Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Cardiovascular disease risk, vascular health and erectile dysfunction among middle-aged, clinically depressed men

International Journal of Impotence Research volume 22, pages 30–35 (2010)Cite this article

Abstract

Erectile dysfunction (ED) is especially common in men with major depressive disorder (MDD). This study examined the extent to which risk factors for cardiovascular disease (CVD) and vascular endothelial dysfunction were associated with ED severity in MDD patients. The sample included 46 middle-aged [M (s.d.)=53 (7) years], sedentary men diagnosed with MDD. ED severity was assessed by the Arizona Sexual Experiences Scale (ASEX), item 3. Depression severity was measured by the Beck Depression Inventory-II (BDI). The Framingham risk score was calculated as a composite measure of CVD risk factors. Vascular endothelial function was measured by flow-mediated dilation (FMD) of the brachial artery. Regression analysis showed that ASEX scores were predicted by the greater Framingham risk score (β=0.41, P=0.008) and lower FMD (β=−0.38, P=0.01), but not by BDI scores (β=0.00, P=0.99). When FMD was included in the regression model, the relationship between Framingham risk and ASEX scores was partially attenuated (β=0.27, P=0.08). ED was associated with greater CVD risk and impaired vascular endothelial function in depressed men. CVD risk factors may affect ED through impairment of vascular endothelial function.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. NIH Consensus Conference. Impotence. JAMA 1993; 270: 83.

    Article  Google Scholar 

  2. Johannes C, Araujo A, Feldman H, Derby C, Kleinman K, McKinlay J . Incidence of erectile dysfunction in men 40–69 years old: longitudinal results from the Massachusetts Male Aging Study. J Urol 2000; 163: 460–463.

    Article  CAS  Google Scholar 

  3. Grover SA, Lowensteyn I, Kaouache M, Marchand S, Coupal L, DeCarolis E et al. The prevalence of erectile dysfunction in the primary care setting. Arch Intern Med 2006; 166: 213–219.

    Article  Google Scholar 

  4. Fung MM, Bettencourt R, Barrett-Connor E . Heart disease risk factors predict erectile dysfunction 25 years later: the Rancho Bernardo Study. Am J Cardiol 2004; 43: 1405–1411.

    Article  Google Scholar 

  5. Seftel A, Sun P, Swindle R . The prevalence of hypertension, hyperlipidemia, diabetes mellitus and depression in men with erectile dysfunction. J Urol 2004; 171: 2341–2345.

    Article  Google Scholar 

  6. Melman A, Gingell JC . The epidemiology and pathophysiology of erectile dysfunction. J Urol 1999; 161: 5–11.

    Article  CAS  Google Scholar 

  7. Bortolotti A, Parazzini F, Colli E, Landon M . The epidemiology of erectile dysfunction and its risk factors. Int J Androl 1997; 20: 323–334.

    Article  CAS  Google Scholar 

  8. Montorsi P, Ravagnani PM, Galli S, Rotatori F, Briganti A, Salonia A et al. The artery size hypothesis: a macrovascular link between erectile dysfunction and coronary artery disease. Am J Cardiol 2005; 96: 19–23.

    Article  Google Scholar 

  9. Montorsi P . Erectile dysfunction as a predictor of cardiovascular risk. Int Congr Ser 2007; 1303: 60–64.

    Article  Google Scholar 

  10. Feldman H, Goldstein I, Hatzichristou D, Krane R, McKinlay J . Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994; 151: 54–61.

    Article  CAS  Google Scholar 

  11. Montorsi P, Ravagnani PM, Galli S, Rotatori F, Venglia F, Briganti A et al. Association between erectile dysfunction and coronary artery disease. Role of coronary clinical presentation and extent of coronary vessels involvement: The COBRA trial. Eur Heart J 2006; 27: 2632–2639.

    Article  Google Scholar 

  12. Schouten BWV, Bohnen AM, Bosch JLHR, Bernsen RMD, Deckers JW, Dohle GR et al. Erectile dysfunction prospectively associated with cardiovascular disease in the Dutch general population: results from the Krimpen Study. Int J Impot Res 2008; 20: 92–99.

    Article  CAS  Google Scholar 

  13. Blumentals WA, Gomez-Caminero A, Joo S, Vannappagari V . Should erectile dysfunction be considered as a marker for acute myocardial infarction? Results from a retrospective cohort study. Int J Impot Res 2004; 16: 350–353.

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  15. Ganz P . Erectile dysfunction: pathophysiologic mechanisms pointing to underlying cardiovascular disease. Am J Cardiol 2005; 96: 8–12.

    Article  Google Scholar 

  16. Maas R, Schwedhelm E, Albsmeier J, Hoger R . The pathophysiology of erectile dysfunction related to endothelial dysfunction and mediators of vascular function. Vasc Med 2002; 7: 213–225.

    Article  Google Scholar 

  17. Carrion R, Bochinski D, Rahman N, Lue T . Oral drug therapy of sexual dysfunction. In: Broderick G (eds). Physiology and Pharmacology of Erectile Dysfunction. Humana Press Inc: Totowa, NJ, 2000, pp 1–24.

    Google Scholar 

  18. Lue TF . Erectile dysfunction. N Engl J Med 2000; 342: 1802–1813.

    Article  CAS  Google Scholar 

  19. Dzau VJ, Antman EM, Black HR, Hayes DL, Manson JE, Plutzky J et al. The cardiovascular disease continuum validated: clinical evidence of improved patient outcomes: part I: Pathophysiology and clinical trial evidence (risk factors through stable coronary artery disease). Circulation 2006; 114: 2850–2870.

