Advertisement
Research Article

Erectile Dysfunction Severity as a Risk Marker for Cardiovascular Disease Hospitalisation and All-Cause Mortality: A Prospective Cohort Study

  • Emily Banks mail,

    Emily.Banks@anu.edu.au

    Affiliations: National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia, The Sax Institute, Sydney, New South Wales, Australia

    X
  • Grace Joshy,

    Affiliation: National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia

    X
  • Walter P. Abhayaratna,

    Affiliation: College of Medicine, Biology and the Environment, Australian National University, Canberra, Australian Capital Territory, Australia

    X
  • Leonard Kritharides,

    Affiliation: Concord Repatriation General Hospital, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia

    X
  • Peter S. Macdonald,

    Affiliation: Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia

    X
  • Rosemary J. Korda,

    Affiliation: National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia

    X
  • John P. Chalmers

    Affiliation: The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia

    X
  • Published: January 29, 2013
  • DOI: 10.1371/journal.pmed.1001372
  • Featured in PLOS Collections

Reader Comments (1)

Post a new comment on this article

Vitamin D deficiency may explain the link between erectile dysfunction and cardiovascular disease

Posted by wbgrant on 31 Jan 2013 at 17:55 GMT

The paper by Banks and colleages reports high risk of cardiovascular disease (CVD) for those with erectile dysfunction (ED) in a prospective study [1]. No resaon was proposed to explain the link. They stated taht ED “is likely to serve as an indicator, or “biomarker”, of the severity of underlying pathological processes such as atherosclerosis and endothelial dysfunction.”

This comment outlines the evidence that an important underlying factor for ED related to CVD is vitamin D deficiency.

The hypothesis that vitamin D deficiency is a risk factor for ED related to vascular problems was outlined in a recent paper [2]. The basis of the hypothesis was noting that the risk factors for ED and CVD were similar, and that about half of the cases of ED are related to vascular problems. It was suggested in that paper and a subsequent letter to the editor [3] that those diagnosed with ED have their vitamin D level measured and, if low, take steps to raise the level to at least 75 nmol/l (30 ng/ml).

The evidence that vitamin D reduces the risk of CVD in general and atherosclerosis, coronary artery disease, myocardial infarction, heart failure, and stroke in particular comes from observational studies [4-6]. The evidence that vitamin D deficiency is a risk factor for all-cause mortality rate has been reported in many observational studies [7].

It was noted in [1] that smokers had a higher rate of ED. While smoking is a risk factor for CVD, smoking also reduces vitamin D levels [8].

Since the study was conducted in Australia, a country with plenty of sunshine, it might be thought that people living there would have adequate vitamin D levels. Unfortunately, that is not the case, possibly due to the concern about skin cancer and melanoma for a largely fair-skinned population. A study reported in 2007 found that vitamin D levels were lower than expected based on the amount of sunlight [9].

Hopefully additional research will be conducted on the role of vitamin D in reducing the risk of ED.

References
1.Banks E, Joshy G, Abhayaratna WB, Kritharides L, Macdonald PS, et al. (2013) Erectile dysfunction severity as a risk marker for cardiovascular disease hospitalisation and all-cause mortality: A prospective cohort study. PLoS Med 10: e1001372

2. Sorenson M, Grant WB (2012) Does vitamin D deficiency contribute to erectile dysfunction? Dermatoendocrinol 4: 128–136.

3. Sorenson M, Grant WB (2013) Those with erectile dysfunction should also be tested for serum 25-hydroxyvitamin D concentration. Mayo Clin Proc 88: 121–121.

4. Anderson JL, May HT, Horne BD, Bair TL, Hall NL, et al. (2010) Relation of vitamin D deficiency to cardiovascular risk factors, disease status, and incident events in a general healthcare population. Am J Cardiol 106: 963–968.

5. Vacek JL, Vanga SR, Good M, Lai SM, Lakkireddy D, et al. (2012) Vitamin D deficiency and supplementation and relation to cardiovascular health. Am J Cardiol 109: 359–363.

6. van de Luijtgaarden KM, Voûte MT, Hoeks SE, Bakker EJ, Chonchol M, et al. (2012) Vitamin D deficiency may be an independent risk factor for arterial disease. Eur J Vasc Endovasc Surg 44: 301–306.

7. Zittermann A, Iodice S, Pilz S, Grant WB, Bagnardi V, et al. (2012) Vitamin D deficiency and mortality risk in the general population: A meta-analysis of prospective cohort studies. Am J Clin Nutr 95: 91–100.

8. Brot C, Jorgensen NR, Sorensen OH (1999) The influence of smoking on vitamin D status and calcium metabolism. Eur J Clin Nutr 53: 920–926.

9. van der Mei IA, Ponsonby AL, Engelsen O, Pasco JA, McGrath JJ, et al. (2007) The high prevalence of vitamin D insufficiency across Australian populations is only partly explained by season and latitude. Environ Health Perspect 115: 1132–1139.

Competing interests declared: I receive funding from Bio-Tech Pharmacal (Fayetteville, AR), and the Sunlight Research Forum (Veldhoven) and have received funding from the UV Foundation (McLean, VA), the Vitamin D Council (San Luis Obispo, CA), and the Vitamin D Society (Canada).