Monday, January 14, 2013


A recent study, undertaken by the Greeks show that the presence of erectile dysfunction ( impotence, in the old days ) is a major coronary risk factor like hypertension, cigarette smoking and hyperlipidemia.
Dr Charalambos Vlachopoulos from the Athens Medical School, Athens, Greece, reported their findings in the 8th Jan issue of the Circulation : CV Quality and Outcomes. They reviewed the data ( so retrospective ) of 14 studies who studied ED and CV outcomes. The total number of patients involved was 92,000 and the mean follow-up was 6.1 years.
They found that the presence of erectile dysfunction increases the risk of MACE by 44%, the risk of heart attacks by 62%, risk of strokes by 39% and the risk of non-cardiac mortality by 25%. Looks like the presence of erectile dysfunction spells trouble, for males.

Relative risk for ED and clinical events

Outcome Relative risk (95% CI)
Cardiovascular events 1.44 (1.27-1.63)
Cardiovascular mortality 1.19 (0.97-1.46)
MI 1.62 (1.34-1.96)
Cerebrovascular events 1.39 (1.23-1.57)
All-cause mortality 1.25 (1.12-1.39)

I presume that their definition of erectile dysfunction was the standard " inability to maintain erection during a sexual act". This study actually supports many earlier study, example the one in JACC 2011 by the group from Suzhou, which showed essentially the same thing although of lesser magnitude.
Looks like if you have erectile dysfunction, you have to go for cardiac screening to know your risk of CAD and if possible, to modify it.  What I not so sure is whether this ED risk is modifiable? Obviously, if you have other major coronary risk factors like cigarette smoking or hypertension, or hyperlipidemia, diabetes, you should seek help and have a thorough cardiac checkup.
The other issue is that physicians must get into the routine of asking patients about their sexual history, as we would with hypertension and diabetes. I think at the moment, this is not routinely done. I am also somewhat shy to go there, and when I teach medical students, they also do not routinely ask. Maybe we should, more often, because, what Dr Charalambos and group is trying to do, is to lobby the European Cardiac Society to include ED as a major coronary risk factor.
Perhaps they are right. The day has come.

No comments: