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Erectile Dysfunction Strong Predictor of Death, Cardiovascular Outcomes DALLAS -- March 16, 2010 -- Erectile dysfunction (ED) is a strong predictor of death from all causes and of myocardial infarction (MI), stroke, and heart failure in men with cardiovascular disease (CVD), according to a study reported in Circulation: Journal of the American Heart Association. In the first study to show that ED is predictive of death and cardiovascular outcomes, researchers found that men with CVD and ED (compared with those without ED) were twice as likely to suffer death from all causes and 1.6 times more likely to suffer the composite of cardiovascular death, MI, stroke and heart failure hospitalisation. More specifically, they were: · 1.9 times more likely to die from cardiovascular disease; · twice as likely to have a MI; · 1.2 times more likely to be hospitalised for heart failure; and · 1.1 times more likely to have a stroke. The researchers also found that, though angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers or a combination of the 2, can reduce cardiovascular events in high-risk patients, the medications didn’t influence the course nor the development of ED. “Erectile dysfunction is something that regularly should be addressed in the medical history of patients; it might be a symptom of early atherosclerosis,” said lead author Michael Böhm, MD, Department of Cardiology and Intensive Care, University of Saarland, Saarland, Germany. The worldwide study included 1,519 men from 13 countries in a substudy of the ONTARGET and TRANSCEND trials of cardiovascular patients. The men answered a questionnaire to determine whether they had ED. Men with ED were then categorised as having mild, mild-to-moderate, moderate or severe ED. The questionnaires were given at the initial visit, after 2 years or at the final visit after an average follow-up of 5 years. ONTARGET patients were either randomly assigned to the ACE inhibitor drug ramipril (n = 400), telmisartan (n = 395) or a combination (n = 381). In TRANSCEND, researchers randomised ACE inhibitor-intolerant patients to placebo (n = 202) or telmisartan (n = 171). The researchers found that patients with ED were older, and had a higher prevalence of hypertension, stroke, diabetes, and lower urinary tract surgery than those without ED. Furthermore, 55% of the men had ED at entry in the trials. Deaths from all causes occurred in 11.3% of the patients who reported ED at baseline, but in only 5.6% of those with no or mild ED at the start of the study. The composite primary outcome of cardiovascular death, MI, stroke, and heart failure hospitalisation occurred in 16.2% of ED patients compared with 10.3% of patients with no or mild ED. The risks of death from all causes and composite outcome increased in a stepwise manner with the progression of ED, researchers said. “It is likely that the presence of ED identified individuals whose cardiovascular disease might be far more advanced than when evaluated with other clinical parameters alone,” Böhm said. ED is closely associated with the endothelial dysfunction that occurs in atherosclerosis and the vascular disturbances such as the build-up of plaque that precedes events such as MI and stroke, Böhm said. “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,” Böhm said. “ED is an early predictor of cardiovascular disease.” SOURCE: American Heart Association E-mail this page to a friend or colleague! To print, use this version