Introduction

Erectile dysfunction (ED) is the ongoing inability to get or keep an erection firm enough for sex. It affects up to 47% of men and becomes more common with age, increasing from 5% in men in their 40s to 15% in their 70s. Factors like high blood pressure, diabetes, smoking, alcohol use, obesity, and abnormal cholesterol levels contribute to ED and also to heart disease. Both conditions involve problems with blood vessels, making ED a potential early warning sign for heart disease.

Social determinants of health, such as where people live, impact health outcomes. People in rural areas often have worse health outcomes due to limited access to healthcare. Studies have shown higher death rates from chronic diseases in rural areas compared to urban ones. However, there is little research on the link between ED, heart disease, and living in rural versus urban areas.

This study aimed to explore two things: whether men with ED living in rural areas have a higher risk of major adverse cardiovascular event (MACE), and whether ED itself is a risk factor for these heart issues. The researchers expected to find that men with ED in rural settings face greater risks of heart problems.

Methods

To accomplish their objectives, the researchers conducted a study comparing men with ED to a control group without ED in Manitoba, Canada. They used health data from the Manitoba Centre for Health Policy, ensuring patient information was de-identified. The study included men from June 1996 to March 2018, excluding those with prior major heart events or insufficient health coverage.

The researchers defined ED as having at least two prescriptions for ED medications within 12 months. Participants were categorized by urban or rural residence. The primary outcome was the time to a MACE, such as heart attack, heart failure, or stroke, requiring hospitalization. Data on comorbidities and socioeconomic status were also collected.

The researchers compared the basic information and baseline characteristics of the men in the study and then looked at the risk of major heart problems over time, considering factors like age, income, and health issues. This method helped them to determine if men with ED, especially those living in rural areas, were more likely to have serious heart problems compared to men without ED.

Results

Ultimately, they found that among 430,621 men in Manitoba, Canada, those with erectile dysfunction had a higher risk of major cardiovascular events than those without ED. Specifically, 10.18% of rural men with ED experienced MACE, compared to 5.19% of rural men without ED.

For urban men, 8.25% with ED had MACE, compared to 4.20% without ED. This study showed that men with ED, particularly those in rural areas, are more likely to face serious heart problems than men without ED. Factors like age, health conditions, and income were considered to ensure accurate comparisons. The risk of MACE was higher in the first few years after an ED diagnosis and remained elevated over time.

Discussion & Conclusion

This study revealed that men in rural areas have a higher risk of MACE compared to urban residents, even after adjusting for factors like income and hypertension. Additionally, men with ED face an increased risk of MACE, with rural men with ED being the most at risk.

The authors’ key findings confirmed previous research and highlight a disparity in healthcare outcomes between rural and urban areas. Importantly, ED can serve as an early warning sign for cardiovascular issues, often preceding heart events by 3-5 years.

This underscores the need for healthcare providers to address cardiovascular risk factors in men presenting with ED, particularly in rural areas where healthcare resources might be limited. Additionally, the authors suggest that improving awareness and intervention for ED in rural communities could help mitigate the higher risks of cardiovascular events in these populations. However, limitations include potential inaccuracies in comorbidity data and the inability of the researchers to account for lifestyle factors like smoking and obesity. Further research could help build on these results.

References:

Mann, U., Bal, D. S., Panchendrabose, K., Brar, R., & Patel, P. (2024). Risk of major adverse cardiovascular events in rural vs urban settings among patients with erectile dysfunction: A propensity-weighted retrospective cohort study of 430 621 men. The Journal of Sexual Medicine, 21(6), 522–528. https://doi.org/10.1093/jsxmed/qdae043