| Summary: | Objectives: Evidence points towards a grading effect of the severity of ED in the predictive ability of this condition for CV events and all-cause mortality. We conducted a meta-analysis of all longitudinal studies for investigating the role of severity of ED in predicting risk of clinical events.
Methods: A comprehensive search of electronic databases was conducted through January 2013. Longitudinal studies that reported relative risk (RR) estimates with 95% confidence intervals (CI) of ED severity were included. Of the 5 studies included (101,147 participants, mean follow-up 6.4 years), all reported results on total CV events and 3 on all-cause mortality (98,212 individuals). Participants were grouped according to their ED severity in 3 different groups.
Results: The pooled relative risks (RRs) for total CV events were 1.32 (95% CI: 1.20 to 1.45, p<0.001) for men with moderate ED and 1.92 (95% CI: 1.37 to 2.68, p<0.001) for men with severe ED compared with men with no/mild ED (p=0.036 for comparison between men with moderate ED vs. severe ED). The pooled RRs for all-cause-mortality were 1.29 (95% CI: 1.01 to 1.65, p=0.043) for men with moderate ED and 1.83 (95% CI: 1.26 to 2.66, p=0.002) for men with severe ED compared with men with no/mild ED (p=0.127 for comparison between men with moderate ED vs. severe ED).
Conclusions: RR for CV events is higher at men with severe ED compared to men with moderate ED, implying a grading effect of ED severity and augmenting the pathophysiological link between ED and CV disease.
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