Selvin Elizabeth, Wang Dan, Tang Olive, Fang Michael, Christenson Robert H, McEvoy John W
Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
JACC Adv. 2023 Jun;2(4). doi: 10.1016/j.jacadv.2023.100380. Epub 2023 Jun 30.
The prevalence of elevated cardiac biomarkers and their link to mortality in men with erectile dysfunction in the U.S. population are unknown.
The purpose of this study was to evaluate the prevalence of elevations in N-terminal prohormone B-type natriuretic peptide, high sensitivity troponin (hs-troponin) T, and 3 hs-troponin I assays and their associations with mortality in U.S. men with and without erectile dysfunction.
We conducted cross-sectional analyses using logistic regression to examine associations of elevated cardiac biomarkers (>90th percentile) with erectile dysfunction in 2,971 male participants aged 20 years or older in the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2004. We conducted prospective analyses using Cox regression to examine the mortality implications of elevations in cardiac biomarkers in the setting of erectile dysfunction.
Elevations in hs-troponin T and the 3 hs-troponin I assays were associated with erectile dysfunction, with the strongest association for hs-troponin T (adjusted OR: 2.01; 95% CI: 1.22-3.30). Elevated N-terminal prohormone B-type natriuretic peptide was not significantly associated with erectile dysfunction (OR: 1.22; 95% CI: 0.74-2.03). There were 673 deaths during a median of 16 years of follow-up. Men with erectile dysfunction were at an elevated risk of death (adjusted HR: 1.23; 95% CI: 1.04-1.46). Those men with elevated cardiac biomarkers in the setting of erectile dysfunction were at highest risk of all-cause and cardiovascular mortality (adjusted HRs ranging from ~1.5 to 2.4).
In this national study, the association of erectile dysfunction with elevated hs-troponin and excess mortality risk suggests that men with erectile dysfunction should be evaluated and targeted for intensive cardiovascular risk management.
在美国人群中，勃起功能障碍男性心脏生物标志物升高的患病率及其与死亡率的关联尚不清楚。
本研究旨在评估N末端B型利钠肽原、高敏肌钙蛋白（hs-肌钙蛋白）T以及3种hs-肌钙蛋白I检测指标升高的患病率，及其与美国有或无勃起功能障碍男性死亡率的关联。
我们利用逻辑回归进行横断面分析，以检验2001年至2004年美国国家健康与营养检查调查（NHANES）中2971名年龄在20岁及以上男性参与者中，心脏生物标志物升高（>第90百分位数）与勃起功能障碍之间的关联。我们利用Cox回归进行前瞻性分析，以检验在勃起功能障碍背景下心脏生物标志物升高对死亡率的影响。
hs-肌钙蛋白T及3种hs-肌钙蛋白I检测指标升高与勃起功能障碍相关，其中hs-肌钙蛋白T的关联最强（校正比值比：2.01；95%置信区间：1.22 - 3.30）。N末端B型利钠肽原升高与勃起功能障碍无显著关联（比值比：1.22；95%置信区间：0.74 - 2.03）。在中位16年的随访期间有673例死亡。勃起功能障碍男性的死亡风险升高（校正风险比：1.23；95%置信区间：1.04 - 1.46）。在勃起功能障碍背景下心脏生物标志物升高的男性全因死亡率和心血管死亡率风险最高（校正风险比范围约为1.5至2.4）。
在这项全国性研究中，勃起功能障碍与hs-肌钙蛋白升高及额外死亡风险之间的关联表明，勃起功能障碍男性应接受评估，并针对强化心血管风险管理。
