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

What Did the Researchers Do and Find?

The researchers used information from the established 45 and Up Study, a large cohort study that includes 123,775 men aged 45 and over, selected at random from the general population of New South Wales, a large region of Australia. A total of 95,038 men were included in this analysis. The male participants completed a postal questionnaire that included a question on erectile functioning, which allowed the researchers to define erectile dysfunction as none, mild, moderate, or severe. Using information captured in the New South Wales Admitted Patient Data Collection—a complete record of all public and private hospital admissions, including the reasons for admission and the clinical diagnosis—and the government death register, the researchers were able to determine health outcomes of all study participants. They then used a statistical model to estimate hospital admissions for cardiovascular disease events for different levels of erectile dysfunction.

The researchers found that the rates of severe erectile dysfunction among study participants were 2.2% for men aged 45–54 years, 6.8% for men aged 55–64 years, 20.2% for men aged 65–74 years, 50.0% for men aged 75–84 years, and 75.4% for men aged 85 years and over. During the study period, the researchers recorded 7,855 hospital admissions related to cardiovascular disease and 2,304 deaths. The researchers found that among men without previous cardiovascular disease, those with severe erectile dysfunction were more likely to develop ischemic heart disease (risk 1.60), heart failure (risk 8.00), peripheral vascular disease (risk 1.92), and other causes of cardiovascular disease (risk 1.26) than men without erectile dysfunction. The risks of heart attacks and heart conduction problems were also increased (1.66 and 6.62, respectively). Furthermore, the combined risk of all cardiovascular disease outcomes was 1.35, and the overall risk of death was also higher (risk 1.93) in these men. The researchers found that these increased risks were similar in men with erectile dysfunction who had previously been diagnosed with cardiovascular disease.

Citation: Banks E, Joshy G, Abhayaratna WP, 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(1): e1001372. doi:10.1371/journal.pmed.1001372

Copyright: © 2013 Banks et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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

St. Jude Medical Riata Implantable Cardioverter Defibrillator ICD Leads – Premature Insulation Failure

ISSUE: The Food and Drug Administration FDA is providing information and recommendations regarding safety concerns with the recalled Riata leads. These leads have an increased risk of premature insulation failure that can impact the lead’s ability to function properly.

 

According to St. Jude Medical, as of 2011, approximately 79,000 Riata leads remained implanted in patients in the United States.

via Safety Alerts for Human Medical Products > St. Jude Medical Riata Implantable Cardioverter Defibrillator ICD Leads: Safety Communication – Premature Insulation Failure.

Bear this in mind when you’re underwriting pacemaker cases.

Six Minute Walk Test May Help Predict Cardio Risk

The 6-minute walk test may improve cardiovascular risk prediction in patients with stable coronary heart disease, researchers found.

Even after adjustment for traditional cardiovascular risk factors and measures of cardiac disease severity, each standard deviation decrease in walk distance was associated with a 30% greater risk of MI, heart failure, or death (HR 1.30, 95% CI 1.10 to 1.53), according to Alexis Beatty, MD, of the University of California San Francisco, and colleagues.

via Medical News: Walk Test May Help Predict Cardio Risk – in Cardiovascular, Atherosclerosis from MedPage Today.

New underwriting requirement for applicants with known heart disease.  Take a walk.

Effect of Aspirin on Vascular and Nonvascular Outcomes Meta-analysis

Conclusion: Despite important reductions in nonfatal MI, aspirin prophylaxis in people without prior CVD does not lead to reductions in either cardiovascular death or cancer mortality. Because the benefits are further offset by clinically important bleeding events, routine use of aspirin for primary prevention is not warranted and treatment decisions need to be considered on a case-by-case basis.

via Arch Intern Med — Abstract: Effect of Aspirin on Vascular and Nonvascular Outcomes: Meta-analysis of Randomized Controlled Trials, February 13, 2012, Seshasai et al. 172 3: 209.

Meaningful Treatments

Thankfully, we’ve learned from our mistakes. Opening blocked vessels is useful in really only two general areas:

Heart attack, where the rule of thumb is to open the tightest blockage (we refer to it as the “infarct-related artery”) and leave the rest as is.

Symptomatic blockages such as the 99% plug that caused my patient his troubles. If, on the other hand, a person has no chest pain or breathing difficulty associated with the disease, we provide no benefit by uncorking it—even if the blockage is 100%.

via Meaningful treatments in the battle against coronary disease.

Declining GFR Linked to Mortality Risk After MI

Patients with chronic kidney disease had a significantly increased risk of death after myocardial infarction, and the risk increased as glomerular filtration rate (GFR) declined, a review of 103,000 myocardial infarction patients showed.

The excess mortality risk ranged from 17% to as much as 500% as the severity of chronic kidney disease (CKD) increased. CKD predicted heightened mortality regardless of the presence or absence of ST-segment elevation.

via Medical News: ASN: Declining GFR Linked to Mortality Risk After MI – in Meeting Coverage, ASN from MedPage Today.

Watch that GFR.