Should erectile dysfunction be considered as a marker for acute myocardial infarction? Results from a retrospective cohort study

Abstract

The association between erectile dysfunction (ED) and acute myocardial infarction (AMI) among men was examined in the Integrated Healthcare Information Services National Managed Care Benchmark Database (IHCIS). The IHCIS is a fully de-identified, HIPAA-compliant database and includes complete medical history for more than 17 million managed care lives; data from more than 30 US health plans, covering seven census regions; and patient demographics, including morbidity, age and gender. A total of 12 825 ED patients and an equal number of male patients without ED were included in the retrospective cohort study. Logistic regression analyses were performed to assess the adjusted risk of AMI that accounted for age at ED diagnosis, smoking, obesity and medications including ACE inhibitors, beta blockers and statins. The cohort of men with ED were observed to have a two-fold increase in the risk for AMI (OR ¼ 1.99, 95% CI ¼ 1.17, 3.38) after adjusting for age at ED diagnosis, smoking, obesity, and use of ACE inhibitors, beta blockers and statins. Some evidence of a possible trend toward increased risk was detected by age group. After controlling for the aforementioned covariates and compared to men 30-39 y of age, it was noted that patients 40-44 y of age were 3.8 times more likely to develop an AMI (OR ¼ 3.76, 95% CI ¼ 1.21, 11.7), 45-to 49-y-old men were also more than three times as likely to have an AMI (OR ¼ 3.14, 95% CI ¼ 1.03, 9.64), and 50-to 55-y-old patients had a four-fold increased risk of developing AMI (OR ¼ 4.04, 95% CI ¼ 1.39, 11.7). The risk becomes more pronounced with increasing age, indicating the need for cardiologists and internists to monitor ED patients who may not necessarily present with cardiovascular symptoms.

The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease

“…6 • ED not only shares risk factors with CVD 7,8 but also is, in itself, an independent marker of increased risk for CVD (ACCF/AHA class Ia). [9][10][11][12][13][14][15] • ED is a marker of significantly increased risk of CVD, coronary artery disease (CAD), stroke, and all-cause mortality.…”

Obesity and sexual dysfunction, male and female

“…24 According to a raising popular view, subjects with ED seem to have a vascular mechanism similar to that seen in atherosclerosis 25 and therefore a diagnosis of ED may be seen as a sentinel event that should prompt investigation for coronary heart disease in asymptomatic men. 26 We evaluated associations between erectile function, endothelial function and markers of systemic vascular inflammation in 80 obese men, aged 35-55 years, divided into two equal groups according to the presence/absence of ED. 27 Compared with nonobese age-matched men, obese men had impaired indices of endothelial function and higher circulating concentrations of the proinflammatory cytokines interleukin-6, interleukin-8, interleukin-18, as well as C-reactive protein (CRP).…”

Prevalence and cardiovascular disease risk differences for erectile dysfunction patients by three metabolic syndrome definitions

“…In addition, a strong and independent correlation between ED and silent CAD had been reported in uncomplicated type 2 diabetic patients by Gazzaruso et al 4 The authors found a higher ED prevalence in uncomplicated type 2 diabetic patients with, than those without, silent myocardial ischemia (33.8 vs 4.7%, P ¼ 0.000). Blumentals et al 5 reported that men with ED had a twofold increase in risk for acute myocardial infarction after correcting for risk factors and medications. Our previous study results also showed independent determinants, including many traditional cardiovascular risk factors and markers of vascular wall and ventricular function, of CAD in ED outpatients.…”