Erectile dysfunction a useful marker for cardiovascular risk in diabetics

Erectile dysfunction (ED) was associated with a range of cardiovascular events in men with type 2 diabetes, including an elevated risk of coronary heart disease and cerebrovascular disease.

In a cohort analysis of the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation) trial population, 6,304 men with type 2 diabetes ages 55 to 88 years were asked about ED and followed for five years through clinical exams and assessment of fatal and nonfatal cardiovascular outcomes, cognitive decline and dementia. Results appeared in the Nov. 22 issue of the Journal of the American College of Cardiology.

At baseline, half the men (3,158 of 6,304) reported ED. Men with ED had statistically significantly worse cardiovascular risk factors, morbidity and drug use because of the large sample size, although absolute differences were generally modest. Men with ED were older, heavier, had lower cognitive function, were more likely to have chronic ill health, and were less physically active. However, they were less likely to smoke, had lower total blood cholesterol, and had lower diastolic blood pressure.

During a mean of five years' follow-up, there were 695 deaths from any cause, 1,579 fatal and nonfatal cardiovascular events, 773 fatal and nonfatal coronary heart disease events, 411 fatal and nonfatal cerebrovascular disease events, 58 cases of dementia, and 1,013 cases of cognitive decline.

After adjustment for existing illness, psychological health and cardiovascular risk factors, baseline ED was associated with an elevated risk of all cardiovascular events (hazard ratio [HR] 1.19; 95% CI, 1.08 to 1.32), coronary heart disease (HR, 1.35; 95% CI, 1.16 to 1.56), and cerebrovascular disease (HR, 1.36; 95% CI, 1.11 to 1.67). Men with ED at baseline and at two-year follow-up had the highest risk for these outcomes.

Authors wrote that, while their study demonstrated an association between ED and cardiovascular outcomes, "[R]ather than having a direct, independent effect on CVD, it is more likely that erectile dysfunction is a marker of CVD risk."