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Erectile dysfunction and risk of cardiovascular and all-cause mortality in the general population: a meta-analysis of cohort studies

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Abstract

Purpose

Studies on the association of erectile dysfunction (ED) with cardiovascular or all-cause mortality have yielded conflicting findings. We conducted this meta-analysis to evaluate the association of ED with cardiovascular or all-cause mortality in the general population.

Methods

Pubmed and Embase databases were searched for prospective studies that evaluated the association of ED with cardiovascular or all-cause mortality in the general population up to 15 December, 2017. The overall combined risk ratio (RR) and 95% confidence intervals (CI) were pooled for the men with or without ED.

Results

A total of 7 studies involving 111,440 participants were included in the meta-analysis. When compared to the men with or without ED, the overall pooled RR was 1.24 (95% CI 1.11–1.39) for all-cause mortality and 1.11 (95% CI 0.92–1.35) for cardiovascular mortality. Subgroup analyses indicated that only men with severe ED significantly increased all-cause mortality risk (RR 1.58; 95% CI 1.37–1.82), but not in the mild (RR 1.07; 95% CI 0.93–1.24) ED and the moderate (RR 1.16; 95% CI 1.00–1.35) ED.

Conclusions

This meta-analysis suggests that severe ED is significantly associated with increased all-cause mortality in the general population. However, the association of ED with cardiovascular mortality should be further investigated.

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References

  1. Lewis RW, Fugl-Meyer KS, Corona G, Hayes RD, Laumann EO, Moreira ED Jr, Rellini AH, Segraves T (2010) Definitions/epidemiology/risk factors for sexual dysfunction. J Sex Med 7(4 Pt 2):1598–1607

    Article  Google Scholar 

  2. Shamloul R, Ghanem H (2013) Erectile dysfunction. Lancet 381(9861):153–165

    Article  CAS  Google Scholar 

  3. Pastuszak AW, Hyman DA, Yadav N, Godoy G, Lipshultz LI, Araujo AB, Khera M (2015) Erectile dysfunction as a marker for cardiovascular disease diagnosis and intervention: a cost analysis. J Sex Med 12(4):975–984

    Article  Google Scholar 

  4. Wang W, Fan J, Huang G, Zhu X, Tian Y, Tan H, Su L (2017) Meta-analysis of prevalence of erectile dysfunction in mainland china: evidence based on epidemiological surveys. Sex Med 5(1):e19–e30

    Article  Google Scholar 

  5. Eardley I (2013) The incidence, prevalence, and natural history of erectile dysfunction. Sex Med Rev 1(1):3–16

    Article  Google Scholar 

  6. Salonia A, Capogrosso P, Clementi MC, Castagna G, Damiano R, Montorsi F (2013) Is erectile dysfunction a reliable indicator of general health status in men? Arab J Urol 11(3):203–211

    Article  Google Scholar 

  7. Thompson IM, Tangen CM, Goodman PJ, Probstfield JL, Moinpour CM, Coltman CA (2005) Erectile dysfunction and subsequent cardiovascular disease. JAMA 294(23):2996–3002

    Article  CAS  Google Scholar 

  8. Araujo AB, Travison TG, Ganz P, Chiu GR, Kupelian V, Rosen RC, Hall SA, McKinlay JB (2009) Erectile dysfunction and mortality. J Sex Med 6(9):2445–2454

    Article  Google Scholar 

  9. Hotaling JM, Walsh TJ, Macleod LC, Heckbert S, Pocobelli G, Wessells H, White E (2012) Erectile dysfunction is not independently associated with cardiovascular death: data from the vitamins and lifestyle (VITAL) study. J Sex Med 9(8):2104–2110

    Article  Google Scholar 

  10. Banks E, Joshy G, Abhayaratna WP, Kritharides L, Macdonald PS, Korda RJ, Chalmers JP (2013) Erectile dysfunction severity as a risk marker for cardiovascular disease hospitalisation and all-cause mortality: a prospective cohort study. PLoS Med 10(1):e1001372

    Article  Google Scholar 

  11. Chung RY, Chan D, Woo J, Kwok T, Leung JC, Lai FT, Wong SY (2015) Erectile dysfunction is associated with subsequent cardiovascular and respiratory mortality in cohort of 1,436 Chinese elderly men. J Sex Med 12(7):1568–1576

    Article  Google Scholar 

  12. Loprinzi PD, Nooe A (2015) Erectile dysfunction and mortality in a national prospective cohort study. J Sex Med 12(11):2130–2133

    Article  Google Scholar 

  13. Hsu B, Hirani V, Naganathan V, Blyth FM, Le Couteur DG, Seibel MJ, Waite LM, Handelsman DJ, Cumming RG (2017) Sexual function and mortality in older men: the concord health and ageing in men project. J Gerontol Ser A Biol Sci Med Sci 72(4):520–527

    Google Scholar 

  14. Dong JY, Zhang YH, Qin LQ (2011) Erectile dysfunction and risk of cardiovascular disease: meta-analysis of prospective cohort studies. J Am Coll Cardiol 58(13):1378–1385

