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Wednesday 15th March, 2006


Erectile dysfunction may warn of significant coronary heart disease according to the Archives of Internal Medicine.


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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.

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 disease.

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

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