P-468: Erectile dysfunction and smoking among men with hypertension in primary care

Erectile dysfunction (ED) affects over 30 million men in the United States, profoundly affecting their quality of life. Although cigarette smoking and hypertension are well established risk factors for ED, 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 ± 12 years) with essential hypertension who were patients of the Family Practice ambulatory care unit of the Wake Forest University School of Medicine. The sample was approximately 29% African American, and the mean duration of diagnosed hypertension was 11.1 years. Information was gathered by self-report regarding health history, including medication use and history of cigarette smoking, psychosocial orientation (affect and stress) and a 64-item symptoms checklist. ED was assessed as part of the checklist by 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 (25.4%) 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, and measures of psychosocial stress and affect. Prevalence of former and current smoking was higher among men with ED (45.0% and 47.4%, respectively) compared to men without ED (34.1% and 13.6%, respectively, p < 0.005). Clinical symptoms were almost twice as high among men with ED compared to men without ED (7.1 ± 4.4 vs. 3.6 ± 3.7, p < 0.005). After adjusting for age, mean arterial pressure, duration of diabetes and blood pressure medications, the adjusted odds for ED among current smokers was 26.8 (95% confidence interval 2.74 - 262), and 10.7 (95% CI 1.20 - 96.3) for former smokers. The adjusted odds for ED among patients with ≥ 5 clinical symptoms was 19.0 (95% CI 1.89 - 209). 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, and may provide additional motivation among hypertensive men to quit smoking.