ED Risk Higher Among Regular NSAID Users

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PARIS—Men who routinely take nonsteroidal anti-inflammatory drugs (NSAIDs) have a higher rate of erectile dysfunction (ED) than what might be ordinarily expected for their age and comorbidity, new data suggest.

The findings, from a large, multi-ethnic cohort, showed that regular NSAID users were roughly 60% more likely to report ED than men who did not report regular NSAID use. Steven J. Jacobsen, MD, PhD, Director of Research at Kaiser Permanente Southern California in Pasadena, presented the results here at the 3rd International Consultation on Sexual Medicine (ICSM).

“Our study used a cross-sectional design, which means that we don't know from the present analysis if the ED was present prior to or after regular NSAID exposure,” Dr. Jacobsen told Renal & Urology News. “However, if the results are verified by additional research, it may be worthwhile for urologists to ask patients taking NSAIDs regularly about their erectile function since there are good medications available to treat ED.”

Dr. Jacobsen and colleagues examined the association between regular NSAID use and ED in 52,518 men who were enrolled in Kaiser Permanente Southern California and Northern California managed-care plans and ranged in age from 45-69 years in 2002. Earlier studies had suggested that inflammation promotes ED, Dr. Jacobsen pointed out. Thus, NSAID use, in theory, should prevent ED.

In their study, ED was determined by questionnaire. Men who reported that they were never or only occasionally able to get and maintain an erection were categorized as having ED. Exposure to NSAIDs was derived from self-report and pharmacy records. Men were identified as regular NSAID users if they currently used NSAIDS more than three times a day or had taken NSAIDs for 100 or more consecutive days. Of the study cohort, 19,483 (37%) were NSAID users, and 14,630 (28%) had ED.

The investigators found that both NSAID use and ED were strongly correlated with age. Overall, the prevalence of regular NSAID use was 30% in men aged 45-49 years, 35% in men aged 50-59, and 42% in men aged 60-69. The rates of ED were 12%, 22%, and 41% in the three groups, respectively.

Self-reported NSAID users were 1.6 times as likely to have ED as men who were not NSAID users. After controlling for age as well as comorbid conditions known to increase ED risk, including diabetes, hypertension, and high cholesterol levels, the association between regular NSAID use and ED was only slightly diminished.

Although the study did not evaluate the association of NSAID exposure and ED by NSAID type, the most commonly used NSAID was aspirin, Dr. Jacobsen said.  

In addition to the study's cross-sectional design, unmeasured confounding may also be a potential study limitation. “There [could] be factors associated with both NSAID use and ED, other than age, diabetes, and hypertension, which may have made it appear that NSAID use is associated with ED,” Dr. Jacobsen said.

“The fact that NSAID use turned out to be a risk factor rather than protective was somewhat of a surprise, although a much smaller study from Finland had reported similar findings,” he noted.

Finally, he emphasized that additional research will shed light on the temporal relationship between NSAID use and ED and added that such information will make possible more definitive clinical recommendations.

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