Erectile Dysfunction and Cardiovascular Disease Risk: An Updated 2024 Systematic Review Meta-Analysis of Prospective Studies

Abstract Background: Erectile dysfunction (ED) has been suggested to be associated with an increased risk of cardiovascular disease (CVD), including coronary artery disease, stroke, and cardiovascular mortality This meta-analysis aims to investigate the relationship between ED and CVD risk using PRISMA 2020 guidelines for reporting systematic reviews and evaluate the risk of specific cardiovascular events such as coronary artery disease (CAD), myocardial infarction (MI), stroke, and cardiovascular mortality. Methods: A systematic literature search was conducted in PubMed, Embase, Cochrane Library, and Web of Science databases from January 2009 to December 2023. Studies were selected based on predefined inclusion criteria. Data extraction and quality assessment were performed independently by two reviewers. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed using the I statistic and Q test. For 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. Results: This updated meta-analysis of prospective studies provides robust evidence that ED was found to be an independent risk factor for CVD outcomes, including coronary artery disease, stroke, and cardiovascular mortality. Clinicians should consider early identification and management of ED, such initiative has great potential to improve cardiovascular risk and using it as stratification criteria would help CVD prevention strategies in men. Keywords: erectile dysfunction, cardiovascular disease, coronary artery disease, stroke, cardiovascular mortality, risk factors, endothelial dysfunction, meta-analysis