Erectile dysfunction ( ED ) appears to be associated with cardiovascular and other chronic diseases and may predict severity and a poor prognosis among those with heart disease, according to three studies published in the Archives of Internal Medicine.

New medications for erectile dysfunction, introduced in 1998, prompted a 50 percent increase in physician visits related to the condition from 1996 to 2000.

Most previous estimates of the impact of erectile dysfunction have either excluded some men based on age, ethnicity or profession or were compiled before these medications became available.
This led the National Institutes of Health Consensus Development Panel on Impotence to call for national epidemiological data to provide information about prevalence and risk factors for erectile dysfunction.

Christopher S. Saigal, The David Geffen School of Medicine at UCLA, Los Angeles, and colleagues at the Urologic Diseases in America Project analyzed data from the 2001-2002 National Health and Nutrition Examinational Survey ( NHANES ).

A total of 2,126 men age 20 years and older responded to the survey, answered questions about sexual function and underwent a physical examination.
Men who said they were sometimes or never able to maintain an erection adequate for sexual intercourse were defined as having erectile dysfunction.

According to that definition, overall prevalence of erectile dysfunction was 18.4 percent, the authors report.
Erectile dysfunction occurred more often as men aged, affecting 6.5 percent of men aged 20 to 29 years and 77.5 of those aged 75 years and older.
When considering other factors that might contribute to ED, including age and other medical conditions, Hispanic men had almost twice the risk of erectile dysfunction as white men.
Obesity, hypertension, smoking and diabetes also were associated with risk of erectile dysfunction.

" Mitigation of these risk factors may ameliorate the burden of erectile dysfunction," the authors write.

In another study, researchers report that men with erectile dysfunction may have more severe cases of coronary heart disease and more risk factors for adverse outcomes than those without erectile dysfunction.

James K. Min, and colleagues at the University of Chicago Hospitals evaluated 221 men with an average age of 58.6 years who were referred for nuclear stress testing, a noninvasive diagnostic test for evolution of heart disease.
The researchers screened the men for erectile dysfunction and then compared their results on the tests.

Of the 221 men, 121 ( 54.8 percent ) reported erectile dysfunction.
Patients with erectile dysfunction were older than men without erectile dysfunction and more likely to have heart disease, diabetes and hypertension and have undergone previous procedures to restore blood flow to the heart.
They also were more likely to have results on the stress test that indicated they were at high cardiovascular risk, and more of them had already developed severe heart disease.

In patients referred for stress testing, " the presence of erectile dysfunction is common and is a strong predictor of clinically significant coronary heart disease and established markers of an adverse cardiovascular prognosis" as indicated by the tests, the authors write. " Erectile dysfunction is a stronger predictor than traditional coronary heart disease risk factors in this population," they conclude. " Sexual function questioning may be useful to stratify risk in patients suspected to have coronary heart disease. Further studies are needed to establish whether patients with erectile dysfunction but no cardiac symptoms should be screened for overt coronary heart disease."

A third study of Canadian men visiting primary care physicians indicates that about half of them report having erectile dysfunction, and that it is linked with cardiovascular disease, diabetes, future heart disease risk and increased fasting blood sugar levels.

Steven A. Grover, Montreal General Hospital and McGill University, Montreal, Quebec, and colleagues surveyed 3,921 men aged 40 to 88 years who visited one of 75 primary care physicians between July 20, 2001, and Nov. 13, 2002.
Participants gave medical histories and received physical examinations, including measurements of fasting blood sugar and lipid levels.

Almost half ( 49.4 percent ) of the men reported erectile dysfunction during the previous four weeks or were taking medication for erectile dysfunction, the authors report.
Men with cardiovascular disease and diabetes were most likely to have erectile dysfunction.
Among men without cardiovascular disease or diabetes, the calculated future risk of developing these conditions was linked to likelihood of having erectile dysfunction. " These data demonstrate that primary care physicians may find that taking a sexual history provides important clinical information beyond the detection of erectile dysfunction," the authors conclude.

Source: American Medical Association, 2006


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