Baseline atrial fibrillation is a risk factor for erectile dysfunction: Systemic review and meta-analysis

<b>Objective</b>: To assess the association between atrial fibrillation (AF) and erectile dysfunction (ED) by a systematic review of the literature and meta-analysis, as ED is commonly found amongst male patients with concurrent cardiovascular conditions, especially atherosclerosis, coronary syndrome, and diabetes; and recent studies suggest that AF is associated with ED in the general male population. <b>Methods</b>: Studies from inception to May 2018 in the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Excerpta Medica dataBASE (EMBASE) were searched. Prospective or retrospective cohort studies that compared new-onset ED between male patients with and without AF were included. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios (RRs) and 95% confidence intervals (CIs). <b>Results</b>: Five studies from 2007 to 2016 were included in the meta-analysis involving 29829 male patients (4096 with AF and 25733 without). The presence of AF was associated with ED (pooled RR 1.61, 95% CI 1.23–2.10; <i>P</i> &lt; 0.001, <i>I</i>² = 42%). <b>Conclusions</b>: Baseline AF increased the risk of ED up to 1.6-fold amongst the general male population. This suggests that AF in male patients is significantly associated with ED. <b>Abbreviations:</b> AF: atrial fibrillation; CV: cardiovascular; ED: erectile dysfunction; EMBASE: Excerpta Medica database; HR: hazard ratio; ICD-9-CM: International Classification of Diseases, Ninth Revision, Clinical Modification; (S)IR: (standardised) incidence ratio; IIEF: International Index of Erectile Function; LVDD: left ventricular diastolic dysfunction; MEDLINE: Medical Literature Analysis and Retrieval System Online; NO: nitric oxide; OR: odds ratio; RR: relative risk

<b>研究目的</b>: 本研究旨在通过系统文献回顾与荟萃分析，评估心房颤动（atrial fibrillation, AF）与勃起功能障碍（erectile dysfunction, ED）之间的关联。鉴于勃起功能障碍常见于合并心血管疾病的男性患者，尤其是动脉粥样硬化、冠状动脉综合征及糖尿病患者；且近期研究提示，普通男性人群中心房颤动与勃起功能障碍存在关联。<b>研究方法</b>: 本研究检索了医学文献分析与检索系统在线版（Medical Literature Analysis and Retrieval System Online, MEDLINE）及荷兰医学文摘数据库（Excerpta Medica dataBASE, EMBASE）自建库至2018年5月的相关文献。纳入对比合并与未合并心房颤动的男性患者新发勃起功能障碍情况的前瞻性或回顾性队列研究。采用德西蒙尼安与莱尔德提出的随机效应通用逆方差法合并各项研究数据，计算风险比（risk ratios, RR）及95%置信区间（confidence intervals, CI）。<b>研究结果</b>: 本荟萃分析共纳入2007年至2016年间的5项研究，涉及29829名男性患者（其中4096名合并心房颤动，25733名未合并心房颤动）。合并分析结果显示，心房颤动与勃起功能障碍存在显著关联（合并风险比1.61，95%置信区间1.23~2.10；<i>P</i> &lt; 0.001，<i>I</i>² = 42%）。<b>研究结论</b>: 普通男性人群中，基线心房颤动可使勃起功能障碍的发病风险升高至1.6倍。该结果提示，男性患者的心房颤动与勃起功能障碍存在显著关联。<b>缩略语说明</b>: AF：心房颤动（atrial fibrillation）；CV：心血管（cardiovascular）；ED：勃起功能障碍（erectile dysfunction）；EMBASE：荷兰医学文摘数据库（Excerpta Medica database）；HR：风险比（hazard ratio）；ICD-9-CM：国际疾病分类第9版临床修订版（International Classification of Diseases, Ninth Revision, Clinical Modification）；(S)IR：（标准化）发病比（(standardised) incidence ratio）；IIEF：国际勃起功能指数（International Index of Erectile Function）；LVDD：左心室舒张功能不全（left ventricular diastolic dysfunction）；MEDLINE：医学文献分析与检索系统在线版（Medical Literature Analysis and Retrieval System Online）；NO：一氧化氮（nitric oxide）；OR：比值比（odds ratio）；RR：相对风险（relative risk）