Erectile dysfunction (ED) is a risk marker for cardiovascular disease (CVD), a large prospective population-based study from Australia has found.

The 45 and Up Study linked data derived from postal surveys, carried out between 2006 and 2009, with hospitalisation and death data, up to June and December 2010, respectively, on 95,038 men in this age group.

The aim of this part of the study was to examine the relationship between the severity of ED and CVD-related hospital admission or all cause mortality.

The authors found that ED increased in prevalence with age. The rate of severe ED was:

• 2.2% age 45-54

• 6.8% age 55-64

• 20.2% age 65-74

• 50% age 75-84

• 75.4% age ≥ 85 years

There were 7,855 admissions for CVD and 2,304 deaths during the follow-up period.

The risk of CVD and death increased steadily with increasing severity of ED. Men were divided into two groups, with and without a previous record of CVD. In those without previous CVD, those with severe versus no ED had increased risks of: ischaemic heart disease risk ratio (RR) 1.60, heart failure RR 8.0, peripheral vascular disease RR 1.92, and all cause mortality RR 1.93. RRs for men with previous CVD were 1.70, 4.40, 2.46, and 2.37, respectively (see table 1).

This is a large study and adds further weight to the argument that all men presenting with ED should be considered as high risk for CVD unless proved otherwise.

ED can be considered as a form of ‘penile angina’ with atherosclerosis affecting the small penile arteries typically a few years before larger coronary arteries are affected.

The authors state clearly that ED is not a cause of CVD but is a risk marker serving as an indicator of underlying common pathophysiological processes such as atherosclerosis and endothelial dysfunction.

While the risk of CVD increases with ED severity it is clear that even those men with mild or moderate ED are at significantly increased risk and should undergo full cardiovascular risk assessment using risk scores.

Dr Jonathan Rees