Rural men with erectile dysfunction at greater risk of MACE

Erectile dysfunction (ED) is independently associated with a higher risk of major adverse cardiovascular events (MACE), suggests a study. Moreover, rural men appear to be at greater risk of MACE, with an even higher risk among those with an ED diagnosis.

This propensity-weighted retrospective cohort study utilized a provincial health administrative database to determine whether men from rural settings with ED are at an increased risk of MACE.

ED referred to having at least two ED prescriptions filled within 1 year, while MACE was characterized by the first hospitalization for an episode of acute myocardial infarction, heart failure, or stroke that resulted in a hospital visit >24 hours.

The investigators classified the study groups into ED urban, ED rural, no ED urban, and no ED rural. They also determined the propensity score using a multiple logistic regression model and applied a stabilized inverse propensity treatment weighting to the propensity score. Finally, the primary outcome of time to a MACE was assessed using a Cox proportional model.

The median time to a MACE was 2,731 days for ED urban (n=32,341), 2,635 days for ED rural (n=18,025), 2,441 days for no ED rural (n=146,358), and 2,508 days for no ED urban (n=233,897). The ED group showed a higher proportion of MACE when compared with the no ED group (8.94 percent vs 4.58 percent).

In stabilized time-varying comodels based on inverse probability treatment weighting, no ED rural correlated with a higher risk of MACE as compared with no ED urban (hazard ratio [HR], 1.06‒1.08). In addition, ED rural showed a significant association with a higher risk of MACE as compared with no ED rural (HR, 1.10‒1.74), with the strength of the effect estimates increasing over time.

“[These findings] highlight the need for physicians treating patients with ED to address cardiovascular risk factors for primary and secondary prevention of cardiovascular diseases,” the investigators said.