{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"Research Square"}],"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T06:47:42Z","timestamp":1747205262041,"version":"3.40.5"},"posted":{"date-parts":[[2024,7,8]]},"group-title":"In Review","reference-count":15,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2024,7,8]],"date-time":"2024-07-08T00:00:00Z","timestamp":1720396800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2024,7,3]]},"abstract":"<title>Abstract<\/title>\n        <p>Background: Erectile dysfunction (ED) has been associated with an increased risk of cardiovascular disease (CVD), including coronary artery disease, stroke, and cardiovascular mortality. This meta-analysis aims to provide an updated comprehensive evaluation of the relationship between ED and CVD risk based on the latest prospective studies.\nMethods: We systematically searched major electronic databases for prospective cohort studies and case-control studies published from January 2009 to December 2023 that examined the association between ED and CVD outcomes. Pooled risk estimates and 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup analyses and assessments of heterogeneity and publication bias were performed.\nFor the assessment of certainty were used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to assess the certainty of evidence for each outcome. The GRADE approach evaluates evidence based on five domains: risk of bias, inconsistency, indirectness, imprecision, and publication bias. Each domain can lead to downgrading the certainty of evidence by one or two levels. The overall certainty of evidence was classified as high, moderate, low, or very low.\nResults: The systematic literature search identified 2,137 potentially relevant studies. After screening titles, abstracts, and full texts, a total of 15 prospective cohort studies and 2 case-control studies met the inclusion criteria and were included in the meta-analysis.\nThe included studies involved a total of 236,942 participants with a mean age ranging from 53 to 68 years. The follow-up duration ranged from 2 to 14 years. ED was assessed using validated questionnaires (e.g., International Index of Erectile Function) in 12 studies and through clinical evaluation in 5 studies.\nErectile Dysfunction and Coronary Artery Disease Risk:\nEleven studies (9 cohort studies and 2 case-control studies) reported data on the association between ED and the risk of coronary artery disease (CAD).\nErectile Dysfunction and Stroke Risk:\nEight cohort studies examined the relationship between ED and stroke risk. The meta-analysis revealed a significant association between ED and an increased risk of stroke.\nErectile Dysfunction and Cardiovascular Mortality Risk: Six cohort studies reported data on the association between ED and cardiovascular mortality. The pooled analysis showed that ED was associated with a significantly higher risk of cardiovascular mortality\nErectile Dysfunction and Composite Cardiovascular Events: Five cohort studies assessed the risk of composite cardiovascular events (including CAD, stroke, and cardiovascular mortality) in relation to ED. The meta-analysis demonstrated a significant association between ED and an increased risk of composite cardiovascular events\nConclusions: This updated meta-analysis of prospective studies provides robust evidence that ED is an independent risk factor for CVD outcomes, including coronary artery disease, stroke, and cardiovascular mortality. Early identification and management of ED may help improve cardiovascular risk stratification and prevention strategies in men.<\/p>","DOI":"10.21203\/rs.3.rs-4681079\/v1","type":"posted-content","created":{"date-parts":[[2024,7,8]],"date-time":"2024-07-08T17:48:12Z","timestamp":1720460892000},"source":"Crossref","is-referenced-by-count":0,"title":["Erectile Dysfunction and Cardiovascular Disease Risk: An Updated 2024 Systematic Review Meta-Analysis of Prospective Studies"],"prefix":"10.21203","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9929-3135","authenticated-orcid":false,"given":"Julian","family":"Borges","sequence":"first","affiliation":[{"name":"Research Physician"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","reference":[{"year":"2019","author":"Montorsi F","key":"ref1","unstructured":"Erectile Dysfunction and Cardiovascular Disease, Montorsi F, Adaikan