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Erectile dysfunction prospectively associated with cardiovascular disease in the Dutch general population: results from the Krimpen Study


The possible relationship between erectile dysfunction and the later occurrence of cardiovascular disease while biologically plausible has been evaluated in only a few studies. Our objective is to determine the relation between ED as defined by a single question on erectile rigidity and the later occurrence of myocardial infarction, stroke and sudden death in a population-based cohort study. In Krimpen aan den IJssel, a municipality near Rotterdam, all men aged 50–75 years, without cancer of the prostate or the bladder, without a history of radical prostectomy, neurogenic bladder disease, were invited to participate for a response rate of 50%. The answer to a single question on erectile rigidity included in the International Continence Society male sex questionnaire was used to define the severity of erectile dysfunction at baseline. Data on cardiovascular risk factors at baseline (age smoking, blood pressure, total- and high-density lipoprotein cholesterol, diabetes) were used to calculate Framingham risk scores. During an average of 6.3 years of follow-up, cardiovascular end points including acute myocardial infarction, stroke and sudden death were determined. Of the 1248 men free of CVD at baseline, 258 (22.8%) had reduced erectile rigidity and 108 (8.7%) had severely reduced erectile rigidity. In 7945 person-years of follow-up, 58 cardiovascular events occurred. In multiple variable Cox proportional hazards model adjusting for age and CVD risk score, hazard ratio was 1.6 (95% confidence interval (CI): 1.2–2.3) for reduced erectile rigidity and 2.6 (95% CI: 1.3–5.2) for severely reduced erectile rigidity. The population attributable risk fraction for reduced and severely reduced erectile rigidity was 11.7%. In this population-based study, a single question on erectile rigidity proved to be a predictor for the combined outcome of acute myocardial infarction, stroke and sudden death, independent of the risk factors used in the Framingham risk profile.

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Baseline was funded by an unconditional grant from SUWO (Foundation for urologic scientific research). Follow up was partly funded by an unconditional grant of Pfizer Inc.

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Correspondence to B W V Schouten.

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Take Home Message: Negative answers on the question ‘Do you get erections?’ increase the risk of cardiovascular disease by a factor between one and a half and two and a half. This appears to be of the same magnitude as the classical risk factors diabetes and smoking.



International Continence Society: Male sex question on erectile dysfunction

Table A1

Table 3 Table A1

Question about sexual activity

Table A2

Table 4 Table A2

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Schouten, B., Bohnen, A., Bosch, J. et al. Erectile dysfunction prospectively associated with cardiovascular disease in the Dutch general population: results from the Krimpen Study. Int J Impot Res 20, 92–99 (2008).

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  • cardiovascular disease
  • erectile dysfunction
  • epidemiology
  • risk factor

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