Erectile dysfunction and coronary risk factors: Prospective results from the Massachusetts Male Aging Study

Background. Erectile dysfunction (ED), a widespread and troublesome conditi on among middle-aged men, is partly vascular in origin. In the Massachusett s Male Aging Study, a random-sample cohort study, we investigated the relat ionship between baseline risk factors for coronary heart disease and subseq uent ED, on the premise that subclinical arterial insufficiency might be ma nifested as ED. Methods. Men ages 40-70, selected from state census lists, were interviewed in 1987-1989 and reinterviewed in 1995-1997. Data were collected and blood was drawn in participants' homes. ED was assessed from responses to a priv ately self-administered questionnaire. Analysis was restricted to 513 men w ith no ED at baseline and no diabetes, heart disease, or related medication s at either time. Results. Cigarette smoking at baseline almost doubled the likelihood of mod erate or complete ED at followup (24% vs 14%, adjusted for age and covariat es, P = 0.01). Cigar smoking and passive exposure to cigarette smoke also s ignificantly predicted incident ED, as did overweight (body-mass index grea ter than or equal to 28 kg/m(2)) and a composite coronary risk score. Weake r prospective associations were seen for hypertension and dietary intake of cholesterol and unsaturated fat. Conclusions. Erectile dysfunction and coronary heart disease share some beh aviorally modifiable determinants in men who, like our sample, are free of manifest ED or predisposing illness. Open questions include whether modific ation of coronary risk factors can prevent ED and whether ED may serve as a sentinel event for coronary disease. (C) 2000 American Health Foundation a nd Academic Press.