ED's strong link to CVD doesn't add predictive value over Framingham

Although erectile dysfunction is strongly associated with later cardiovascular disease, it's no better a predictor than Framingham risk scores. But its no-cost, low-risk nature makes it an important assessment tool for physicians, researchers concluded.

Both conditions share pathophysiologic mechanisms and are often present together. Men with erectile dysfunction (ED) have a 40% higher risk of developing cardiovascular disease (CVD) than those without. The risk of CVD associated with ED is the same as smoking, hypertension or a family history of myocardial infarction. To determine whether ED predicted CVD beyond such traditional risk factors, researchers conducted a prospective, population-based study of 1,709 men ages 40 to 70. Subjects were followed for CVD for an average follow-up of 11.7 years. Researchers reported results in the Journal of the American College of Cardiology.

Researchers drew reports from the Massachusetts Male Aging Study (MMAS), a prospective, observational cohort study of aging, health, and endocrine and sexual function in a random sample of men. A total of 1,709 respondents completed the baseline protocol from 1987 to 1989 and were seen again twice, from 1995 to 1997 (n=1,156, 77% response rate) and from 2002 to 2004 (n=853, 65% response rate).

ED was assessed by a 23-item questionnaire completed in private and returned in a sealed envelope. Data on CVD were obtained from self reports, comparisons of MMAS data with the National Death Index, and medical records. CVD was based on self-reports of major end points such as myocardial infarction, atherosclerosis, stroke, coronary artery bypass graft surgery or congestive heart failure.

Researchers included 1,057 men with complete risk factor data who were free of CVD and diabetes at baseline. During follow-up, 261 new cases of CVD occurred. ED was associated with CVD incidence controlling for age (hazard ratio [HR], 1.42; 95% CI, 1.05 to 1.90), age and traditional CVD risk factors (HR, 1.41; CI, 1.05 to 1.90) and age and Framingham risk score (HR, 1.40; CI, 1.04 to 1.88).

Despite these significant findings, ED did not significantly improve prediction beyond traditional risk factors. Researchers wrote this was not surprising because of the strength of the association between traditional risk factors and CVD, the magnitude of the hazard ratio associated with ED, and the numerous studies showing that the factors that comprise the Framingham risk score are also associated with ED.

"Nonetheless," researchers wrote, "any reclassification would be useful clinically given that the assessment of ED is associated with little cost and no risks."