More than 10 million men in the United States are affected by erectile dysfunction (ED), with an estimated 100 million men affected worldwide, according to background information in the article. The risk of erectile dysfunction is related to many factors, including age, smoking, diabetes, heart disease, depression, and hypertension. Because cardiovascular disease and erectile dysfunction share etiologies as well as pathophysiology (endothelial dysfunction) and because of evidence that degree of erectile dysfunction correlates with severity of cardiovascular disease, it has been postulated that erectile dysfunction is a sentinel symptom in patients with cardiovascular disease.
Ian M. Thompson, M.D., of the University of Texas Health Science Center at San Antonio, and colleagues studied a group of men who were assessed for ED and subsequent cardiovascular disease over the course of 7 years. The study included men aged 55 years or older who were randomized to the placebo group (n = 9,457) in the Prostate Cancer Prevention Trial at 221 U.S. centers. Participants were evaluated every 3 months for cardiovascular disease and erectile dysfunction between 1994 and 2003. In analysis, factors at study entry taken into account included age, body mass index, blood pressure, serum lipids, diabetes, family history of heart attack, race, smoking history, current use of antihypertensive medication, physical activity, and quality of life.
Of the 9,457 men randomized to placebo, 8,063 (85 percent) had no cardiovascular disease at study entry; of these men, 3,816 (47 percent) had erectile dysfunction at study entry. Among the 4,247 men without erectile dysfunction at study entry, 2,420 men (57 percent) reported incident erectile dysfunction after 5 years. After adjustment, incident
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