Cardiometabolic Preventative Care in Men Presenting with Erectile Dysfunction
Leelakrishna Channa, BS1, Ilene Staff, PhD2, Tara McLaughlin, PhD2, Kevin Pinto, BS3, Laura Olivo Valentin, BS3, Jared Bieniek, MD3.
1UConn School of Medicine, Farmington, CT, USA, 2Hartford Hospital, Hartford, CT, USA, 3Tallwood Urology & Kidney Institute, Hartford HealthCare, Hartford, CT, USA.
BACKGROUND: Men generally underutilize the healthcare system, as compared to women, with lower rates of preventative visits and higher rates of many chronic conditions. As a medical condition that often drives men to seek care, erectile dysfunction (ED) commonly has a vasculogenic etiology and may predict future cardiovascular events. We hypothesize that men presenting with ED as opposed to alternative diagnoses are less engaged with physical and mental preventative health, offering a potential opportunity to improve care.
METHODS: Male patients presenting to a multidisciplinary men's health clinic were asked to complete a preventative care men's health checklist. A convenience sample of self-reported questionnaires for the year preceding the COVID pandemic (Mar 2019 - Feb 2020) were collected and charts reviewed for demographics and visit information. Checklist and patient data were compared between men with a primary diagnosis of ED and men with other urologic diagnoses. Wilcoxon ranked sum tests were employed for nonparametric continuous data while Pearson's chi squared and Fisher's exact tests were used for categorical data. SPSSv26 was used for all statistical analyses with p<0.05 considered significant.
RESULTS: During the study period, 1,706 men completed a men's health checklist. A sample of 803 men with readily available electronic data was selected for inclusion, 120 (14.9%) of which had a primary diagnosis of ED. Median age was similar between ED and non-ED patients (62.0 vs 64.2, p=0.08). No significant difference in the frequency of ED diagnosis was noted across race (p=0.14) or ethnicity (p=0.12). Body mass index (BMI) was higher among men presenting with erectile complaints (28.7 vs 27.5, p=0.003) as well as self-reported rates of weight struggles (24.1% vs 14.5%, p=0.009). Over 94% of all men reported that they had seen their primary care physician within the recommended timeframe (1-2 years based on patient age) with similar rates between ED and non-ED groups (p=0.70). Completion rates of recommended cardiometabolic screening including blood pressure assessment (p=0.79), lipid panel (p=0.52), and fasting glucose (p=0.53) were likewise comparable. Men with ED were much more likely to self-identify as needing help with their mental health (16.8% vs 6.4%, p<0.001).
CONCLUSIONS: While the vast majority of men reported routine primary care evaluation, higher BMI and self-reported difficulties with weight were more common in men with ED compared to those with other urologic complaints. Mental health concerns, which can impact cardiometabolic risk, are more commonly reported by men with ED and warrant further exploration at individual and population levels.
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