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Research ArticleOriginal Research

Erectile Dysfunction and Undiagnosed Diabetes, Hypertension, and Hypercholesterolemia

Sean C. Skeldon, Allan S. Detsky, S. Larry Goldenberg and Michael R. Law
The Annals of Family Medicine July 2015, 13 (4) 331-335; DOI: https://doi.org/10.1370/afm.1816
Sean C. Skeldon
1The Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
2Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
3Department of Urological Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
MD
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  • For correspondence: sean.skeldon@ubc.ca
Allan S. Detsky
4The Institute of Health Policy, Management and Evaluation, and Department of Medicine, University of Toronto, and the Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
MD, PhD
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S. Larry Goldenberg
3Department of Urological Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
MD
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Michael R. Law
1The Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
PhD
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    Table 1

    Characteristics of Analytic Study Samples

    CharacteristicBlood Pressure Sample, No. (%)
    (n=2,224)
    Cholesterol Sample, No. (%)
    (n=2,287)
    Fasting Glucose Sample, No. (%)
    (n=1,417)
    Erectile dysfunction
     No1,874 (89.1)1,813 (87.3)1,090 (83.8)
     Yes350 (10.9)474 (12.7)327 (16.2)
    Age-group, y
     20–391,029 (49.8)1,027 (51.5)539 (43.6)
     40–59789 (40.3)732 (37.1)487 (40.5)
     ≥60350 (9.9)528 (11.5)391 (15.9)
    Ethnicity
     White1,142 (71.4)1,158 (70.4)788 (72.6)
     Black391 (9.1)441 (10.2)242 (9.8)
     Mexican American539 (10.2)542 (10.1)297 (8.5)
     Other152 (9.3)146 (9.3)90 (9.1)
    Physically activea
     No1,267 (58.1)1,329 (59.4)834 (61.2)
     Yes957 (41.9)958 (40.6)583 (38.8)
    Alcohol use
     Never159 (7.1)164 (7.3)97 (6.8)
     Former195 (8.2)209 (8.8)130 (9.1)
     Current1,870 (84.6)1,914 (83.8)1,190 (84.1)
    Current smoker
     No1,559 (69.8)1,596 (68.6)1,043 (72.5)
     Yes665 (30.2)691 (31.4)374 (27.5)
    History of hypertension
     No2,224 (100.0)1,799 (82.4)1,042 (75.6)
     Yes0 (0.0)488 (17.6)375 (24.4)
    History of high cholesterol
     No1,779 (79.5)2,287 (100.0)1,025 (72.2)
     Yes445 (20.5)0 (0.0)392 (27.8)
    History of diabetes
     No2,130 (96.9)2,159 (96.8)1,417 (100.0)
     Yes94 (3.1)128 (3.2)0 (0.0)
    History of cardiovascular diseaseb
     No2,154 (97.7)2,160 (96.8)1,282 (93.4)
     Yes70 (2.3)127 (3.2)135 (6.6)
    Family history of hypertension/strokec
     No1,668 (72.8)1,669 (70.5)1,028 (69.6)
     Yes556 (27.2)618 (29.5)389 (30.4)
    Family history of angina/heart attackc
     No1,985 (87.0)2,043 (87.0)1,263 (86.6)
     Yes239 (13.0)244 (13.0)154 (13.4)
    Family history of diabetes
     No1,217 (54.3)1,262 (55.3)779 (54.8)
     Yes1,007 (45.7)1,025 (44.7)638 (45.2)
    Weight statusd
     Normal weight/underweight681 (30.8)689 (30.8)364 (25.4)
     Overweight760 (33.6)727 (31.3)476 (33.2)
     Obese783 (35.7)871 (37.9)577 (41.5)
    Undiagnosed disease
     No1,933 (89.3)2,017 (87.9)1,352 (95.8)
     Yese291 (10.4)270 (12.1)65 (4.2)
    • Note: All percentages are probability weighted to account for the National Health and Nutrition Examination Survey sampling design.

