Abstract 1305: Erectile Dysfunction Predicts Cardiovascular Events in High Risk Patients Receiving Telmisartan, Ramipril or Both
Background: Erectile Dysfunction (ED) is associated with cardiovascular risk factors and atherosclerosis. Inhibition of the renin-angiotensin system in high-risk patients reduces cardiovascular events. The predictive power of ED in individuals with cardiovascular disease for future outcomes is unknown. We evaluated whether ED is predictive for mortality and cardiovascular outcomes and tested the effects on ED of randomized treatments with telmisartan, ramipril and the combination of the two drugs (ONTARGET) as well as with telmisartan or placebo in ACE-inhibitor intolerant patients (TRANSCEND).
Methods and Results: In a pre-specified substudy, 1549 patients underwent double blind randomization with 400 participants to receive ramipril, 395 telmisartan and 381 the combination (ONTARGET), and 171 telmisartan and 202 placebo (TRANSCEND). Outcomes and ED were evaluated at 2 years and the penultimate visits. ED was predictive for all cause death (HR 2.04, 1.4 –2.97, p<0.0002), and the composite outcome (HR 1.62, 1.22–2.17, p<0.0001) consisting of cardiovascular death (HR 2.26, 1.4 –3.64, p<0.0009), myocardial infarction (HR 1.73, 1.02–2.91, p<0.04), hospitalization for chronic heart failure (HR 1.57, 0.87–2.84, p<0.1324) and stroke (HR 1.31, 0.78 –2.21, p=0.3101). These associations were robust when adjusted for age, systolic and diastolic blood pressure, smoking, history of hypertension and diabetes. Trial treatments neither influenced the course or development of ED nor adversely affected erectile function.
Conclusions: ED is a potent predictor of all cause death and the composite of cardiovascular death, myocardial infarction, stroke and heart failure. No trial treatment significantly improved or worsened ED.