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Erectile Dysfunction Plus Heart Disease Raises Death Risk

Study confirms that impotence is a risk factor for heart trouble

MONDAY, March 15 (HealthDay News) -- Men suffering from both cardiovascular disease and erectile dysfunction are at greater risk for heart attack, stroke, heart failure and death, a new study finds.

Moreover, treatments for cardiovascular disease had no effect on erectile dysfunction, so the German researchers concluded that erectile dysfunction is an independent risk factor for cardiovascular disease.

"This is an important study that adds to a growing body of literature, which clearly demonstrates that erectile dysfunction is a potent risk factor for death and future cardiovascular events," said Dr. R. Parker Ward, an associate professor of medicine at the University of Chicago Medical Center. "Presence of erectile dysfunction is a potent risk factor for future heart disease independent of other risk factors or prior cardiovascular disease."

In fact, the researchers found that men with cardiovascular disease along with erectile dysfunction were 1.9 times more likely to die from cardiovascular disease, twice as likely to have a heart attack, 1.2 times more likely to be hospitalized for heart failure and 1.1 times more likely to have a stroke.

The report was released online March 15 in advance of publication in the March 30 print edition of Circulation.

For the study, a team led by Dr. Michael Bohm, chairman of internal medicine in the Department of Cardiology and Intensive Care at the University of Saarland in Germany, collected data on 1,519 men from around the world who took part in one of two heart disease trials: ONTARGET or TRANSCEND.

These men were classified as having mild, mild-to-moderate, moderate or severe erectile dysfunction. In addition, they were given questionnaires to complete at the start of each study and again about five years later. In both trials, in addition to cardiovascular disease, 55 percent of the men also had erectile dysfunction.

In the ONTARGET study, men were randomly selected to take blood pressure-lowering drugs -- either the ACE inhibitor ramipril (Altace) or the angiotensin II receptor antagonist telmisartan (Micardis) or a combination of both. In the TRANSCEND trial, ACE inhibitor-intolerant patients were treated with Micardis or a placebo.

The researchers found men suffering from erectile dysfunction were more likely to have high blood pressure, stroke, diabetes and lower urinary tract surgery, compared to men without erectile dysfunction.

Among those with erectile dysfunction, 11.3 percent died from any cause, compared with 5.6 percent of men with mild or no erectile dysfunction. In addition, 16.2 percent of the men with erectile dysfunction died from a cardiovascular problem, heart attack, stroke or were hospitalized for heart failure, compared with 10.3 percent of men with no or mild erectile dysfunction, the researchers reported.

Erectile dysfunction is linked to the endothelial dysfunction (problems with the cells that line the blood vessels) that occurs in atherosclerosis and the vascular disturbances such as the build-up of plaque that happens before heart attack and stroke, the study authors explained.

Men need to realize that erectile dysfunction is a risk factor for cardiovascular disease just as high blood pressure and cholesterol are, Bohm said in a statement: "If a man has erectile dysfunction, then he needs to ask his physician to check for other risk factors of cardiovascular disease."

This study provides further evidence that all physicians should include questions about erectile function as part of their office-based assessment of a patient's risk of future cardiovascular disease, Ward said.

"It is important that we make patients aware of implications of erectile dysfunction on their heart health so they freely discuss these sensitive issues with their physicians," he said. "While the best strategies to reduce this additional risk in patients with erectile dysfunction have not been proven, it is reasonable for physicians to intensify traditional strategies aimed at lowering cardiac risk in patients with erectile dysfunction."

Another expert, Dr. Gregg Fonarow, a professor of cardiovascular medicine at the University of California, Los Angeles, said that "erectile dysfunction is observed more frequently in men with cardiovascular risk factors and those with established cardiovascular disease, and recent studies have suggested men with erectile dysfunction may be at increased risk for heart attack and stroke."

He added that "erectile dysfunction may be an important indicator of more advanced atherosclerotic vascular disease and endothelial dysfunction."

More information

For more information on erectile dysfunction, visit the U.S. National Library of Medicine.

SOURCES: Gregg Fonarow, M.D., professor, cardiovascular medicine, University of California, Los Angeles; R. Parker Ward, M.D., associate professor, medicine, University of Chicago Medical Center; March 15, 2010, Circulation, online

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