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Severe Depressive Symptoms and Cardiovascular Risk in Subjects with Erectile Dysfunction


  • Drs Bandini and Fisher equally contributed to the article.

Mario Maggi, MD, University of Florence—Andrology Unit, Department of Clinical Physiopathology, 51039 Florence, Italy. Tel: (+39) 0554271415; Fax: (+39) 0554271413; E-mail:


Introduction.  Erectile dysfunction (ED) and mood depression are often associated and both are correlated with an increased risk of cardiovascular morbidity and mortality.

Aim.  The aim of the present study is to explore biological and clinical correlates of depressive symptomatology in a sample of men consulting for sexual dysfunction and to verify possible associations between depressive symptoms and incidence of major cardiovascular events (MACE).

Methods.  A consecutive series of 2,303 male patients attending the Outpatient Clinic for sexual dysfunction was retrospectively studied. A subset of the previous sample (N = 1,687) was enrolled in a longitudinal study. All patients were investigated using a Structured Interview on Erectile Dysfunction (SIEDY), composed of 3 scales which explore organic, relational and intra-psychic components of ED. MHQ-D scoring from Middlesex Hospital Questionnaire (MHQ) was used as a putative marker of depressive symptoms.

Main Outcome Measures.  Information on MACE was obtained through the City of Florence Registry Office.

Results.  We found a positive relationship between MHQ-D score and a progressive impairment in obtaining an erection hard enough for penetration, even after adjusting for confounding factors. Moreover, we observed positive relationships between MHQ-D score and the three pathogenetic domains underlying ED. When the longitudinal subset was evaluated, during a mean follow-up of 4.3 ± 2.6 years, 139 MACE, 15 of which were fatal, were observed. Unadjusted incidence of MACE was significantly associated with baseline depressive symptoms. When the presence of severe depressive symptoms were introduced in a Cox regression model, along with the arteriogenic ED and partner's hypoactive sexual desire, after adjusting for age, Chronic Diseases Score, and ΣMHQ (a broader index of psychopathology), severe depressive symptomatology was independently associated with a higher incidence of MACE.

Conclusion.  Depressive symptomatology constitutes an independent risk factor for cardiac morbidity and mortality in men with ED. Bandini E, Fisher AD, Corona G, Ricca V, Monami M, Boddi V, Balzi D, Melani C, Forti G, Mannucci E, and Maggi M. Severe depressive symptoms and cardiovascular risk in subjects with erectile dysfunction. J Sex Med 2010;7:3477–3486.