    • ↵a Men responding “more active” to the question “Compared with most men your age, would you say that you are …” were considered to be physically active; those responding “less active” or “about the same” were considered not physically active.

    • ↵b Included angina, heart attack, coronary heart disease, congestive heart failure, or stroke.

    • ↵c Before the age of 50.

    • ↵d Using World Health Organization classification: obese (body mass index [BMI] ≥30 kg/m2 or waist circumference [WC] ≥102 cm), overweight (BMI ≥25 kg/m2 but <30 kg/m2 or WC ≥94 cm but <102 cm), or normal weight or underweight (BMI <25 kg/m2 or WC <94 cm).

    • ↵e Undiagnosed hypertension: average systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg; undiagnosed hypercholesterolemia: total cholesterol ≥6.21 mmol/L (≥240 mg/dL); undiagnosed diabetes: fasting plasma glucose level ≥126 mg/dL (≥7.0 mmol/L).

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    Table 2

    Odds Ratios (95% CIs) for Association of Erectile Dysfunction With Undiagnosed Hypertension, Hypercholesterolemia, and Diabetes Among Men Aged ≥20 Years in NHANES 2001–2004

    Undiagnosed Hypertension (n=2,224)Undiagnosed Hypercholesterolemia (n=2,287)Undiagnosed Diabetes (n=1,417)
    CharacteristicUnadjusted OR (95% CI)Adjusted OR (95% CI)Unadjusted OR (95% CI)Adjusted OR (95% CI)Unadjusted OR (95% CI)Adjusted OR (95% CI)
    Erectile dysfunction2.35 (1.78–3.11)1.27 (0.87–1.85)0.73 (0.47–1.15)0.67 (0.42–1.07)4.58 (2.54–8.24)2.20 (1.10–4.37)a
    Age-group, y
     20–39 (ref)1.001.001.001.001.001.00
     40–592.47 (1.69–3.61)2.38 (1.55–3.66)a1.88 (1.25–2.84)1.84 (1.24–2.75)a8.24 (2.49–27.19)5.56 (1.78–17.35)a
     ≥607.29 (4.90–10.84)7.41 (4.43–12.37)a1.12 (0.76–1.65)1.45 (0.87–2.43)14.83 (5.19–42.34)8.70 (2.91–26.03)a
    Ethnicity
     Non-Hispanic white (ref)1.001.001.001.001.001.00
     Non-Hispanic black1.47 (1.07–2.02)1.99 (1.34–2.97)a0.76 (0.47–1.23)0.87 (0.54–1.40)0.78 (0.39–1.56)1.25 (0.57–2.71)
     Mexican American0.64 (0.41–0.98)0.90 (0.60–1.35)0.92 (0.64–1.31)0.97 (0.65–1.46)0.25 (0.11–0.58)0.53 (0.21–1.33)
     Other0.66 (0.34–1.30)0.92 (0.46–1.85)1.13 (0.64–1.99)1.37 (0.77–2.44)1.21 (0.46–3.15)2.39 (0.87–6.55)
    Physically active0.99 (0.77–1.28)0.84 (0.62–1.13)0.82 (0.59–1.14)0.84 (0.60–1.18)0.70 (0.33–1.47)0.73 (0.35–1.55)
    Alcohol use
     Never (ref)1.001.001.001.001.001.00
     Former1.57 (0.78–3.17)1.31 (0.53–3.25)1.28 (0.54–3.04)0.90 (0.36–2.26)1.73 (0.56–5.36)1.42 (0.47–4.30)
     Current0.85 (0.47–1.51)0.95 (0.44–2.06)3.12 (1.57–6.21)2.48 (1.20–5.10)a0.62 (0.23–1.68)0.67 (0.29–1.55)
    Current smoker0.65 (0.43–0.98)0.82 (0.50–1.32)1.59 (1.16–2.18)1.65 (1.17–2.32)a0.57 (0.25–1.34)1.00 (0.41–2.41)
    History of hypertensionn/abn/ab1.10 (0.72–1.68)0.95 (0.56–1.61)3.88 (2.16–6.96)1.83 (0.92–3.65)
    History of high cholesterol1.21 (0.87–1.68)0.71 (0.48–1.05)n/abn/ab2.89 (1.68–4.98)1.55 (0.81–2.99)
    History of diabetes0.96 (0.46–1.98)0.56 (0.28–1.14)0.54 (0.27–1.08)0.45 (0.21–0.97)an/abn/ab
    History of cardiovascular disease1.11 (0.45–2.74)0.59 (0.20–1.76)1.20 (0.62–2.33)1.24 (0.60–2.59)1.48 (0.71–3.07)0.46 (0.18–1.17)
    Family history of hypertension/stroke0.90 (0.60–1.35)1.22 (0.76–1.95)0.75 (0.53–1.06)0.68 (0.47–0.99)a0.93 (0.54–1.62)0.96 (0.54–1.72)
    Family history of angina/heart attack0.59 (0.38–0.92)0.68 (0.41–1.13)1.12 (0.71–1.78)1.18 (0.74–1.90)1.36 (0.65–2.86)1.26 (0.50–3.14)
    Family history of diabetes0.93 (0.74–1.18)1.02 (0.78–1.32)1.33 (0.95–1.87)1.30 (0.92–1.84)2.24 (1.40–3.59)2.35 (1.50–3.68)a
    Weight status
     Normal weight/underweight (ref)1.001.001.001.001.001.00
     Overweight2.10 (1.45–3.04)1.75 (1.15–2.67)a2.23 (1.51–3.30)2.17 (1.46–3.23)a2.83 (0.74–10.81)2.28 (0.74–6.99)
     Obese3.11 (2.18–4.46)2.37 (1.64–3.43)a2.79 (1.70–4.58)2.74 (1.68–4.47)a5.98 (1.69–21.10)3.60 (1.30–9.93)a
    • n/a = not applicable; NHANES = National Health and Nutrition Examination Survey; OR = odds ratio; ref = reference group.

