Erectile Dysfunction and Cardiovascular Disease Risk: An Updated 2024 Systematic Review Meta-Analysis of Prospective Studies

Abstract Background: Erectile dysfunction (ED) has been associated with an increased risk of cardiovascular disease (CVD), including coronary artery disease, stroke, and cardiovascular mortality. This meta-analysis aims to provide an updated comprehensive evaluation of the relationship between ED and CVD risk based on the latest prospective studies. Methods: We systematically searched major electronic databases for prospective cohort studies and case-control studies published from January 2009 to December 2023 that examined the association between ED and CVD outcomes. Pooled risk estimates and 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup analyses and assessments of heterogeneity and publication bias were performed. For the assessment of certainty were used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to assess the certainty of evidence for each outcome. The GRADE approach evaluates evidence based on five domains: risk of bias, inconsistency, indirectness, imprecision, and publication bias. Each domain can lead to downgrading the certainty of evidence by one or two levels. The overall certainty of evidence was classified as high, moderate, low, or very low. Results: The systematic literature search identified 2,137 potentially relevant studies. After screening titles, abstracts, and full texts, a total of 15 prospective cohort studies and 2 case-control studies met the inclusion criteria and were included in the meta-analysis. The included studies involved a total of 236,942 participants with a mean age ranging from 53 to 68 years. The follow-up duration ranged from 2 to 14 years. ED was assessed using validated questionnaires (e.g., International Index of Erectile Function) in 12 studies and through clinical evaluation in 5 studies. Erectile Dysfunction and Coronary Artery Disease Risk: Eleven studies (9 cohort studies and 2 case-control studies) reported data on the association between ED and the risk of coronary artery disease (CAD). Erectile Dysfunction and Stroke Risk: Eight cohort studies examined the relationship between ED and stroke risk. The meta-analysis revealed a significant association between ED and an increased risk of stroke. Erectile Dysfunction and Cardiovascular Mortality Risk: Six cohort studies reported data on the association between ED and cardiovascular mortality. The pooled analysis showed that ED was associated with a significantly higher risk of cardiovascular mortality Erectile Dysfunction and Composite Cardiovascular Events: Five cohort studies assessed the risk of composite cardiovascular events (including CAD, stroke, and cardiovascular mortality) in relation to ED. The meta-analysis demonstrated a significant association between ED and an increased risk of composite cardiovascular events Conclusions: This updated meta-analysis of prospective studies provides robust evidence that ED is an independent risk factor for CVD outcomes, including coronary artery disease, stroke, and cardiovascular mortality. Early identification and management of ED may help improve cardiovascular risk stratification and prevention strategies in men.