Erectile dysfunction in RA tied to lower risk of heart failure, myocardial infarction

The incidence of erectile dysfunction (ED) is not statistically higher in patients with rheumatoid arthritis (RA), a study has found. ED also does not increase the overall rate of cardiovascular events in RA, but it contributes to an increased risk of peripheral arterial disease (PAD) and a decreased risk of myocardial infarction (MI), heart failure (HF), and death.

“While these trends require further study, they may be explained by common pathologic mechanisms, healthcare-related confounding variables, or the use of vasoactive pharmacologic therapy for ED,” the researchers said.

In this population-based cohort study, a comprehensive medical record system was used to extract data concerning RA, ED, and cardiovascular diagnoses for men with RA (n=260) diagnosed in Olmsted County, Minnesota, US, as well as age-matched male comparators. [J Rheumatol 2021;48:1641-1647]

ED incidence did not significantly differ between the RA cohort and comparators (hazard ratio [HR], 0.80, 95 percent confidence interval [CI], 0.55–1.16). Previous studies reported either an increased prevalence of ED in RA or similar to rates of ED in controls. [Arthritis Rheum 1984;27:217-220; Egypt Rheumatol 2013;35:201-205; J Rheumatol 1987;14:570-576; Ann Rheum Dis 2012;71:1102-1103]

“In this study, we did not observe an increased rate of ED in men with RA,” the researchers said. “This could be secondary to well-controlled RA disease activity, as inflammatory disease activity increases ED prevalence.” [Egypt Rheumatol 2017;39:135-138; Clin Rheumatol 2012;31:601-606; Semin Arthritis Rheum 2020;50:557-573]

Moreover, ED diagnosis in men with RA correlated with a trend toward a higher risk of PAD (HR, 2.22, 95 percent CI, 0.98–5.03) and a significantly lower rate of MI (HR, 0.26, 95 percent CI, 0.07–0.90), HF (HR, 0.49, 95 percent CI, 0.25–0.94), and death (HR, 0.56, 95 percent CI, 0.36–0.87).

In men with RA and ED, use of phosphodiesterase-5 (PDE5) inhibitor resulted in a reduced risk of death (HR, 0.35, 95 percent CI, 0.16–0.79), with a trend toward a lower risk of some cardiovascular diagnoses.

“Although it would seem that more frequent follow-up in men with RA could lead to increased access to cardiovascular preventive measures, previous studies have shown that patients with RA have suboptimal cardiovascular prevention,” the researchers said. [Scand J Rheumatol 2019;48:345-352; Rheumatology 2018;57:1789-1794; Rheumatology 2017;56:1472-1478]

“Cardiovascular risk may also be confounded as the men who are diagnosed with ED may have variation in health-based limitations for sexual activity, capacity for self-care, independence, and education concerning sexual health,” they added.

“Another less likely possibility is that vasoactive medications, such as PDE5 inhibitors, which are used for ED, may have additional CV benefits in this population,” the researchers said.

Further research on the implications of ED on cardiovascular risk is warranted to improve the assessment and treatment of such risk in inflammatory arthritis.

“[A]ssessment of whether ED is a reflection of traditional cardiovascular risk or is altered by the inflammatory state could help to inform risk-based models,” the researchers said.