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Wednesday 15th March, 2006
Erectile dysfunction may warn of significant coronary heart
disease according to the Archives of Internal Medicine.
Erectile dysfunction (ED) affects approximately one in five American
men, 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 in the January 23 issue of
Archives of Internal Medicine, one of the JAMA/Archives journals.
New medications for ED, introduced in 1998, prompted a 50 percent
increase in physician visits related to the condition from 1996 to 2000,
according to background information in one of the articles. Most
previous estimates of the impact of ED 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 ED, the authors write.
Christopher S. Saigal, M.D., M.P.H., 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 ED.
According to that definition, overall prevalence of ED was 18.4
percent, the authors report. ED 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 ED as white men. Obesity, hypertension, smoking
and diabetes also were associated with risk of ED. "Mitigation of these
risk factors may ameliorate the burden of ED," the authors write.
Editor's Note: This study was supported in part by the National
Institute of Diabetes & Digestive & Kidney Diseases, Bethesda, Md. Drs.
Wessells and Saigal have received grant funding from the National
Institute of Diabetes & Digestive & Kidney Diseases. Dr. Wessells is a
speaker for Pfizer.
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Severe Heart Disease, Poor Prognosis Linked to ED
In another study, researchers report that men with ED may have more
severe cases of coronary heart disease and more risk factors for adverse
outcomes than those without ED.
James K. Min, M.D., 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 ED and
then compared their results on the tests.
Of the 221 men, 121 (54.8 percent) reported ED. Patients with ED were
older than men without ED 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
In patients referred for stress testing, "the presence of ED 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 ED but no cardiac symptoms should be
screened for overt coronary heart disease."
Editor's Note: This study was supported in part by an unrestricted
independent medical grant from Pfizer Pharmaceuticals, New York.
ED Common in Primary Care Patients
A third study of Canadian men visiting primary care physicians
indicates that about half of them report having ED, and that it is
linked with cardiovascular disease, diabetes, future heart disease risk
and increased fasting blood sugar levels.
"Primary care physicians are uniquely positioned to inquire about a
patient's sexual function during a routine office visit," the authors
write. "They can also screen for modifiable risk factors and treatable
comorbidities. However, there is little information available regarding
the prevalence of ED among patients seen in this clinical setting."
Steven A. Grover, M.D., M.P.A., F.R.C.P.C., 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 ED during the previous
four weeks or were taking medication for ED, the authors report. Men
with cardiovascular disease and diabetes were most likely to have ED.
Among men without cardiovascular disease or diabetes, the calculated
future risk of developing these conditions was linked to likelihood of
having ED. "These data demonstrate that primary care physicians may find
that taking a sexual history provides important clinical information
beyond the detection of ED," the authors conclude.
Arch Intern Med. 2006; 166:201-206
Arch Intern Med. 2006; 166:207-212
Arch Intern Med. 2006; 166:213-219