Depression and Erectile Dysfunction Are Independent Risk Factors for Heart Disease

July 18, 2010 (Florence, Italy) — The presence of depressive symptoms increased the risk of cardiovascular events in men with erectile dysfunction, a new study has shown [1].

The study, published in the August 2010 issue of the Journal of Sexual Medicine, was conducted by a team led by Dr Elisa Bandini (University of Florence, Italy). Bandini commented to heartwire : "In a large sample of men with erectile dysfunction, after controlling for other risk factors, we found that those with severe depression had increased risk of cardiovascular events. We know that depression and erectile dysfunction are both risk factors for heart disease, but this study shows that these risk factors are independent of each other."

She added: "Our results show that when evaluating patients for sexual dysfunction, doctors should think about general health as well. Erectile dysfunction may be the first disease or depression may be first disease, but we should look beyond these initial conditions to look at secondary consequences such as increased cardiovascular risk. If we treat depression and sexual dysfunction, we may be able to improve cardiovascular outcomes, too."

What is important . . . is the broader concept of the sexual-medicine problem no longer being just about a man's performance in the bedroom, but about his psychological mood and his cardiovascular health.
Editor-in-chief of the Journal of Sexual Medicine, Dr Irwin Goldstein (Alvarado Hospital, San Diego, CA), added: "What is important about this study is the broader concept of the sexual-medicine problem no longer being just about a man's performance in the bedroom, but about his psychological mood and his cardiovascular health. This is a valid reason for a woman to encourage her partner to seek help for his erectile dysfunction."

In the study, 1687 patients with erectile dysfunction were screened for depression using the Middlesex Hospital Questionnaire. Those in the highest quintile of depression score were compared with the rest of the sample. Results showed a positive relationship between depression score and progressive erectile dysfunction, even after adjustment for confounding factors. During a mean follow up of 4.3 years, there were a total of 139 cardiovascular events, 15 of which were fatal. Unadjusted incidence of cardiovascular events was significantly associated with baseline depressive symptoms. And severe depressive symptomatology was independently associated with a higher incidence of cardiovascular events in a Cox regression model controlling for degree of erectile dysfunction, partner’s hypoactive sexual desire, age, chronic diseases score, and another measure of psychopathology.

Association Still There After Controlling for Obesity

Because obesity is an important risk factor for cardiovascular events in subjects with sexual dysfunction, the authors looked at whether the presence of obesity might explain the effect of depression on cardiovascular events in this study. But in an alternative Cox model, they showed that depressive symptoms retained an independent ability to predict cardiovascular events, although their effect was more evident in leaner subjects.

The need for a regular screening for cardiac morbidity in men with erectile dysfunction is even greater in those patients showing depressive symptoms.
While no study has yet evaluated the possible effect of treatment of depression on the incidence of cardiovascular events, Bandini et al say that their study suggests that recognizing depressive symptoms in erectile-dysfunction subjects is mandatory not only for improving their sexual life, but also for preventing heart disease.

They conclude: "Owing to the complex multidimensional relationships existing among erectile dysfunction, cardiovascular disease, and depression, clinicians involved in the management of sexual dysfunction should be aware that the presence of one component of this triad necessitates inquiry regarding the other two components."

They add: "The wellness of the body, of the couple, and of the mind independently affects the cardiovascular fate of men with erectile dysfunction," and "the need for a regular screening for cardiac morbidity in men with erectile dysfunction is even greater in those patients showing depressive symptoms."