(205) Erectile Dysfunction is an Independent Risk Factor for Major Adverse Cardiovascular Events

Abstract

Abstract Introduction Erectile dysfunction (ED) and cardiovascular disease share similar risk profiles which include: aging, hypertension, diabetes, smoking, obesity, and dyslipidemia. Previous literature has suggested ED as a potential harbinger of future cardiovascular disease. Objective As such, we sought to investigate the association between ED and major adverse cardiovascular events (MACE) using a large population based database. As a secondary objective, we sought to investigate the relationship of place of residence (rural or urban) in regards to the incidence of MACE. Methods A propensity-weighted, retrospective cohort study was conducted by accessing provincial health administrative databases. Eligibility criteria included men 18 years and older, with no prior ED or MACE, who had at least 1 year of provincial health coverage from their index date between June 1st 1996 to March 31st 2018. ED was defined as having at least two ED prescriptions filled within one year (including oral, intraurethral, and/or injection therapies). MACE was defined as myocardial infarction, coronary revascularization procedures, ischemic stroke, or hospitalizations for heart failure. We then classified study groups into ED Urban, ED Rural, No ED Urban and No ED Rural. Multiple logistic regression model that included age categories, socioeconomic status, index year, diabetes, hypertension, dyslipidemia and renal disease was used to determine the propensity score. Stabilized inverse propensity treatment weighting was then applied to the propensity score. A cox proportional hazard model was used to examine our primary outcome of time to a MACE. Results The median time to a MACE was 2721, 2620, 2520, and 2438 days in the ED Urban (N=32,138), ED Rural (N=17,821), No ED Rural (N=145,209) and No ED Urban (N=233,073) study groups, respectfully. The ED Rural, ED Urban and No ED Rural study groups had a 54% (Hazard Ratio [HR] 1.54, 95% CI [1.45 – 1.63]), 26% (HR 1.26, 95% CI[1.20 – 1.32]) and 14% (HR 1.14, 95% CI[1.11 – 1.18]) higher risk of a MACE event as compared to the No ED Urban group, in weighted analyses, respectfully. Among individuals with ED, men from a rural setting had a 22% (HR 1.22, 95% CI[1.14 – 1.32]) higher risk of a MACE event, as compared from an urban setting. Conclusions Our study demonstrates that men diagnosed with ED had a higher risk of MACE as compared to controls. ED is demonstrated to be an independent risk factor for MACE when controlling for comorbidities. In addition, men residing in rural communities had a higher risk of MACE as compared to other urban counterparts. It is imperative for health care professionals who manage patients with ED to discuss the risk of future cardiovascular disease and identify comorbid conditions to mitigate risk. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.