A study led by German researchers found that erectile dysfunction was a strong predictor of death from all causes as well as death from heart attack, stroke and heart failure in men with cardiovascular disease.
You can read about the findings in a paper published online before print on 15 March in the Circulation, a journal of the American Heart Association.
Lead author Dr Michael Böhm, chairman of internal medicine in the Department of Cardiology and Intensive Care at the University of Saarland, Germany, told the press that these findings mean:
“Erectile dysfunction is something that regularly should be addressed in the medical history of patients; it might be a symptom of early atherosclerosis.”
For the study, Böhm and colleagues examined questionnaire data on 1,519 men from 13 countries involved in a double-blind randomization substudy of the ONTARGET and TRANSCEND trials of cardiovascular patients. (Double blind means neither the patients nor the medical staff who administered them the drugs knew which drugs were the active ones and which were the placebos).
All the men had cardiovascular disease and they completed questionnaires when they joined the study, after two years, or after an average follow up of 5 years. The questionnaires included questions about erectile dysfunction that allowed the researchers to categorize the respondents as having mild, mild-to-moderate, moderate or severe erectile dysfunction.
In the ONTARGET trial, 400 of participants received the ACE inhibitor drug ramipril (brand name Altace in the US), 395 received telmisartan (Micardis), and 381 received a combination.
In the TRANSCEND trial 171 participants received telmisartan (Micardis) and 202 received placebo.
When they analyzed the results, the researchers found that men who had cardiovascular disease and erectile dysfunction (compared to men who had cardiovascular disease but did not have erectile dysfunction) were twice as likely to die from all causes and 1.6 times more likely to suffer the composite of cardiovascular death, heart attack, stroke and heart failure hospitalization.
More specifically, they were:
- 1.9 times more likely to die from cardiovascular disease.
- Twice as likely to have a heart attack.
- 1.2 times more likely to be hospitalized for heart failure, and
- 1.1 times more likely to have a stroke.
The researchers also found that though ACE inhibitors, angiotensin receptor blockers or a combination of the two were effective in reducing cardiovascular disease, they had no effect on either the course nor the development of erectile dysfunction.
At a more detailed level, the results showed that:
- 55 per cent of the men had erectile dysfunction when they started the trial.
- Men with erectile dysfunction were older and more likely to have high blood pressure, have suffered a stroke, have diabetes or have had lower urinary tract surgery than men without.
- Death from all causes occurred in 11.3 per cent of those who had erectile dysfunction at the start of the trial, compared to only 5.6 per cent of those with no or only mild dysfunction.
- The composite primary outcome of cardiovascular death, heart attack, stroke and heart failure hospitalization occurred in 16.2 per cent of the men with erectile dysfunction compared to 10.3 per cent of those with no or only mild dysfunction.
- The risk of death from all causes and composite outcome increased in step with progression of erectile dysfunction.
The researchers concluded that:
“ED [erectile dysfunction] is a potent predictor of all-cause death and the composite of cardiovascular death, myocardial infarction, stroke, and heart failure in men with cardiovascular disease. Trial treatment did not significantly improve or worsen ED.”
Böhm said it was likely that:
” The presence of ED identified individuals whose cardiovascular disease might be far more advanced than when evaluated with other clinical parameters alone.”
He explained that ED is closely linked to to the endothelial dysfunction that occurs in atherosclerosis and other vascular changes that lead up to heart attacks and strokes, such as the build up of plaque.
Emphasizing that this study shows ED to be an early potential predictor of cardiovascular disease, Böhm urged that:
“Men with ED going to a general practitioner or a urologist need to be referred for a cardiology workup to determine existing cardiovascular disease and proper treatment.”
He explained that many men with ED see their GP or a urologist and get medication for ED. The medication works and then they don’t come back.
“These men are being treated for the ED, but not the underlying cardiovascular disease. A whole segment of men is being placed at risk,” said Böhm.
The researchers suggest men should start viewing ED as a risk factor for cardiovascular disease, in the same way as they are already accustomed to regarding high blood pressure and cholesterol.
“If a man has erectile dysfunction, then he needs to ask his physician to check for other risk factors of cardiovascular disease,” urged Böhm.
“Erectile Dysfunction Predicts Cardiovascular Events in High-Risk Patients Receiving Telmisartan, Ramipril, or Both. The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (ONTARGET/TRANSCEND) Trials.”
Michael Böhm, Magnus Baumhäkel, Koon Teo, Peter Sleight, Jeffrey Probstfield, Peggy Gao, Johannes F. Mann, Rafael Diaz, Gilles R. Dagenais, Garry L.R. Jennings, Lisheng Liu, Petr Jansky, Salim Yusuf, and for the ONTARGET/TRANSCEND Erectile Dysfunction Substudy Investigators.
DOI:10.1161/CIRCULATIONAHA.109.864199
Source: AHA.
Written by: Catharine Paddock, PhD