    Article  Google Scholar 

  15. Vlachopoulos CV, Terentes-Printzios DG, Ioakeimidis NK, Aznaouridis KA, Stefanadis CI (2013) Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systematic review and meta-analysis of cohort studies. Circ Cardiovasc Qual Outcomes 6(1):99–109

    Article  Google Scholar 

  16. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283(15):2008–2012

    Article  CAS  Google Scholar 

  17. O’Donnell AB, Araujo AB, Goldstein I, McKinlay JB (2005) The validity of a single-question self-report of erectile dysfunction. Results from the Massachusetts Male Aging Study. J Gen Intern Med 20(6):515–519

    Article  Google Scholar 

  18. Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P The Newcastle–Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 6 Mar 2018

  19. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634

    Article  CAS  Google Scholar 

  20. Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50(4):1088–1101

    Article  CAS  Google Scholar 

  21. Chew KK, Finn J, Stuckey B, Gibson N, Sanfilippo F, Bremner A, Thompson P, Hobbs M, Jamrozik K (2010) Erectile dysfunction as a predictor for subsequent atherosclerotic cardiovascular events: findings from a linked-data study. J Sex Med 7(1 Pt 1):192–202

    Article  Google Scholar 

  22. Solomon H, Man JW, Jackson G (2003) Erectile dysfunction and the cardiovascular patient: endothelial dysfunction is the common denominator. Heart 89(3):251–253

    Article  CAS  Google Scholar 

  23. Vlachopoulos C, Ioakeimidis N, Terentes-Printzios D, Stefanadis C (2008) The triad: erectile dysfunction–endothelial dysfunction–cardiovascular disease. Curr Pharm Des 14(35):3700–3714

    Article  CAS  Google Scholar 

  24. Araujo AB, Dixon JM, Suarez EA, Murad MH, Guey LT, Wittert GA (2011) Clinical review: endogenous testosterone and mortality in men: a systematic review and meta-analysis. J Clin Endocrinol Metab 96(10):3007–3019

    Article  CAS  Google Scholar 

  25. Sanchez E, Pastuszak AW, Khera M (2017) Erectile dysfunction, metabolic syndrome, and cardiovascular risks: facts and controversies. Transl Androl Urol 6(1):28–36

    Article  Google Scholar 

  26. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A (1997) The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 49(6):822–830

    Article  CAS  Google Scholar 

  27. Lau J, Ioannidis JP, Terrin N, Schmid CH, Olkin I (2006) The case of the misleading funnel plot. BMJ 333(7568):597–600

    Article  Google Scholar 

  28. Gupta BP, Murad MH, Clifton MM, Prokop L, Nehra A, Kopecky SL (2011) The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: a systematic review and meta-analysis. Arch Intern Med 171(20):1797–1803

    Article  Google Scholar 

  29. Nehra A, Jackson G, Miner M, Billups KL, Burnett AL, Buvat J, Carson CC, Cunningham GR, Goldstein I, Guay AT, Hackett G, Kloner RA, Kostis J, Montorsi P, Ramsey M, Rosen RC, Sadovsky R, Seftel AD, Vlachopoulos C, Wu FC (2013) Diagnosis and treatment of erectile dysfunction for reduction of cardiovascular risk. J Urol 189(6):2031–2038

    Article  CAS  Google Scholar 

  30. Andersson DP, Trolle Lagerros Y, Grotta A, Bellocco R, Lehtihet M, Holzmann MJ (2017) Association between treatment for erectile dysfunction and death or cardiovascular outcomes after myocardial infarction. Heart 103(16):1264–1270

    Article  Google Scholar 

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Acknowledgements

This work was supported by Jiangsu Provincial Key & D special Fund (BE2015666, BE2016715).

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Authors and Affiliations

  1. Cancer Institute, The Affiliated People’s Hospital, Jiangsu University, Zhenjiang, 212002, Jiangsu, China

    Yu Fan, Binbin Hu & Changfeng Man

  2. Department of Urology Surgery, The Affiliated People’s Hospital, Jiangsu University, No. 8 Dianli Road, Zhenjiang, 212002, Jiangsu, China

    Feilun Cui

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  1. Yu Fan
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  2. Binbin Hu
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Contributions

YF and BH made the literature search, extracted data, and evaluated the study quality. CM performed the statistical analysis. YF drafted the manuscript. FC designed the study, interpreted the results, and revised the manuscript.

Corresponding author

Correspondence to Feilun Cui.

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There are no conflicts of interest for any author.

Research involving human participants and/or animals

This manuscript adopted study level data, not involving human individual participants and/or animals.

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Fan, Y., Hu, B., Man, C. et al. Erectile dysfunction and risk of cardiovascular and all-cause mortality in the general population: a meta-analysis of cohort studies. World J Urol 36, 1681–1689 (2018). https://doi.org/10.1007/s00345-018-2318-3

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  • DOI: https://doi.org/10.1007/s00345-018-2318-3

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