    • ↵a Statistically significant (P <.05).

    • ↵b Men with previous history excluded.

Additional Files

  • Tables
  • Supplemental Figure

    Supplementary Figure. Flowchart depicting creation of three analytic subsamples (Blood Pressure, Cholesterol, Fasting Glucose) from NHANES 2001-2004 for undiagnosed hypertension, hypercholesterolemia and diabetes.

    Files in this Data Supplement:

    • Supplemental data: Figure - PDF file
  • The Article in Brief

    Erectile Dysfunction and Undiagnosed Diabetes, Hypertension, and Hypercholesterolemia

    Sean C. Skeldon , and colleagues

    Background Previous research suggests that erectile dysfunction is an early indicator for cardiovascular disease. This study examines whether there is an association between erectile dysfunction and undiagnosed hypertension, hypercholesterolemia, or diabetes.

    What This Study Found Erectile dysfunction doubles the odds of having undiagnosed diabetes. For an average man aged 40 to 59 years, the probability of undiagnosed diabetes jumps from one in 50 to one in 10 in men with erectile dysfunction. There is no association between erectile dysfunction and undiagnosed hypertension or hypercholesterolemia.

    Implications

    • The authors call for physicians to be vigilant in obtaining sexual histories in middle-aged men and screening those with erectile dysfunction for diabetes.
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Erectile Dysfunction and Undiagnosed Diabetes, Hypertension, and Hypercholesterolemia
Sean C. Skeldon, Allan S. Detsky, S. Larry Goldenberg, Michael R. Law
The Annals of Family Medicine Jul 2015, 13 (4) 331-335; DOI: 10.1370/afm.1816

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Erectile Dysfunction and Undiagnosed Diabetes, Hypertension, and Hypercholesterolemia
Sean C. Skeldon, Allan S. Detsky, S. Larry Goldenberg, Michael R. Law
The Annals of Family Medicine Jul 2015, 13 (4) 331-335; DOI: 10.1370/afm.1816
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