Introduction: Erectile dysfunction (ED) and cardiovascular disease share similar risk profiles which include: aging, hypertension, diabetes, smoking, obesity, and dyslipidemia. Previous literature has suggested ED as a potential harbinger of future cardiovascular disease. As such, we sought to investigate the association between ED and major adverse cardiovascular events (MACE) using a large population based database.
Methods: A propensity-weighted, retrospective cohort study was conducted by accessing provincial health administrative databases. Eligibility criteria included men 18 years and older, with no prior ED or MACE, who had at least 1 year of provincial health coverage from their index date between April 1st, 1995 to December 31st, 2018. ED was defined as having at least two ED prescriptions filled within one year (including oral, intraurethral, and/or injection therapies). MACE was defined as myocardial infarction, coronary revascularization procedures, ischemic stroke, or hospitalizations for heart failure. Controls were assigned a pseudo-index date at random based on the frequency distribution of index dates in the study group. Logistic regression model that included age, socioeconomic status, index year, diabetes, hypertension, dyslipidemia and renal disease was used to determine the propensity score. Stabilized inverse propensity treatment weighting was then applied to the propensity score. A cox proportional hazard model was used to examine our primary outcome of time to a MACE.
Results: Among 50,291 men with ED and 379,518 controls, men with ED had an 81% higher risk of a MACE (Hazard Ratio 1.81, 1.76 – 1.87) in unweighted and 24% higher risk (Hazard Ratio 1.24, 1.20 – 1.29) in weighted analyses. The median time to a MACE was 2888 and 2668 days in the study and control cohort, respectfully. The proportion of individuals with a MACE was 9.1% and 4.9% in men with ED and controls, respectfully.
Conclusions: Our study demonstrates that men diagnosed with ED had a higher risk of MACE as compared to controls. ED is demonstrated to be an independent risk factor for MACE when controlling for comorbidities. It is imperative for health care professionals who manage patients with ED to discuss the risk of future cardiovascular disease and identify comorbid conditions to mitigate risk.
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