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The Prevalence of Erectile Dysfunction in the Primary Care Setting
Importance of Risk Factors for Diabetes and Vascular Disease
Steven A. Grover, MD, MPA, FRCPC;
Ilka Lowensteyn, PhD;
Mohammed Kaouache, MSc;
Sylvie Marchand, RN;
Louis Coupal, MSc;
Emidio DeCarolis, PhD;
Joseph Zoccoli, BSc;
Isabelle Defoy, PhD
Arch Intern Med. 2006;166:213-219.
Background The prevalence of erectile dysfunction (ED) and associated risk factors has been described in many clinical settings, but there is little information regarding men seen by primary care physicians. We sought to identify independent factors associated with ED in a primary care setting.
Methods We surveyed a cross-sectional sample of 3921 Canadian men, aged 40 to 88 years, seen by primary care physicians. Participants completed a full medical history, physical examination, and measurement of fasting blood glucose and lipid levels. We used the International Index of Erectile Function to define ED as a score of less than 26 on the erectile function domain.
Results The overall prevalence of ED was 49.4%. The presence of cardiovascular disease (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.16-1.81; P<.01) or diabetes (OR, 3.13; 95% CI, 2.35-4.16; P<.001) increased the probability of ED after adjustment for other confounders. Among those individuals without cardiovascular disease or diabetes, the calculated 10-year Framingham coronary risk (OR, 1.03 per 1% increase; 95% CI, 1.02-1.05; P<.001) and fasting blood glucose levels (OR, 1.14 per 18-mg/dL [1-mmol/L] increase; 95% CI, 1.04-1.24; P<.01) were independently associated with ED. Erectile dysfunction was also independently associated with undiagnosed hyperglycemia (OR, 1.46; 95% CI, 1.02-2.10; P = .04), impaired fasting glucose (OR, 1.26; 95% CI, 1.08-1.46; P = .004), and the metabolic syndrome (OR, 1.45; 95% CI, 1.24-1.69; P<.001).
Conclusions Cardiovascular disease, diabetes, future coronary risk, and increasing fasting glucose levels are independently associated with ED. It remains to be determined if ED precedes the development of these conditions.
Author Affiliations: Centre for the Analysis of Cost-Effective Care and the Divisions of General Internal Medicine and Clinical Epidemiology, The Montreal General Hospital, and Departments of Medicine and Epidemiology & Biostatistics, McGill University, Montreal, Quebec (Drs Grover and Lowensteyn, Messrs Kaouache and Coupal, and Ms Marchand), and Pfizer Canada, Kirkland, Quebec (Drs DeCarolis and Defoy and Mr Zoccoli).
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