From Our 2010 Archives
ED, Heart Disease May Be Deadly Duo
Men With ED and Cardiovascular Disease Have Higher Risk of Early Death, Study Finds
By Bill Hendrick
Reviewed by Laura J. Martin, MD
March 15, 2010 -- Erectile dysfunction is a major warning sign for cardiovascular disease and early death.
The finding comes from placebo-controlled studies comparing randomly selected men with ED and cardiovascular disease and men without ED.
The men with ED and cardiovascular disease were:
The researchers say they found that medications like ramipril, an angiotensin-converting enzyme ACE inhibitors used to treat high blood pressure and heart failure, can reduce cardiovascular events but don't seem to influence the course or development of ED.
"Erectile dysfunction is something that regularly should be addressed in the medical history of patients," Michael Bohm, MD, lead author of the study and chairman of internal medicine at the University of Saarland in Germany, says in a news release. "It might be a symptom of early atherosclerosis."
The study included 1,549 male cardiovascular patients in 13 countries. Each was asked if he had ED, and men who answered in the affirmative were then categorized as having mild, mild-to-moderate, moderate, or severe ED. The average follow-up was five years.
Patients in one trial involving 400 men were randomly assigned to take ramipril, telmisartan -- an angiotensin II receptor antagonist used to treat hypertension and heart failure -- or a combination.
In another, ACE inhibitor-intolerant patients were randomly assigned to take a placebo or telmisartan.
Patients with ED were older and had a higher prevalence of hypertension, stroke, diabetes, and lower urinary track surgery than men without ED. And 55% of men had ED when they entered the trials.
Researchers say deaths from all causes occurred in 11.3% of patients who had ED at the start, but in only 5.6% of people with no ED or only mild problems at baseline.
They report that 16.2% of ED patients died from cardiovascular problems, suffered heart attacks or strokes, or were hospitalized for heart failure. Only 10.3% of men with no or mild ED had similar outcomes.
As ED worsened, risk of death from all causes increased, suggesting that ED identifies men whose cardiovascular disease might be dangerously advanced.
Bohm says that ED is closely associated with conditions that occur in atherosclerosis and vascular problems, such as plaque buildup, which often precedes heart attacks and strokes.
"Men with ED going to a general practitioner or a urologist need to be referred for a cardiology workup to determine existing cardiovascular disease and proper treatment," Bohm says. "ED is an early predictor of cardiovascular disease."
Men with ED are often treated for impotence but not underlying cardiovascular disease, he says, thus placing "a whole segment of men" at increased risk of death.
Therefore, men and their doctors need to view ED as a risk factor, just as they do high blood pressure and cholesterol, he says.
The study is published in the March 15 issue of Circulation: Journal of the American Heart Association.