Prognostic value of exercise capacity among men undergoing pharmacologic treatment for erectile dysfunction: The FIT Project

Robert V. Same, Mahmoud Al Rifai, David I. Feldman, Kevin Lenuell Billups, Clinton A. Brawner, Zeina A. Dardari, Jonathan K. Ehrman, Steven J. Keteyian, Mouaz H. Al-Mallah, Michael Blaha

Research output: Contribution to journalArticle

Abstract

Background: Vascular erectile dysfunction (ED) has been identified as a potentially useful risk factor for predicting future cardiovascular events, particularly in younger men. Because these men typically score more favorably on traditional cardiovascular disease risk assessment tools, there exists a gap in knowledge for how to most appropriately identify those men who would benefit from more aggressive treatments. To date, no studies have examined the impact of fitness on cardiovascular outcomes in men with ED. This study sought to examine the prognostic impact of maximal exercise capacity on cardiovascular-related outcomes in men ages 40 to 60 years being treated for ED. Hypothesis: We hypothesized that there would be an independent association between higher baseline fitness level and lower cardiovascular events. Methods: We analyzed 1152 men with pharmacy claims file–confirmed active pharmacologic treatment for ED from the Henry Ford Exercise Testing (FIT) Project (1991–2009). All patients were free of coronary heart disease and heart failure, and underwent clinician-referred exercise stress testing, with fitness measured in metabolic equivalents of task (METs). Multivariable Cox proportional hazard models adjusted for traditional cardiovascular risk factors were used to study the association between fitness and all-cause mortality, major adverse cardiovascular events (MACE) (defined as myocardial infarction or revascularization), and incident type 2 diabetes mellitus. Results: The mean age of the population was 53 years, with 39% African Americans. In multivariable analysis, each 1 MET of fitness was associated with a 16% lower risk of death (hazard ratio [HR]: 0.84, 95% confidence interval [CI]: 0.76-0.94, P = 0.002), and a nonsignificant reduction in MACE (HR: 0.89, 95% CI: 0.79-1.003, P = 0.048), and incident diabetes (HR: 0.92, 95% CI: 0.85-1.01, P = 0.129). Conclusions: Higher baseline fitness is associated with improved cardiovascular prognosis in a population of middle-aged men treated for ED.

Original languageEnglish (US)
Pages (from-to)1049-1054
Number of pages6
JournalClinical Cardiology
Volume40
Issue number11
DOIs
StatePublished - Nov 1 2017

Fingerprint

Erectile Dysfunction
Exercise
Metabolic Equivalent
Confidence Intervals
Therapeutics
Myocardial Revascularization
Exercise Test
Proportional Hazards Models
African Americans
Type 2 Diabetes Mellitus
Population
Coronary Disease
Blood Vessels
Cardiovascular Diseases
Heart Failure
Myocardial Infarction
Mortality

Keywords

  • Endothelial Function/Dysfunction
  • Exercise Physiology
  • Exercise Testing
  • Preventive Cardiology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prognostic value of exercise capacity among men undergoing pharmacologic treatment for erectile dysfunction : The FIT Project. / Same, Robert V.; Al Rifai, Mahmoud; Feldman, David I.; Billups, Kevin Lenuell; Brawner, Clinton A.; Dardari, Zeina A.; Ehrman, Jonathan K.; Keteyian, Steven J.; Al-Mallah, Mouaz H.; Blaha, Michael.

In: Clinical Cardiology, Vol. 40, No. 11, 01.11.2017, p. 1049-1054.

