Population‐based study of erectile dysfunction and polypharmacy

Abstract

What ' s known on the subject? and What does the study add?It is known that medical conditions such as diabetes, high blood pressure, high cholesterol, smoking and prescribed medications cause erectile dysfunction (ED). This has been studied at the molecular level and reported in population studies. The present study shows that, after accounting for known medical problems, there is a doseresponse relationship, in which worsening degrees of ED are seen when a greater number of medications are taken, regardless if they are prescribed or over the counter.The study can help primary care doctors and urologists to make a differential diagnosis of ED and it can also help improve patient ' s erectile function by tailoring and curtailing current medication use to maximize therapeutic benefi t but minimize ED side effects in men, thus improving health-related quality of life. OBJECTIVE• To study the association between erectile dysfunction (ED) and polypharmacy use in a large, ethnically and racially diverse cohort of men enrolled in the California Men ' s Health Study (CMHS). PATIENTS AND METHODS• Men from the Kaiser Permanente Southern California (KPSC) health plan, enrolled in the CMHS in 2002, had an age range of 45 -69 years. ED and comorbidities of these subjects were identifi ed by questionnaire responses.• The number of drugs taken was determined from the year before enrollment through electronic pharmacy records and questionnaire responses. RESULTS• Among the 37 712 (KPSC) subjects, 10 717 (29%) reported moderate or severe ED.• Across all age groups, ED was more prevalent as the number of medications increased.• In men taking 0 -2, 3 -5,6 -9 and ≥ 10 medications, the percentage of men reporting moderate ED was 15.9, 19.7, 25.5 and 30.9%, respectively ( P < 0.001).• With adjustment for age, race, smoking, diabetes, hypertension, hyperlipidaemia, peripheral vascular disease, coronary artery disease and body mass index, men taking > 10 drugs were more likely to have ED (odds ratio = 2.32, 95% confi dence interval 2.14 -2.52) with evidence of a dose -response relationship. CONCLUSION• These data suggest that the number of medications a man takes is associated with worse ED, even after comorbidities have been taken into account. KEYWORDS

Is Erectile Dysfunction a Reliable Proxy of General Male Health Status? The Case for the International Index of Erectile Function—Erectile Function Domain

“…Moreover, we lacked data about the potential impact that drugs, either taken individually or together for various comorbid conditions, may eventually have on erectile functioning. Indeed, there are data suggesting that the number of medications a man takes is associated with worse ED even after comorbidities have been taken into account [6,38,39,52]. Similarly, our analyses did not take into consideration cigarette smoking and other recreational habits that had been already clearly associated with ED of various degrees of severity, with data also suggesting a potential interaction with the patient's medical history [46,48,53,54].…”

The global prevalence of erectile dysfunction: a review

“…The global prevalence of ED as assessed by the MMASderived self-assessment was 15.5-69.2% (Table 2 [12,[28][29][30][31][32][33][34][35][36]). The prevalence of ED by continent was: 22.0-57.8% [12,32,36], 15.5-55.2% [29][30][31]34,35], 17.2% [30], 60.69 [28], 22.4-69.2% [30,33], for North America, South America, Europe, Oceania and Asia, respectively. The prevalence of ED increased with increasing age where the study population was aged >40 years [29,[31][32][33][34].…”

“…Martins et al [29] studied a young (aged 18-40 years) population of men in Brazil and found a higher prevalence of ED amongst those aged 18-25 years (35.6%) compared to those aged 26-40 years (30.7%). The prevalence of ED was inversely associated with ED severity, 25.1-36.7%, 8.5-25.0%, 1.3-16.77% had mild, moderate, and severe ED, respectively [12,28,31,[33][34][35][36]. Derby et al [12] measured ED prevalence using both the IIEF and MMAS self-assessment methods.…”

Common prescription medication use and erectile dysfunction: results from the Boston Area Community Health (BACH) survey

“…Whether prescription medication use contributes to ED in addition to the effect of the illness itself remains controversial. Overall, an increase in the number of prescription medications has been associated with increased odds of ED . Results from the National Health and Nutrition Examination Survey (NHANES) and the Health Professionals Follow‐up Study (HPFS) suggest that AHT and antidepressant use may increase the risk of ED .…”