Association of erectile dysfunction with all-cause and cardiovascular mortality in US men: findings from NHANES 2001-2004 with 16-year follow-up.

Erectile dysfunction (ED) is a common condition in men; however, evidence of its association with mortality is limited. We examined the association between ED and long-term all-cause and cardiovascular (CV) mortality in a nationally representative cohort of adult men. This prospective cohort study included data from men aged 20 years and older from the 2001-2004 National Health and Nutrition Examination Survey linked to National Death Index records through December 31, 2019. ED was defined as reporting sometimes or never being able to achieve or maintain an erection adequate for satisfactory intercourse. Primary outcomes were the associations of ED with all-cause and  CV mortality, evaluated using survey-weighted Cox proportional hazards regression models. Among 4 110 men followed for a median of 16.3 years, 1 226 deaths (419 CV deaths) occurred. In fully adjusted models, ED was independently associated with an increased risk of all-cause (HR, 1.45; 95% CI, 1.20-1.75) and CV (HR, 1.57; 95% CI, 1.12-2.19) mortality. The magnitude of these associations was similar to those observed for other CV risk factors such as diabetes mellitus, hypertension, and stroke. These findings suggest the need to broaden clinical perspectives on ED beyond sexual health to recognize its significance as a marker of mortality risk.