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CARDIOVASCULAR RISK

Does Erectile Dysfunction Contribute to Cardiovascular Disease Risk Prediction Beyond the Framingham Risk Score?

Andre B. Araujo, PhD^_*,_*, Susan A. Hall, PhD^_*, Peter Ganz, MD, Gretchen R. Chiu, MS^_*, Raymond C. Rosen, PhD^_*, Varant Kupelian, PhD^_*, Thomas G. Travison, PhD^_* and John B. McKinlay, PhD^_*

^_* New England Research Institutes, Watertown, Massachusetts
Division of Cardiology, San Francisco General Hospital, University of California–San Francisco, San Francisco, California

Manuscript received May 22, 2009; revised manuscript received August 26, 2009, accepted August 30, 2009.

^_* Reprint requests and correspondence: Dr. Andre B. Araujo, New England Research Institutes, 9 Galen Street, Watertown, Massachusetts 02472 (Email: aaraujo{at}neriscience.com).

Objectives: This study was designed to determine whether erectile dysfunction (ED) predicts cardiovascular disease (CVD) beyond traditional risk factors.

Background: Both ED and CVD share pathophysiological mechanisms and often co-occur. It is unknown whether ED improves the prediction of CVD beyond traditional risk factors.

Methods: This was a prospective, population-based study of 1,709 men (of 3,258 eligible) age 40 to 70 years. The ED data were measured by self-report. Subjects were followed for CVD for an average follow-up of 11.7 years. The association between ED and CVD was examined using the Cox proportional hazards regression model. The discriminatory capability of ED was examined using C statistics. The reclassification of CVD risk associated with ED was assessed using a method that quantifies net reclassification improvement.

Results: Of the prospective population, 1,057 men with complete risk factor data who were free of CVD and diabetes at baseline were included. During follow-up, 261 new cases of CVD occurred. We found ED was associated with CVD incidence controlling for age (hazard ratio [HR]: 1.42, 95% confidence interval [CI]: 1.05 to 1.90), age and traditional CVD risk factors (HR: 1.41, 95% CI: 1.05 to 1.90), as well as age and Framingham risk score (HR: 1.40, 95% CI: 1.04 to 1.88). Despite these significant findings, ED did not significantly improve the prediction of CVD incidence beyond traditional risk factors.

Conclusions: Independent of established CVD risk factors, ED is significantly associated with increased CVD incidence. Nonetheless, ED does not improve the prediction of who will and will not develop CVD beyond that offered by traditional risk factors.

Key Words: aging • erectile dysfunction • cardiovascular disease • longitudinal studies • men

Abbreviations and Acronyms   CHD = coronary heart disease   CI = confidence interval   CVD = cardiovascular disease   ED = erectile dysfunction   HDL-C = high-density lipoprotein cholesterol   HR = hazard ratio   ICD = International Classification of Diseases   NDI = National Death Index

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J. Am. Coll. Cardiol. 2010 55: A35-A33. [Full Text] [PDF]