| Researchers also found
that men with erectile dysfunction have an 80 percent higher risk of
heart disease. "The highest risk for coronary
heart disease was in younger men," says researcher Jennifer St. Sauver,
Ph.D. The study was published in the February 2009 issue of Mayo Clinic
Proceedings. The results suggest that younger men and their doctors may
need to consider erectile dysfunction a harbinger of future risk of
coronary heart disease -- and take appropriate steps to prevent it, says
Dr. St. Sauver.
"The importance of the study cannot be overstated,"
writes Martin Miner, M.D., in an editorial in the same issue of Mayo
Clinic Proceedings . The results "raise the possibility of a 'window
of curability,' in which progression of cardiac disease might be slowed
or halted by medical intervention," writes Dr. Miner, who practices at
the Men's Health Center, Miriam Hospital, Providence, R.I.
Erectile dysfunction is common, and prevalence
increases with age. It affects 5 to 10 percent of men at age 40. By age
70, from 40 to 60 percent of men have the condition.
Dr. St. Sauver says researchers wanted to learn more
about the connections between age, cardiovascular disease and erectile
dysfunction. Two previous studies, both published in 2005, laid
groundwork for the Mayo Clinic study. One found that erectile
dysfunction predicted an increased risk of heart disease, but the
erectile dysfunction of the study participants was not assessed with an
externally validated questionnaire and cardiac events were not subjected
to standardized review for diagnostic accuracy [Thompson et al, JAMA
, 2005]. The second predicted that future cardiovascular disease
would be higher in younger men with erectile dysfunction, but wasn't
able to follow the men to determine if heart disease developed [Ponholzer
et al, Eur Urol , 2005].
For the Mayo Clinic study, the investigators
identified 1,402 men who lived in Olmsted County, Minn., in 1996 and did
not have heart disease. Every two years for 10 years, these men were
assessed for urological and sexual health.
Answers to questions from the Brief Male Sexual
Function Inventory, a statistically validated questionnaire, were used
to determine erectile dysfunction. The baseline prevalence of erectile
dysfunction in study participants was: 2.4 percent in men aged 40-49;
5.6 percent in men aged 50-59; 17 percent in men aged 60-69 and 38.8
percent in men 70 years and older. Those initial data and the increasing
incidence of erectile dysfunction over time were linked to data from a
long-term study of heart disease in Olmsted County residents, led by
Veronique Roger, M.D., Mayo Clinic cardiologist.
Over 10 years of follow-up, researchers found that men
with erectile dysfunction were 80 percent more likely to develop
coronary heart disease compared to men without erectile dysfunction. The
highest risk of new heart disease was seen in the youngest study
participants who had erectile dysfunction. In men 40 to 49 years old
when the study began, the number of new cases in men with erectile
dysfunction was more than 50-fold higher than in men without erectile
dysfunction. Statistically, that's a cumulative incidence of 48.52 per
1,000 person years in those with erectile dysfunction compared to 0.94
per 1,000 person years in those without erectile dysfunction).
In men in their 50s, 60s and 70s, the total incidence
of new cases of heart disease also was higher in those with erectile
dysfunction. However, the differences were not as striking as those seen
among the 40- to 49-year- olds.
"In older men, erectile dysfunction may be of less
prognostic importance for development of future heart disease," says Dr.
St. Sauver.
This study did not determine reasons for the increased
risk of heart disease among men with erectile dysfunction. Some have
theorized that erectile dysfunction and coronary artery disease may be
different manifestations of the same underlying disease process. A
buildup of plaque that can block arteries around the heart may plug the
smaller penile arteries first, causing erectile dysfunction.
Alternatively, arteries may lose elasticity over time, contributing to
heart disease. This arterial stiffening may affect the smaller penile
arteries first. |