Research output: Contribution to journalArticle

Same, RV, Al Rifai, M, Feldman, DI, Billups, KL, Brawner, CA, Dardari, ZA, Ehrman, JK, Keteyian, SJ, Al-Mallah, MH & Blaha, M 2017, 'Prognostic value of exercise capacity among men undergoing pharmacologic treatment for erectile dysfunction: The FIT Project', Clinical Cardiology, vol. 40, no. 11, pp. 1049-1054. https://doi.org/10.1002/clc.22768
Same, Robert V. ; Al Rifai, Mahmoud ; Feldman, David I. ; Billups, Kevin Lenuell ; Brawner, Clinton A. ; Dardari, Zeina A. ; Ehrman, Jonathan K. ; Keteyian, Steven J. ; Al-Mallah, Mouaz H. ; Blaha, Michael. / Prognostic value of exercise capacity among men undergoing pharmacologic treatment for erectile dysfunction : The FIT Project. In: Clinical Cardiology. 2017 ; Vol. 40, No. 11. pp. 1049-1054.
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abstract = "Background: Vascular erectile dysfunction (ED) has been identified as a potentially useful risk factor for predicting future cardiovascular events, particularly in younger men. Because these men typically score more favorably on traditional cardiovascular disease risk assessment tools, there exists a gap in knowledge for how to most appropriately identify those men who would benefit from more aggressive treatments. To date, no studies have examined the impact of fitness on cardiovascular outcomes in men with ED. This study sought to examine the prognostic impact of maximal exercise capacity on cardiovascular-related outcomes in men ages 40 to 60 years being treated for ED. Hypothesis: We hypothesized that there would be an independent association between higher baseline fitness level and lower cardiovascular events. Methods: We analyzed 1152 men with pharmacy claims file–confirmed active pharmacologic treatment for ED from the Henry Ford Exercise Testing (FIT) Project (1991–2009). All patients were free of coronary heart disease and heart failure, and underwent clinician-referred exercise stress testing, with fitness measured in metabolic equivalents of task (METs). Multivariable Cox proportional hazard models adjusted for traditional cardiovascular risk factors were used to study the association between fitness and all-cause mortality, major adverse cardiovascular events (MACE) (defined as myocardial infarction or revascularization), and incident type 2 diabetes mellitus. Results: The mean age of the population was 53 years, with 39{\%} African Americans. In multivariable analysis, each 1 MET of fitness was associated with a 16{\%} lower risk of death (hazard ratio [HR]: 0.84, 95{\%} confidence interval [CI]: 0.76-0.94, P = 0.002), and a nonsignificant reduction in MACE (HR: 0.89, 95{\%} CI: 0.79-1.003, P = 0.048), and incident diabetes (HR: 0.92, 95{\%} CI: 0.85-1.01, P = 0.129). Conclusions: Higher baseline fitness is associated with improved cardiovascular prognosis in a population of middle-aged men treated for ED.",
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AU - Same, Robert V.

AU - Al Rifai, Mahmoud

AU - Feldman, David I.

AU - Billups, Kevin Lenuell

AU - Brawner, Clinton A.

AU - Dardari, Zeina A.

AU - Ehrman, Jonathan K.

AU - Keteyian, Steven J.

AU - Al-Mallah, Mouaz H.

AU - Blaha, Michael

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N2 - Background: Vascular erectile dysfunction (ED) has been identified as a potentially useful risk factor for predicting future cardiovascular events, particularly in younger men. Because these men typically score more favorably on traditional cardiovascular disease risk assessment tools, there exists a gap in knowledge for how to most appropriately identify those men who would benefit from more aggressive treatments. To date, no studies have examined the impact of fitness on cardiovascular outcomes in men with ED. This study sought to examine the prognostic impact of maximal exercise capacity on cardiovascular-related outcomes in men ages 40 to 60 years being treated for ED. Hypothesis: We hypothesized that there would be an independent association between higher baseline fitness level and lower cardiovascular events. Methods: We analyzed 1152 men with pharmacy claims file–confirmed active pharmacologic treatment for ED from the Henry Ford Exercise Testing (FIT) Project (1991–2009). All patients were free of coronary heart disease and heart failure, and underwent clinician-referred exercise stress testing, with fitness measured in metabolic equivalents of task (METs). Multivariable Cox proportional hazard models adjusted for traditional cardiovascular risk factors were used to study the association between fitness and all-cause mortality, major adverse cardiovascular events (MACE) (defined as myocardial infarction or revascularization), and incident type 2 diabetes mellitus. Results: The mean age of the population was 53 years, with 39% African Americans. In multivariable analysis, each 1 MET of fitness was associated with a 16% lower risk of death (hazard ratio [HR]: 0.84, 95% confidence interval [CI]: 0.76-0.94, P = 0.002), and a nonsignificant reduction in MACE (HR: 0.89, 95% CI: 0.79-1.003, P = 0.048), and incident diabetes (HR: 0.92, 95% CI: 0.85-1.01, P = 0.129). Conclusions: Higher baseline fitness is associated with improved cardiovascular prognosis in a population of middle-aged men treated for ED.

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