Mei Yangyang, Chen Yiming, Wang Xiaogang, Xu Renfang, Xu Rui, Feng Xingliang
Department of Urology, Jiangyin People's Hospital Affiliated to Nantong University, Jiangyin, Jiangsu, China.
Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
Front Endocrinol (Lausanne). 2024 Dec 17;15:1442904. doi: 10.3389/fendo.2024.1442904. eCollection 2024.
Erectile dysfunction (ED) is considered the tip of the iceberg for cardiovascular disease (CVD). However, there is still conflicting evidence regarding their relationship. Recently, a validated tool for the Atherosclerotic Cardiovascular Disease (ASCVD) risk score has provided a key opportunity to delve deeper into the relationship between ED and CVD. Therefore, we intended to assess the relationship between ED and 10-year ASCVD risk score.
Complete data of 1207 participants from the 2001-2004 National Health and Nutrition Examination Survey (NHANES) were used in the study. Various weighted logistic and linear regression models were employed to investigate the effect of the presence of ED on the higher 10-Year ASCVD risk score or high risk of 10-Year ASCVD. Conversely, logistic regression models were repeated to explore the effect of continuous or categorical ASCVD risk score on the prevalence of ED. Sensitivity analyses were also conducted, focusing on severe ED with a more stringent definition. Additionally, we supplemented our study with subgroup analyses, restricted cubic spline (RCS) analysis, and receiver operating characteristic (ROC) analysis to enhance the robustness of our results.
Participants with ED had higher ASCVD risk scores and a higher risk of ASCVD, which corresponded to a greater prevalence of ED or severe ED. When considering the presence of ED as the exposure, our results indicated that the presence of ED increased the ASCVD risk score (Model 3: β [95%CI]: 2.09 [1.12, 3.06]) in Model 3, as well as the high risk of ASCVD (OR [95%CI]: 2.27 [1.13, 4.59]). Conversely, a continuous increase in the ASCVD risk score was also associated with an increased prevalence of ED (OR [95%CI]: 1.04 [1.02,1.06]). Additionally, those in the borderline ASCVD risk group (OR [95% CI]: 2.95 [1.60, 5.44]), intermediate ASCVD risk group (OR [95% CI]: 4.53 [2.35, 8.73]), and high ASCVD risk group (OR [95% CI]: 7.62 [3.19, 18.19]) exhibited progressively increasing ED risk when compared to the low-risk group. Furthermore, the RCS analysis demonstrated a linear relationship between ED prevalence and the continuous ASCVD risk score, with the latter showing high efficacy in predicting ED (AUC [95%CI]: 0.794 [0.768, 0.821]).
The presence of ED may precede the onset of ASCVD by some years. Consequently, timely and dynamic evaluation of the cardiovascular status provides an earlier opportunity to identify and implement effective prevention strategies to promote cardiovascular health for ED patients.
勃起功能障碍（ED）被认为是心血管疾病（CVD）的冰山一角。然而，关于它们之间的关系仍存在相互矛盾的证据。最近，一种经过验证的动脉粥样硬化性心血管疾病（ASCVD）风险评分工具为更深入地探究ED与CVD之间的关系提供了关键契机。因此，我们旨在评估ED与10年ASCVD风险评分之间的关系。
本研究使用了2001 - 2004年国家健康与营养检查调查（NHANES）中1207名参与者的完整数据。采用各种加权逻辑回归和线性回归模型来研究ED的存在对较高的10年ASCVD风险评分或10年ASCVD高风险的影响。相反，重复逻辑回归模型以探讨连续或分类的ASCVD风险评分对ED患病率的影响。还进行了敏感性分析，重点关注定义更严格的重度ED。此外，我们通过亚组分析、受限立方样条（RCS）分析和受试者工作特征（ROC）分析来补充我们的研究，以增强结果的稳健性。
患有ED的参与者具有更高的ASCVD风险评分和更高的ASCVD风险，这对应于ED或重度ED的患病率更高。当将ED的存在视为暴露因素时，我们的结果表明，在模型3中，ED的存在增加了ASCVD风险评分（模型3：β[95%置信区间]：2.09[1.12，3.06]）以及ASCVD的高风险（比值比[95%置信区间]：2.27[1.13，4.59]）。相反，ASCVD风险评分的持续增加也与ED患病率的增加相关（比值比[95%置信区间]：1.04[1.02，1.06]）。此外，与低风险组相比，边缘ASCVD风险组（比值比[95%置信区间]：2.95[1.60，5.44]）、中度ASCVD风险组（比值比[95%置信区间]：4.53[2.35，8.73]）和高ASCVD风险组（比值比[95%置信区间]：7.62[3.19，18.19]）的ED风险逐渐增加。此外，RCS分析表明ED患病率与连续的ASCVD风险评分之间存在线性关系，后者在预测ED方面显示出高效性（曲线下面积[95%置信区间]：0.794[0.768，0.821]）。
ED的存在可能比ASCVD的发病提前数年。因此，及时和动态地评估心血管状况为识别和实施有效的预防策略提供了更早的机会，以促进ED患者的心血管健康。
