Coronary Heart Disease and Erectile Dysfunction

Coronary heart disease (CHD) is a common condition associated with a high mortality. There is now growing evidence that erectile dysfunction (ED) in men may be a suitable marker of sub-clinical cardiovascular disease, identifying patients at high risk for future CHD. We investigated the association between CHD risk factors and ED during a period of 25 years, in a population based cohort of men, aged 58-78 at follow-up. Risk factors were assessed at baseline and at study-end, and analyses were made in relation to ED prevalence at study end. ED evaluation was by the validated IIEF-5 questionnaire. We also examined if coronary endothelial and smooth muscle cell function was impaired, expressed as reduced coronary flow velocity reserve (CFVR), in otherwise healthy men with ED. CFVR in men with ED was compared to age-matched healthy controls and to men with diabetes or impaired fasting glucose. The results showed that: Men with ED had a reduced CFVR, independently of other risk factors for CHD. The magnitude of the CFVR reduction was similar in men with ED, as compared to men with diabetes or impaired fasting glucose. A number of classical CHD risk factors, identified at the baseline examination 25 years earlier, were associated with increased risk of ED. During the follow-up period, men with ED at study-end had a greater increase in fasting glucose levels, and were more likely to have developed the metabolic syndrome or diabetes, compared to men without ED. At study-end, several CHD risk factors including diabetes, low physical activity and low self rated health, were independently associated with ED. Furthermore, men with ED were more likely to be on antihypertensive and cholesterol-lowering medications at study-end. Our studies support the close epidemiological and pathophysiological links between ED and CHD. Men presenting with ED should be carefully evaluated for risk factors regarding CHD. Primary prevention can then be instituted, with modification of CHD risk factors, thus reducing future cardiovascular risk and in some cases simultaneously resulting in improvement of erectile function