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CLINICAL RESEARCH: ATHEROSCLEROTIC RISK FACTORS

Heart disease risk factors predict erectile dysfunction 25 years later

The Rancho Bernardo Study

Maple M. Fung, MD^*, Richele Bettencourt, MS and Elizabeth Barrett-Connor, MD^,*

^* Department of Internal Medicine, University of California, San Diego, USA
Division of Epidemiology, Department of Family and Preventive Medicine, University of California San Diego, La Jolla, California, USA

Manuscript received July 17, 2003; revised manuscript received November 7, 2003, accepted November 20, 2003.

^* Reprint requests and correspondence: Dr. Elizabeth Barrett-Connor, Division of Epidemiology, Department of Family and Preventive Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093-0607, USA.
ebarrettconnor{at}ucsd.edu

OBJECTIVES: We examined whether common coronary heart disease (CHD) risk factors measured in mid-life predict erectile dysfunction (ED) 25 years later.

BACKGROUND: Retrospective and cross-sectional studies have suggested that ED is associated with classic CHD risk factors, but few prospective studies have studied these associations.

METHODS: In this prospective study of community-dwelling men age 30 to 69 years, seven classic CHD risk factors (age, smoking, hypertension, diabetes, hypercholesterolemia, hypertriglyceridemia, and obesity) were assessed from 1972 to 1974. In 1998, after an average follow-up of 25 years, surviving male participants were asked to complete the International Index of Erectile Function (IIEF-5), which allows stratification of ED into five groups.

RESULTS: Sixty-eight percent of the surviving men returned, and 60% completed the IIEF-5 questionnaire. Respondents had more favorable levels of all heart disease risk factors at baseline than non-respondents. At baseline, the average age of the 570 ED study participants was 46 years; at follow-up, their average age was 72 years. Mean age, body mass index, cholesterol, and triglycerides were each significantly associated with an increased risk of ED. Cigarette smoking was marginally more common in those with severe/complete ED, as compared with those without ED. Blood pressure and fasting blood glucose were not significantly associated with ED, likely due to selective mortality.

CONCLUSIONS: Improving CHD risk factors in mid-life may decrease the risk of ED as well as CHD. Erectile dysfunction should be included as an outcome in clinical trials of lipid-lowering agents and lifestyle modifications.

Abbreviations and Acronyms   BMI = body mass index   BP = blood pressure   CHD = coronary heart disease   CI = confidence interval   DBP = diastolic blood pressure   ED = erectile dysfunction   FPG = fasting plasma glucose   IIEF-5 = 5-item International Index of Erectile Function   MMAS = Massachusetts Male Aging Study   OR = odds ratio   SBP = systolic blood pressure

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