Erectile dysfunction and major adverse cardiovascular events in patients with prostate cancer: A propensity score matching study

Erectile dysfunction (ED) and cardiovascular diseases share common pathological mechanisms of endothelial dysfunction and risk factors, and ED serves as a potential independent risk factor for cardiovascular diseases. This study aimed to investigate the association between ED and major adverse cardiovascular events in patients with prostate cancer (PCa). Adult patients diagnosed with PCa in Hong Kong, China between January 1999 and June 2024 were identified. Propensity score matching at a 1:4 ratio was used to minimize the influence of confounding factors. The primary endpoint of the study was the incidence of new-onset four-point major adverse cardiovascular events (4P-MACE), defined as the first occurrence of all-cause mortality, myocardial infarction, heart failure, or stroke. The secondary endpoint was all-cause mortality. After propensity score matching, 129 patients were assigned to the ED group and 480 patients to the non-ED group over a median follow-up duration of 6.8 (IQR: 2.4–11.2) years. Patients with ED had significantly higher risks of 4P-MACE (hazard ratio [HR] 1.49, 95% CI 1.14–1.95, p =0.004) and all-cause mortality (HR 1.38, 95% CI 1.07–1.79, p =0.014). Among patients with ED, phosphodiesterase 5 inhibitor (PDE5i) users demonstrated significantly lower risks of 4P-MACE (HR 0.22, 95% CI 0.07–0.66, p =0.004) and all-cause mortality (HR 0.34, 95% CI 0.11–0.92, p =0.043) compared to non-PDE5i users. ED is associated with increased cardiovascular risk in patients with PCa, and the use of PDE5i may be associated with a lower incidence of 4P-MACE and all-cause mortality.