Association of erectile dysfunction and cardiovascular diseases: an umbrella review of systematic reviews and meta-analyses.

Erectile dysfunction, a common problem in men, has been shown to be associated with cardiovascular diseases. However, the underlying data are partly contradictory and the strength and mechanism of the association between erectile dysfunction and cardiovascular diseases have not been fully clarified.

The aim of this umbrella review is to present an overall picture of the evidence regarding the association of erectile dysfunction with cardiovascular diseases.

We included systematic reviews and meta-analyses that studied the association of erectile dysfunction with any cardiovascular disease. We did not restrict the population to a particular group or age.

We searched PubMed, Embase, the JBI database of systematic reviews and implementation reports, the Cochrane database of systematic reviews, database of abstracts of reviews of effects and the PROSPERO register to find relevant systematic reviews with or without meta-analyses from inception to April 2020. Methodological quality The JBI Critical appraisal checklist for systematic reviews and research syntheses was used for the critical appraisal. Only studies with acceptable quality were included.

Two independent reviewers extracted the data using the JBI URARI data extraction tool for qualitative and quantitative data extraction.

We presented the data in two qualitative overview and quantitative overview tables.

The summary estimate shows a higher risk of cardiovascular disease (RR :1.45, 95% CI,1.36 to 1.54; P<0.001), coronary heart disease (RR: 1.50, 95% CI, 1.37 to 1.64; P<0.001), cardiovascular related mortality (RR: 1.50, 95% CI, 1.37 to 1.64]; P<0.001), all-cause mortality (RR: 1.25, 95% CI, 1.18 to 1.32; P<0.001), myocardial infarction (RR; 1.55, 95% CI, 1.33 to 1.80; P<0.001) and Stroke (RR: 1.36, 95% CI, 1.26 to 1.46; P<0.001) in patients with erectile dysfunction rather than other patients.

Our results confirm that erectile dysfunction is an independent predictor of cardiovascular diseases and their outcomes. Erectile dysfunction and cardiovascular disease are two presentations of the same physiologic phenomenon. Erectile dysfunction normally precedes symptomatic cardiovascular disease providing a window period for healthcare practitioners to screen and early detect high-risk patients to prevent avoidable morbidity and mortality.

BJU international. 2020 Dec 01 [Epub ahead of print]

Hadi Mostafaei, Keiichiro Mori, Sakineh Hajebrahimi, Mohammad Abufaraj, Pierre I Karakiewicz, Shahrokh F Shariat

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran., Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada.

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