Association Between Cardiovascular Health and Endothelial Function With Future Erectile Dysfunction: The Multi-Ethnic Study of Atherosclerosis

Am J Hypertens. 2017 Aug 1;30(8):815-821. doi: 10.1093/ajh/hpx060.


Background: The association of Cardiovascular Health (CVH; defined by the American Heart Association by assigning points for health-related behavioral and clinical factors) with endothelial and erectile dysfunction has not been reported, although endothelial and erectile dysfunction have been associated with components of CVH.

Methods: Data were collected in 1,136 men in the Multi-Ethnic Study of Atherosclerosis at baseline and erectile dysfunction status (measured by survey or medication use) at exam 5. CVH was determined with 7 health metrics. Endothelial function was measured with brachial artery flow-mediated dilation (FMD). Poisson regression was used to determine associations between CVH and erectile dysfunction across categories of CVH (low, moderate, and high).

Results: Age and proportion of Black or Latino participants decreased while proportion of Chinese-American participants increased with higher CVH category. FMD was higher in men without erectile dysfunction and higher in men with high vs. low CVH. Erectile dysfunction prevalence was lower with better CVH; 58% in men with low CVH, 41% with moderate CVH, and 33% with high CVH (P < 0.001). CVH was associated with erectile dysfunction; prevalence ratio = 0.75 (95% confidence interval (CI) = 0.66, 0.84) with moderate CVH and 0.68 (95% CI = 0.49, 0.94) with high CVH (vs. men with low CVH) and 0.93 (95% CI = 0.91, 0.96) for every 1-point higher CVH score in a fully adjusted model, including FMD, age, education, depression score, use of antidepressant or beta-blocker medications, chronic disease, heavy drinking, and race.

Conclusion: CVH is associated with future erectile dysfunction, even after adjustment for baseline FMD. Maintaining high CVH may improve quality of life for men.

Keywords: blood pressure; cardiovascular health; erectile dysfunction; flow-mediated dilation; hypertension.

MeSH terms

  • Adrenergic beta-Antagonists / adverse effects
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Alcoholism / complications
  • Alcoholism / epidemiology
  • Asian
  • Atherosclerosis / complications*
  • Atherosclerosis / physiopathology
  • Black People
  • Brachial Artery / physiopathology
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / physiopathology
  • Chronic Disease
  • Educational Status
  • Endothelium, Vascular / physiopathology*
  • Erectile Dysfunction / etiology*
  • Erectile Dysfunction / physiopathology
  • Ethnicity
  • Health Status
  • Hispanic or Latino
  • Humans
  • Male
  • Middle Aged
  • Prevalence


  • Adrenergic beta-Antagonists