Modifiable risk factors and erectile dysfunction: Can lifestyle changes modify risk?

Objectives. To prospectively examine whether changes in smoking, heavy alco hol consumption, sedentary lifestyle, and obesity are associated with the r isk of erectile dysfunction. Methods. Data were collected as part of a cohort study of a random sample o f men 40 to 70 years old, selected from street listings in the Boston Metro politan Area, Massachusetts. In-home interviews were completed by 1709 men at baseline in 1987 to 1989 and 1156 men at follow-up in 1995 to 1997 (aver age follow-up 8.8 years). Analyses included 593 men without erectile dysfun ction at baseline, who were free of prostate cancer, and had not been treat ed for heart disease or diabetes. The incidence of moderate to complete ere ctile dysfunction was determined by discriminant analysis of responses to a self-administered sexual function questionnaire. Results, Obesity status was associated with erectile dysfunction (P = 0.006 ), with baseline obesity predicting a higher risk regardless of follow-up w eight loss. Physical activity status was associated with erectile dysfuncti on (P = 0.01), with the highest risk among men who remained sedentary and t he lowest among those who remained active or initiated physical activity. C hanges in smoking and alcohol consumption were not associated with the inci dence of erectile dysfunction (P > 0.3). Conclusions. Midlife changes may be too late to reverse the effects of smok ing, obesity, and alcohol consumption on erectile dysfunction. In contrast, physical activity may reduce the risk of erectile dysfunction even if init iated in midlife. Early adoption of healthy lifestyles may be the best appr oach to reducing the burden of erectile dysfunction on the health and well- being of older men. UROLOGY 56: 302-306, 2000. (C) 2000, Elsevier Science I nc.