Increased Risk of Stroke Among Men with Erectile Dysfunction: A Nationwide Population-Based Study

Abstract

Introduction Previous cross-sectional studies have suggested that erectile dysfunction (ED) represents an independent risk factor for future cardiovascular events. However, very few studies have attempted to examine the association between ED and subsequent stroke. Aim The aim of this study is to estimate the risk of stroke during a 5-year follow-up period after the first ambulatory care visit for the treatment of ED using nationwide, population-based data and a retrospective case-control cohort design in Taiwan. Methods This study used data sourced from the “Longitudinal Health Insurance Database.” The study cohort comprised 1,501 patients who received a principal diagnosis of ED between 1997 and 2001 and 7,505 randomly selected subjects as the comparison cohort. Each patient (N = 9,006) was then individually tracked for 5 years from their index ambulatory care visit to identify those who had diagnosed episodes of stroke. Main Outcome Measure Stratified Cox proportional hazard regressions were performed as a means of comparing the 5-year stroke-free survival rate for the two cohorts. Results Of the sampled patients, 918 (10.2%) developed stroke within the 5-year follow-up period, that is, 188 individuals (12.5% of the patients with ED) from the study cohort and 730 individuals (9.7% of patients in the comparison cohort) from the comparison cohort. The log-rank test indicated that patients with ED had significantly lower 5-year stroke-free survival rates than those in the comparison cohort (P < 0.001). After adjusting for the patient’s monthly income, geographical location, hypertension, diabetes, coronary heart disease, peripheral vascular disease, atrial fibrillation, and hyperlipidemia, patients with ED were more likely to have a stroke during the 5-year follow-up period than patients in the comparison cohort (hazard ratio = 1.29, 95% confidence interval = 1.08 − 1.54, P < 0.01). Conclusions These results suggest that ED is a surrogate marker for future stroke in men.

The Role Erectile Dysfunction Plays in Cardiovascular Diseases

“…Thus lumen obstruction may lead to the development of ED prior to cardiac signs or stroke (22). Corroborating with this idea Lojanapiwat et al performed studies showing that patients who developed ED had endothelial dysfunction prior to the clinical symptoms.…”

“…More importantly, men with ED were more likely to have strokes than those without. In the others words, ED has been cited as a strong indicator of stroke, as well as a clinical marker for cerebrovascular diseases (22,(48)(49). Ponholzer et al , reported that 2,561 men with moderate to severe ED had an increased risk of stroke over 10 years (24.7% and 43.6%) (50).…”

“…In addition, Vicenzini et al suggested that cerebrovascular reactivity was reduced in patients with ED without other signs of clinical atherosclerosis (52). Finally Chung et al, suggested that men with ED have a significant increased risk for stroke 5 years after ED symptoms first began (22).…”

“…As a result, this condition is considered multifactorial and includes arterial, neurogenic, hormonal, cavernosal, iatrogenic, and psychogenic causes. However, it is now accepted that organic ED, in a substantial majority of men, is due to underlying vascular causes (22)(23). Endothelial dysfunction is thought to be the main etiologic factor in systemic and peripheral vascular diseases, including ED (24).…”

Erektions- und Ejakulationsstörungen

“…Die endotheliale Dysfunktion konnte als gemeinsamer pathophysiologischer Mechanismus bei kardiovaskulären Erkrankungen, sowie bei der ED ermittelt werden [6]. In mehreren Studien konnte ein klarer Zusammenhang zwischen der ED und kardiovaskulären Erkrankungen gesehen werden [7,8]. Oft ist die ED das erste klinische Zeichen , welches innerhalb 36 Monaten einen bevorstehenden Myokardinfarkt oder eine Angina pectoris voraussagt [9].…”