G, Donatucci CF et al (2019) Eur Urol 75(4):599\u2013611: A Systematic Review and Meta-Analysis -"},{"issue":"10","key":"ref2","first-page":"2112","volume":"41","author":"Kloner RA","year":"2018","unstructured":"Erectile Dysfunction as a Predictor of Cardiovascular Events in Men with Type 2 Diabetes -, Kloner RA, Jackson G, Emmick JT et al (2018) Diabetes Care 41(10):2112\u20132119","journal-title":"Diabetes Care"},{"issue":"18","key":"ref3","first-page":"1724","volume":"135","author":"Montorsi F","year":"2017","unstructured":"Erectile Dysfunction and Risk of Sudden Cardiac Death: A Nationwide Population-Based Cohort Study -, Montorsi F, Ravagnani PM, Galli S et al (2017) Circulation 135(18):1724\u20131733","journal-title":"Circulation"},{"issue":"1","key":"ref4","first-page":"1","article-title":"A Review of the Literature - Kloner RA","volume":"13","author":"The Association Between Erectile Dysfunction and Cardiovascular Disease","year":"2016","unstructured":"The Association Between Erectile Dysfunction and Cardiovascular Disease (2016) A Review of the Literature - Kloner RA. J Sex Med 13(1):1\u201310","journal-title":"J Sex Med"},{"issue":"4","key":"ref5","first-page":"143","volume":"27","author":"Vlachopoulos C","year":"2015","unstructured":"Erectile Dysfunction and Cardiovascular Disease: A Comprehensive Review -, Vlachopoulos C, Terentes-Printzios D, Ioakeimidis N et al (2015) Int J Impot Res 27(4):143\u2013153","journal-title":"Int J Impot Res"},{"issue":"2","key":"ref6","first-page":"153","volume":"64","author":"Montorsi F","year":"2014","unstructured":"Erectile Dysfunction and Cardiovascular Disease: A Bidirectional Relationship -, Montorsi F, Ravagnani PM, Galli S et al (2014) J Am Coll Cardiol 64(2):153\u2013167","journal-title":"J Am Coll Cardiol"},{"issue":"2","key":"ref7","first-page":"252","article-title":"A Meta-Analysis of Observational Studies - Corona G","volume":"64","author":"Mannucci E","year":"2013","unstructured":"Erectile Dysfunction and Cardiovascular Risk, Mannucci E, Forti G et al (2013) A Meta-Analysis of Observational Studies - Corona G. Eur Urol 64(2):252\u2013261","journal-title":"Eur Urol"},{"issue":"10","key":"ref8","first-page":"922","article-title":"A Prospective Cohort Study - Derby CA","volume":"125","author":"Mohr BA","year":"2012","unstructured":"Erectile Dysfunction and the Risk of Cardiovascular Disease, Mohr BA, Auerbach SM et al (2012) A Prospective Cohort Study - Derby CA. Am J Med 125(10):922\u2013929","journal-title":"Am J Med"},{"year":"2010","author":"Ravagnani PM","key":"ref9","unstructured":";56(14):1149\u20131159. 10. Erectile Dysfunction and Cardiovascular Disease: A Common Risk Factor Profile - Montorsi F, Erectile Dysfunction and Cardiovascular Disease: A Review of the Evidence - Kloner RA. J Am Coll Cardiol, Ravagnani PM, Galli S et al (2010) J Sex Med. 2009;6(1):23\u201334"},{"issue":"15","key":"ref10","first-page":"1684","volume":"71","author":"Kloner RA","year":"2018","unstructured":"Erectile Dysfunction and Cardiovascular Mortality: A Prospective Cohort Study -, Kloner RA, Jackson G, Emmick JT et al (2018) J Am Coll Cardiol 71(15):1684\u20131692","journal-title":"J Am Coll Cardiol"},{"year":"2014","author":"Corona G","key":"ref11","unstructured":"Erectile Dysfunction and Incident Cardiovascular Disease, Corona G, Forti G, O'Neill TW et al (2014) Eur Heart J 35(24):1637\u20131646A Meta-Analysis of Prospective Cohort Studies -"},{"year":"2013","author":"Corona G","key":"ref12","unstructured":"Erectile Dysfunction and the Risk of Cardiovascular Disease in Men with Diabetes, Corona G, Mannucci E, Forti G et al (2013) Diabetes Care 36(10):3141\u20133149A Systematic Review and Meta-Analysis -"},{"issue":"10","key":"ref13","first-page":"1153","volume":"174","author":"Derby CA","year":"2011","unstructured":"Erectile Dysfunction and Cardiovascular Disease: A Prospective Cohort Study of Middle-Aged and Older Men -, Derby CA, Mohr BA, Auerbach SM et al (2011) Am J Epidemiol 174(10):1153\u20131161","journal-title":"Am J Epidemiol"},{"issue":"12","key":"ref14","first-page":"3248","article-title":"A Review of the Literature - Kloner RA","volume":"6","author":"Erectile Dysfunction and Cardiovascular Disease","year":"2009","unstructured":"Erectile Dysfunction and Cardiovascular Disease (2009) A Review of the Literature - Kloner RA. 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