The Journal of Sexual Medicine · Mar 9, 2026
Risk factors associated with cardiac dysfunction in men with erectile dysfunction
By Durukan E, Jensen CFS, Dons M et al.
BACKGROUND: Erectile dysfunction (ED) is recognized as an early marker of cardiovascular disease, but the specific clinical characteristics associated with cardiac dysfunction remain unclear. AIM: To identify risk factors for cardiac dysfunction in men with ED as assessed with echocardiography. METHODS: In this cross-sectional study, men with ED were recruited from a urology outpatient clinic and through invitations to randomly selected men >40 years. Echocardiography was used to assess left ventricular (LV) systolic and diastolic dysfunction. OUTCOMES: Associations between cardiac dysfunction and clinical variables-including age, body mass index (BMI), blood pressure, lipid profile, hemoglobin A1c (HbA1c), high-sensitivity C-reactive protein, and cardiovascular comorbidities-were examined. RESULTS: Among 398 men, univariable analyses showed that BMI, diastolic blood pressure, and high-sensitivity C-reactive protein were associated with increased odds of LV systolic dysfunction. In multivariable analysis, BMI (OR 1.08; 95% CI: 1.01-1.15), diastolic blood pressure (OR 1.04; 95% CI: 1.01-1.07), and HbA1c (OR 1.06; 95% CI: 1.01-1.12) remained significant. For LV diastolic dysfunction, BMI (OR 1.09; 95% CI: 1.00-1.19) and dyslipidemia (OR 2.54; 95% CI: 1.11-5.72) were associated with LV diastolic dysfunction. CLINICAL IMPLICATIONS: These findings support the importance of cardiovascular risk assessment and targeted prevention strategies in men with ED. STRENGTHS AND LIMITATIONS: A key strength of this study is the large, well-characterized cohort, enabling robust analyses of risk factors for cardiac dysfunction. Its cross-sectional design, however, precludes causal inference. CONCLUSION: Cardiometabolic risk factors are associated with echocardiographic signs of cardiac dysfunction in men with ED. Elevated BMI, diastolic blood pressure, and HbA1c are linked to LV systolic dysfunction, while BMI and dyslipidemia are associated with LV diastolic dysfunction. CLINICAL TRIAL REGISTRATION: The study was prospectively registered at ClinicalTrials.gov (NCT05285280).