    Article  Google Scholar 

  20. Kovacs I, Csaszar A, Toth J, Siller G, Farkas A, Tarjan J et al. Correlation between flow-mediated dilation and erectile dysfunction. J Cardiovasc Pharmacol 2008; 51: 148–153.

    Article  CAS  Google Scholar 

  21. Kaya C, Uslu Z, Karaman I . Is endothelial function impaired in erectile dysfunction patients? Int J Impot Res 2006; 18: 55–60.

    Article  CAS  Google Scholar 

  22. Kaiser DR, Billups K, Mason C, Wetterling R, Lundberg JL, Bank AJ . Impaired brachial artery endothelium-dependent and -independent vasodilation in men with erectile dysfunction and no other clinical cardiovascular disease. J Am Coll Cardiol 2004; 43: 179–184.

    Article  Google Scholar 

  23. Bodie JA, Beeman WW, Monga M . Psychogenic erectile dysfunction. Int J Psychiatry Med 2003; 33: 273–293.

    Article  Google Scholar 

  24. Araujo A, Durante R, Feldman H, Goldstein I, McKinlay J . The relationship between depressive symptoms and male erectile dysfunction: cross-sectional results from the Massachusetts Male Aging Study. Psychosom Med 1998; 60: 458–465.

    Article  CAS  Google Scholar 

  25. Hamilton M . A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23: 56–62.

    Article  CAS  Google Scholar 

  26. Blumenthal JA, Babyak MA, Doraiswamy MP, Watkins L, Hoffman B, Barbour KA et al. Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosom Med 2007; 69: 587–596.

    Article  CAS  Google Scholar 

  27. Beck AT, Steer RA, Brown GK . Manual for the Beck Depression Inventory II. Psychological Corporation: San Antonio, TX, 1996.

    Google Scholar 

  28. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders—IV—Text Revision. American Psychiatric Association: Washington DC, 2004.

  29. First M, Spitzer R, Gibbon M, Williams J . Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Research Version. Biometrics Research Department, New York Psychiatric Institute: New York, 1996.

    Google Scholar 

  30. McGahuey CA, Gelenberg AJ, Laukes CA, Moreno FA, Delgado PL, McKnight KM et al. The Arizona Sexual Experience Scale (ASEX): reliability and validity. J Sex Marital Ther 2000; 26: 25–40.

    Article  CAS  Google Scholar 

  31. de Boer BJ, Bots ML, Lycklama a Nijeholt AAB, Moors JPC, Pieters HM, Verheij ThJM . Impact of various questionnaires on the prevalence of erectile dysfunction. The ENIGMA-study. Int J Impot Res 2004; 16: 214–219.

    Article  CAS  Google Scholar 

  32. O'Donnell AB, Araujo A, Goldstein I, McKinlay JB . The validity of a sing-question self-report of erectile dysfunction. J Gen Intern Med 2005; 20: 515–519.

    Article  Google Scholar 

  33. Derby CA, Araujo A, Johannes CB, Feldman HA, McKinlay JB . Measurement of erectile dysfunction in population-based studies: the use of a single question self-assessment in the Massachusetts Male Aging Study. Int J Impot Res 2000; 12: 197–204.

    Article  CAS  Google Scholar 

  34. D'Agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM et al. General cardiovascular risk profile for use in primary care: The Framingham Heart Study. Circulation 2008; 117: 743–753.

    Article  Google Scholar 

  35. Celermajer DS, Sorensen KE, Gooch VM, Spiegelhalter DJ, Miller OI, Sullivan ID et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet 1992; 340: 1111–1115.

    Article  CAS  Google Scholar 

  36. Benjamin EJ, Larson MG, Keyes MJ, Mitchell GF, Vasan RS, Keaney JF et al. Clinical correlates and heritability of flow-mediated dilation in the community: The Framingham Heart Study. Circulation 2004; 109: 613–619.

    Article  Google Scholar 

  37. Vita JA, Keaney JF . Endothelial function: a barometer for cardiovascular risk? Circulation 2002; 106: 640–642.

    Article  Google Scholar 

  38. Tabachnick BG, Fidell LS . Using Multivariate Statistics. Harper Collins: New York, 1996.

    Google Scholar 

  39. Rosen RC, Cappelleri JC, Gendrano III N . The International Index of Erectile Function (IIEF): a state-of-the-science review. Int J Impot Res 2002; 14: 226–244.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This study was supported by Grant nos MH 49679 and HL 080664 from the National Institutes of Health, and Grant no. M01-RR-30 from the General Clinical Research Center Program, National Center for Research Resources, National Institutes of Health.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA

    B M Hoffman, A Sherwood, P J Smith, M A Babyak, P M Doraiswamy & J A Blumenthal

  2. Department of Medicine, University of North Carolina, Chapel Hill, NC, USA

    A Hinderliter

Authors
  1. B M Hoffman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A Sherwood
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P J Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M A Babyak
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P M Doraiswamy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A Hinderliter
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J A Blumenthal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B M Hoffman.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hoffman, B., Sherwood, A., Smith, P. et al. Cardiovascular disease risk, vascular health and erectile dysfunction among middle-aged, clinically depressed men. Int J Impot Res 22, 30–35 (2010). https://doi.org/10.1038/ijir.2009.43

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijir.2009.43

Keywords

This article is cited by

Search

Advanced search

Quick links