Cardiovascular Mortality in Men with Erectile Dysfunction: Increased Risk But Not Inevitable

Abstract

Introduction It is unclear whether men with erectile dysfunction (ED) ultimately die of cardiovascular (CV) causes. Aim This study examined the causes of death in men with ED and their risk of CV death. Methods Based on statutory death registrations and hospital morbidity data, the risk of CV death in men with ED in a linked-data study was assessed against the CV mortality risk in a reference male population. Main Outcome Measures Deaths from CV causes as proportions of all deaths. Age-specific rate, mortality rate ratio (MRR), standardized mortality rate ratio (SMRR), and adjusted hazard ratio (HR). Results CV mortality was 4.0%. Compared with the reference population, the risk of CV death was higher in men with ED (SMRR 2.2; 95% confidence interval [CI] 1.6, 3.0). Risk of CV mortality was higher in men with CV disease prior to ED (adjusted HR 1.7; 95% CI 1.1, 2.6) or with history of hospital admissions for CV events (adjusted HR 2.2; 95% CI 1.3, 3.8), compared with those without the respective history. MRR was significantly increased in the 40–69 years age group (MRR 4.1; 95% CI 3.2, 5.2). The median time interval between manifestation of ED and CV death was 10.0 years. A greater proportion of deaths from oncological than from CV causes (25.0% vs. 10.8%) occurred within the first 5 years of the manifestation of ED. Conclusions Although the risk of CV mortality is greater in men with ED, almost as many men die of oncological as of CV causes, with a higher proportion of oncological deaths occurring sooner subsequent to the first manifestation of ED.

Profiling Characteristics of Men Who Use Phosphodiesterase Type 5 Inhibitors Based on Obtaining Patterns: Data from the Nationwide Japanese Population

“…According to the Princeton II guideline, it is an accepted concept that ED is an early symptom or harbinger of coronary artery disease, due to the common risk factors and pathophysiology mediated through endothelial dysfunction [18]. Therefore, prevention of cardiovascular events by the early identification of ED with subsequent treatment might lead to reduce cardiovascular disease mortality, which should be encouraged [19–21]. In Japan, the majority of HCPs prescribing PDE5i were initially urologists, however it has now shifted to plastic surgeons and psychosomatic medicine practitioners, who are not specialists in sexual medicine and are taking advantage of the ability to prescribe PDE5i quickly with minimal examination.…”

Basic Science Evidence for the Link Between Erectile Dysfunction and Cardiometabolic Dysfunction

“…Current biomedical advances in sexual medicine affirm its real pathophysiologic basis and support its strong links with clinical health and disease [7,8]. Moreover, beyond its multiple associations with health co‐morbidities, ED appears also to carry long‐term health risks and adversely impact survival [9–11].…”

Integrating disparate snippets of information in an approach to PSA testing in Australia and New Zealand

“…A simple patient‐reported index, a modified form of the Total Illness Burden Index modified for prostate cancer, has also shown good utility for predicting death in a large prostate cancer cohort and may have future relevance clinically. Recent evidence suggests that erectile dysfunction alone may prove to be a simple surrogate measure, with a large, recently published study from Western Australia reporting that the median time interval between the onset of erectile dysfunction and cardiovascular death was 10 years .…”