Erectile dysfunction is associated with a high prevalence of hyperlipidemia and coronary heart disease risk

Objectives: Erectile dysfunction (ED) is frequently of vascular origin. An association between ED and ischemic heart disease has been suggested as a consequence of endothelial disease of penile and coronary arteries. The role of serum lipid levels has been demonstrated in coronary heart disease (CHD), but the relationship with ED is poorly documented. We evaluated undiagnosed hyperlipidemia in ED patients and their coronary heart disease risk. Methods: We prospectively compared a group of patients with ED to matched non-ED patients. Risk factors for ED and CHD were noticed and a serum lipid work up (total cholesterol [TC], triglycerides [TG], HDL-cholesterol [HDL-C], LDL-cholesterol [LDL-C] and TC/HDL-C ratio) was measured. We compared the prevalence of hyperlipidemia in the two groups and its impact as predictor of ED. We calculated the risk to develop CHD in patients with or without ED based upon commonly accepted variables of the Framingham Heart study. Results: 215 patients had ED (mean age 57.6 +/- 9.6 years) and 100 no ED (mean age 59.7 +/- 8.3 years). The prevalence of hypercholesterolemia (TC >200 mg/dl or 5.17 mmol/1) was 70.6% vs. 52% in ED and non-ED groups respectively (p = 0.06). After exclusion of confounding factors, logistic regression analyses showed HDL-C and TC/HDL-C ratio as significant predictors of ED (p = 0.011 and 0.000 respectively). Increased 10-year CHD risk was found in 56.6% in the ED group compared to 32.6% in the control group (p < 0.05). The median risk was 12.18% vs. 9.07% respectively with a significant age-related risk (p < 001). Conclusions: Hyperlipidemia is common in ED patients. HDL-C and TC/HDL-C ratio are predictors of ED. These patients have a high risk of later developing CHD. Erectile dysfunction might therefore serve as sentinel event for coronary heart disease. (C) 2003 Elsevier B.V. All rights reserved.