Smoking, Hypertension, And Erectile Dysfunction

Journal of Family Practice, Jan, 2001 by John G. Spangler, John H. Summerson, Ronny A. Bell, Joseph C. Konen

TO THE EDITOR:

Erectile dysfunction (ED) affects more than 30 million men in the United States, profoundly influencing their quality of life.[1] Although cigarette smoking and hypertension are well-established risk factors for ED,[1-5] the effect of cigarette smoking on ED has not been previously quantified among men in a primary care setting.

We gathered information on 59 men (mean age=59 [ or -] 12 years) with essential hypertension who were patients of the family practice ambulatory care clinic of the Wake Forest University School of Medicine. The sample population was approximately 29% African American, and the mean duration of diagnosed hypertension was 11 years. Information was gathered by self-report of health history, including medication use, history of cigarette smoking, psychosocial orientation (affect and stress), and a 64-item symptom checklist. ED was assessed as part of the checklist through response to the question, "Within the past month, have you had impotence or difficulty with erections?" Serum lipids, insulin, and glucose were also assessed from a blood draw after a 12-hour fast.

Overall, 15 men (25%) were classified as having ED. Men with and without ED did not differ significantly by age, duration of hypertension, blood pressure, fasting insulin or cholesterol levels, or measures of psychosocial stress and affect. Prevalence of former and current smoking was higher among men with ED (40% and 53%, respectively) compared with men who did not have it (14% and 34%, respectively; P [is less than] .005). Clinical symptoms were almost twice as high among men with ED compared with men who did not have it (7.1 [ or -] 4.4 vs 3.6 [ or -] 3.7, P [is less than] .005). After adjusting for age, mean arterial pressure, duration of diabetes, and blood pressure medications, the adjusted odds for ED among current smokers was 27 (95% confidence interval [CI], 2.7-202), and 11 (95% CI, 1-96) for former smokers. The adjusted odds for ED among patients with 5 or more clinical symptoms was 19 (95% CI, 1.9-209).

The large odds ratios and wide confidence intervals should be interpreted with caution, since there was only 1 never-smoking hypertensive patient with ED. However, despite the small sample size these data indicate a significant adverse effect of cigarette smoking on ED, even among former smokers and after controlling for Other risk factors. These data are consistent in direction with larger epidemiologic studies, even to the extent of showing a doubling of risk of ED among current smokers relative to former smokers. Smoking history should be ascertained among all primary care patients, particularly those with ED. Informing primary care patients with hypertension about the high risk of ED associated with cigarette smoking should become a standard part of care for these patients and may provide additional motivation to quit.

John G. Spangler, MD, MPH John H. Summerson, MS Ronny A. Bell, PhD, MS Wake Forest University School of Medicine Winston-Salem, NC Joseph C. Konen, MD, MSPH Carolinas Medical Center Charlotte, NC

REFERENCES

[1.] Impotence: National Institutes of Health Consensus Development Panel on Impotence Conference. JAMA 1993; 270:83.

[2.] Jeremy JY, Mikhailidis DP. Cigarette smoking and erectile dysfunction. J Royal Society Health 1998; 115:151-55.

[3.] Mannino DM, Klevens RM, Flanders WD. Cigarette smoking: an independent risk factor for impotence. Am J Epidemiol 1994; 140:1003.

[4.] Condra M, Morales A, Owen JA, Surridge DH, Fenemore J. Prevalence and significance of tobacco smoking in impotence. Urology 1986; 27:495.

[5.] Hirshkowitz M, Karacan I, Howell JW, Arcasoy MO, Williams RL Nocturnal penile tumescence in cigarette smokers with erectile dysfunction. Urology 1992; 39:101.