In men with type 2 diabetes mellitus, the presence of erectile dysfunction increased ischemic heart disease risk to 15.7% versus 11.5% without diabetes (OR 1.44, 95% CI 1.41-1.46).
Observational (n=40,645,211)
Yes
Does the presence of erectile dysfunction increase the risk of cardiovascular disease in men with type 2 diabetes mellitus?
Erectile dysfunction in men with type 2 diabetes is a clinically relevant marker of systemic vascular disease that substantially increases the risk of major cardiovascular events.
Effect estimate: OR 1.44 (95% CI 1.41-1.46)
Absolute Event Rate: 15.7% vs 11.5%
Background Erectile dysfunction (ED) is highly prevalent among men with type 2 diabetes mellitus (T2DM) and reflects systemic vascular and metabolic dysfunction. Shared mechanisms include endothelial dysfunction, oxidative stress, inflammation, autonomic neuropathy, and hypogonadism. Therefore, ED may function not only as a complication of T2DM but also as an early clinical marker of cardiometabolic disease. Objective This narrative review summarizes current evidence on the epidemiology, mechanisms, and cardiometabolic implications of ED in men with T2DM, and evaluates the impact of major cardiometabolic therapies on erectile function. A real-world cohort study was conducted using the TriNetX Global Collaborative Network, a large federated electronic health record database comprising healthcare organizations across multiple countries. Content ED is closely linked with hypertension, obesity, dyslipidaemia, heart failure, ischemic heart disease, and stroke in men with T2DM, reflecting shared microvascular and macrovascular diseases. Cohort and real-world studies indicate a strong bidirectional relationship: poor cardiometabolic control worsens erectile function, whereas improvements in glycaemia, weight, blood pressure, and lipids are associated with higher International Index of Erectile Function (IIEF) scores. Using data from the TriNetX Global Collaborative Network, large-scale real-world analyses further demonstrate that the coexistence of ED and T2DM substantially increases cardiovascular risk. In a propensity-score-matched cohort (200,000 individuals per group), men with ED and T2DM had higher risks of ischemic heart disease (15.7% vs. 11.5%, OR: 1.44; 95% CI 1.41-1.46), stroke (OR 1.45; 95% CI 1.42-1.48), peripheral artery disease (OR 1.38; 95% CI 1.35-1.41), and heart failure (8.4% vs. 4.9%, OR 1.78; 95% CI 1.74-1.81). Conversely, among individuals with T2DM, the presence of ED was associated with increased ischemic heart disease, stroke, and peripheral artery disease. Mechanistic and clinical data suggest heterogeneous treatment effects: GLP-1 receptor agonists and SGLT2 inhibitors show promising vascular benefits with mixed erectile outcomes, whereas ARBs and finerenone appear favorable compared with older agents associated with sexual adverse effects. Conclusion ED in T2DM should be regarded as a clinically relevant marker of systemic vascular disease. Routine assessment may enhance cardiovascular risk stratification and motivate earlier, comprehensive risk-factor intervention. Future prospective and randomized studies with erectile function as a predefined endpoint are needed.
Mores et al. (2026) conducted an observational in Men aged ≥20 years with type 2 diabetes mellitus (T2DM) for real-world cohort analysis (n=40,645,211). Erectile dysfunction (ED) presence vs. Men without ED; men without T2DM was evaluated on Incidence and prevalence of ED and cardiovascular outcomes including ischemic heart disease, stroke, peripheral artery disease, heart failure, composite cardiovascular disease (OR 1.44, 95% CI 1.41-1.46). In men with type 2 diabetes mellitus, the presence of erectile dysfunction increased ischemic heart disease risk to 15.7% versus 11.5% without diabetes (OR 1.44, 95% CI 1.41-1.46).