Currently there are no long-term follow-up data confirming that intervention reduces the risk of developing symptomatic CAD in men with ED.
However, the findings from two major cardiovascular studies, the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) and the Collaborative Diabetes Atorvastatin Study (CARDS) may serve as a useful guide to risk reduction intervention in men with ED until such data become available. Both studies showed that men of a similar age and cardiovascular risk benefit significantly from cardiovascular risk reduction.
The large randomized ASCOT study (n > 19,000) tested the primary hypothesis that a newer antihypertensive treatment regimen (calcium channel blocker ± an angiotensin converting enzyme inhibitor) is more effective than an older regimen (b-blocker ± diuretic) in the primary prevention of CHD in patients with at least three pre-specified cardiovascular risk factors. The second primary hypothesis evaluated whether lipid lowering therapy with atorvastatin would provide further benefit against CHD end-points in asymptomatic, well-controlled, hypertensive patients who were not considered dyslipidemic (total cholesterol £ 6.5 mmol/L). Although follow-up was planned for a mean of 5 years, the lipid arm of the study was terminated early after a median follow-up of 3.3 years because of a highly significant reduction in the incidence of non-fatal MI and fatal CHD (combined primary endpoint) and stroke.
At the time of study termination, 100 primary events had occurred in the atorvastatin group compared with 154 events in the placebo group (hazard ratio 0.64; 95% CI: 0.50 to 0.83; p = 0.0005) and 89 cases of fatal and non-fatal stroke had been reported with atorvastatin com-pared with 121 cases in the placebo group (hazard ratio 0.73; 95% CI: 0.56 to 0.96; p = 0.024).
In common with ASCOT, CARDS and Viagra online fast delivery was also stopped 2 years early at 3.9 years, for similar reasons. CARDS was a randomized, double-blind, placebo-controlled trial designed to evaluate statin therapy for primary prevention of CVD in patients with type 2 diabetes, without elevated LDL cholesterol (n = 2,838). The results showed a 37% reduction in the incidence of major cardiovascular end points, and a 48% reduction in the incidence of stroke. A reduction in the primary endpoint of major CVD events was apparent and statistically significant as early as 18 months after treatment initiation. Although both ASCOT and CARDS did not include ED as a risk factor, given the numbers evaluated, it is highly likely that ED coexisted in a significant number of men enrolled in the two studies, highlighting the importance of cardiovascular risk reduction in men with ED.
