Abstract
Introduction: A recent meta-analysis showed that erectile dysfunction (ED) was associated with elevated cardiovascular disease (CVD) mortality. However, findings from studies examining the relationship between ED and sub-clinical CVD have been conflicting. This study summarizes the current evidence related to the association of ED and vascular disease as measured by flow mediated dilation (FMD) of the endothelium and carotid intima media thickness (CIMT).
Methods: We searched multiple internet databases for published literature on studies assessing the association of ED and FMD, and CIMT between 1964 and 2014. A total of 11 studies met the inclusion criteria for examining the association between ED and FMD, while 7 studies met criteria for assessing the association with CIMT. Fixed-effect and random-effect models were used to assess and compare the standardized mean difference (SMD) of FMD and CIMT between persons with and without ED.
Results: From a total of 795 individual participant data (590 with and 205 without ED), persons with ED had a 0.66mm (0.49, 0.83) increase in CIMT by fixed effects model or 0.67mm (0.44, 0.90) by random effects model compared to those without ED. Similarly, from 1055 individual participant data (536 with and 419 without ED), ED was associated with a significant reduction in FMD by both fixed effect (-1.10% (95% CI: -2.10, -0.95)) and random effect models (-1.53% (95% CI: -2.10, -0.95)). There was significant heterogeneity among studies assessing the relationship between ED and FMD (I2 = 93.2%, p<0.001) but not among those comparing CIMT among persons with ED (I2 = 43.5% p=0.09).
Conclusion: This study confirms that ED is associated with both worsening endothelial function and increased CIMT. Thus, worsening vascular function may be a pathogenic mechanism for increased CVD morbidity and mortality in persons with ED. A diagnosis of ED should prompt a thorough CV work-up and aggressive preventive management.
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