go far enough to address the cardiovascular risks of men who may not currently be eligible for statin treatment.
The general practice-based study of 173 men with untreated erectile dysfunction specifically looked at those at low cardiovascular risk, who were not on any antihypertensive or lipid-lowering treatment
Those aged 55 to 65 years had a mean predicted 10-year cardiovascular risks of 12%, and those aged 65 years or older had a 10-year risk of 23%. Simvastatin 40mg treatment reduced these risks by 10% and 15%, respectively over six months.
An analysis of costs and QALY benefits showed such a strategy was likely to be highly cost effective – with the probability of treatment being cost effective for willingness to pay thresholds of £20,000 to £30,000 86% and 83%, respectively.
The study also showed a significant improvement in sexual health-related quality of life, but no difference in erectile dysfunction.
Study leader Professor Mike Kirby, professor of health and human sciences at the University of Hertfordshire, said erectile dysfunction was being considered for inclusion as a risk factor in the upcoming JBS3 guidelines.
He recommended: ‘GPs should routinely ask men about erectile dysfunction and treat those who have it as potential cardiac patients for the future and manage their cardiac risk factors aggressively – that means doing lipid tests, HbA1C and blood pressure.’
He added that questions about erectile dysfunction should be included in the Government’s NHS Health Check programme.
He said: ‘It is very cost-effective and we found those who were most severe got the most benefit.’
The research team are now planning another trial looking at high-dose atorvastatin and extending the six-month study period to better assess the impact on the condition itself.
Professor Kirby said: ‘Patients are embarrassed to mention it and in another study we found 66% of men who had a heart attack had suffered from erectile dysfunction but not told anyone. There are missed opportunities here.’
Dr Terry McCormack, a GP in Whitby, North Yorkshire, and cardiovascular lead in North Yorkshire, said there was a clear correlation between erectile dysfunction and coronary risk and GPs should not wait for men to come forward but ask them proactively.
He said: ‘In anyone with erectile dysfunction, the tests you need to be doing are testosterone and cholesterol. That is far more important than doing something like a PSA test.’
He added that health professionals and nurses had not really taken on board how important erectile dysfunction was as a marker of cardiovascular risk.
Statins in ED
Men aged 55 to 65 years
Mean predicted 10-year cardiovascular risk – 12%, and those aged
Reduction in risk with simvastatin 40mg – 10%
Men aged 65 years or older
Mean predicted 10-year cardiovascular risk – 23%.
Reduction in risk with simvastatin 40mg – 15%
Source: BJU International 2012, online 11 Jun