Cardiovascular risk among men seeking help for erectile dysfunction

Ann Epidemiol. 2006 Feb;16(2):85-90. doi: 10.1016/j.annepidem.2005.06.047. Epub 2005 Oct 12.


Purpose: The introduction of sildenafil put the risk of cardiovascular disease (CVD) among men with erectile dysfunction (ED) on the agenda of physicians. The question arose, Is EDsentinel to CVD? We sought to answer this question in the present study.

Methods: A historical cohort study was set up using medical records of general practices all over the Netherlands. Incident cases of ED were selected before and after the introduction of sildenafil using a catchment population of 60,000 men aged 35 to 74 years. Two to three men without ED (controls) were, subsequently, matched to each case. Incidence of CVD was determined for cases and controls, respectively.

Results: Overall, incidence of ED doubled from 5.3 per 1000 men-years in the period before introduction of sildenafil to 10.1 after the introduction. The relative risk of incident CVD among men with ED compared to controls was 1.7 [95%-CI 0.9-3.3] before the introduction and 1.1 [95%-CI 0.6-1.8] afterwards.

Conclusions: While ED could be seen as a marker for CVD before the introduction of sildenafil, it was clearly not afterwards.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Cardiovascular Diseases / complications
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / etiology*
  • Case-Control Studies
  • Cohort Studies
  • Erectile Dysfunction / complications*
  • Erectile Dysfunction / drug therapy
  • Erectile Dysfunction / epidemiology
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Myocardial Infarction / etiology
  • Piperazines / therapeutic use
  • Prevalence
  • Proportional Hazards Models
  • Purines / therapeutic use
  • Retrospective Studies
  • Risk Factors
  • Sexual Behavior / physiology*
  • Sildenafil Citrate
  • Sulfones / therapeutic use
  • Vasodilator Agents / therapeutic use


  • Piperazines
  • Purines
  • Sulfones
  • Vasodilator Agents
  • Sildenafil Citrate