***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We provide current , normative data on the prevalence of impotence , and its physiological and psychosocial correlates in a general population using results from the Massachusetts Male Aging Study . The Massachusetts Male Aging Study was a community based , r and om sample observational survey of noninstitutionalized men 40 to 70 years old conducted from 1987 to 1989 in cities and towns near Boston , Massachusetts .  Blood sample s , physiological measures , socio-demographic variables , psychological indexes , and information on health status , medications , smoking and lifestyle were collected by trained interviewers in the subject 's home . A self-administered sexual activity question  naire was used to characterize erectile potency . The combined prevalence of minimal , moderate and complete impotence was 52 % . The prevalence of complete impotence tripled from 5 to 15 % between subject ages 40 and 70 years . Subject age was the variable most strongly associated with impotence . After adjustment for age , a higher probability of impotence was directly correlated with heart disease , hypertension , diabetes , associated medications , and indexes of anger and depression , and inversely correlated with serum dehydroepi and rosterone , high density lipoprotein cholesterol and an index of dominant personality . Cigarette smoking was associated with a greater probability of complete impotence in men with heart disease and hypertension . We conclude that impotence is a major health concern in light of the high prevalence , is strongly associated with age , has multiple determinants , including some risk factors for vascular disease , and may be due partly to modifiable para-aging phenomena Introduction Coronary artery disease ( CAD ) and vascular erectile dysfunction ( ED ) are related to endothelial dysfunction . Elevated  asymmetrical dimethylarginine ( ADMA ) levels and ED are common in patients with increased cardiovascular risk . Our aim was to investigate whether ADMA has a predictive role for major adverse cardiovascular events ( MACE ) in acute coronary syndrome ( ACS ) . The secondary aim of this study was to investigate whether severity of ED predicts MACE in these patients . Material and methods Follow-up data were available for severity of ED in 71 patients with ACS .  Plasma ADMA levels  were determined by ELISA in 57 patients . Erectile dysfunction was assessed by the International Index of Erectile Function-6 ( IIEF-6 ) score . Major adverse cardiovascular events ( reinfa rct ion , all-cause hospitalisation , stroke and all-cause death ) was evaluated after a median of 10 months . Results Severe ED had no significantly increased hazard ratio for cardiovascular events compared with mild , mild to moderate , and moderate ED ( 0.259 [ 95 % CI 0.041–1.6 ] , p = 0.147 ; 0.605 [ 95 % CI 0.095–3.8 ] , p = 0.594 ; 0.980 [ 95 % CI 0.233–4.1 ] , p = 0.978 ; and 0.473 [ 95 % CI 0.052–1.3 ] , p = 0.508 ) . The patients who had ADMA levels ≥ 0.32 µmol/l had no significantly increased hazard ratio for cardiovascular events compared with patients who had ADMA levels < 0.32 µmol/l ( 2.018 [ 95 % CI 0.615–6.6 ] , p = 0.247 ) . Conclusions Severity of ED and ADMA did not increase the risk of cardiovascular events in follow-up patients with ACS in our study . Larger prospect i ve studies are necessary to evaluate whether ADMA predicts cardiovascular events in patients with ACS CONTEXT The risk factors for cardiovascular disease and erectile dysfunction are similar . OBJECTIVE To examine the association of erectile dysfunction and subsequent cardiovascular disease . DESIGN , SETTING , AND PARTICIPANTS Men aged 55 years or older who were r and omized to the placebo group ( n = 9457 ) in the Prostate Cancer Prevention Trial at 221 US centers were evaluated every 3 months for cardiovascular disease and erectile dysfunction between 1994 and 2003 . Proportional hazards regression models were used to evaluate the association of erectile dysfunction and cardiovascular disease . In an adjusted model , covariates included age , body mass index , blood pressure , serum lipids , diabetes , family history of myocardial infa rct ion , race , smoking history , physical activity , and quality of life . MAIN OUTCOME MEASURES Erectile dysfunction and cardiovascular disease . RESULTS Of the 9457 men r and omized to placebo , 8063 ( 85 % ) had no cardiovascular disease at study entry ; of these men , 3816 ( 47 % ) had erectile dysfunction at study entry . Among the 4247 men without erectile dysfunction at study entry , 2420 men ( 57 % ) reported incident erectile dysfunction after 5 years . After adjustment , incident erectile dysfunction was associated with a hazard ratio of 1.25 ( 95 % confidence interval [ CI ] , 1.02 - 1.53 ; P = .04 ) for subsequent cardiovascular events during study follow-up . For men with either incident or prevalent erectile dysfunction , the hazard ratio was 1.45 ( 95 % CI , 1.25 - 1.69 ; P<.001 ) . For subsequent cardiovascular events , the unadjusted risk of an incident cardiovascular event was 0.015 per person-year among men without erectile dysfunction at study entry and was 0.024 per person-year for men with erectile dysfunction at study entry . This association was in the range of risk associated with current smoking or a family history of myocardial infa rct ion . CONCLUSIONS Erectile dysfunction is a harbinger of cardiovascular clinical events in some men . Erectile dysfunction should prompt investigation and intervention for cardiovascular risk factors OBJECTIVES This study was design ed to determine whether  erectile dysfunction ( ED )  predicts cardiovascular disease ( CVD ) beyond traditional risk factors . BACKGROUND Both ED and CVD share pathophysiological mechanisms and often co-occur . It is unknown whether ED improves the prediction of CVD beyond traditional risk factors . METHODS This was a prospect i ve , population -based study of 1,709 men ( of 3,258 eligible ) age 40 to 70 years . The ED data were measured by self-report . Subjects were followed for CVD for an average follow-up of 11.7 years . The association between ED and CVD was examined using the Cox proportional hazards regression model . The discriminatory capability of ED was examined using C statistics . The reclassification of CVD risk associated with ED was assessed using a method that quantifies net reclassification improvement . RESULTS Of the prospect i ve population , 1,057 men with complete risk factor data who were free of CVD and diabetes at baseline were included . During follow-up , 261 new cases of CVD occurred . We found ED was associated with CVD incidence controlling for age ( hazard ratio [ HR ] : 1.42 , 95 % confidence interval [ CI ] : 1.05 to 1.90 ) , age and traditional CVD risk factors ( HR : 1.41 , 95 % CI : 1.05 to 1.90 ) , as well as age and Framingham risk score ( HR : 1.40 , 95 % CI : 1.04 to 1.88 ) . Despite these significant findings , ED did not significantly improve the prediction of CVD incidence beyond traditional risk factors . CONCLUSIONS Independent of established CVD risk factors , ED is significantly associated with increased CVD incidence . Nonetheless , ED does not improve the prediction of who will and will not develop CVD beyond that offered by traditional risk factors OBJECTIVES We examined the predictive power of erectile dysfunction ( ED ) on coronary heart disease ( CHD ) events in Chinese men with type 2 diabetes . BACKGROUND Subjects with diabetes are prone to develop cardiovascular complications . Erectile dysfunction is strongly associated with CHD in cross-sectional studies , but prospect i ve data are lacking . METHODS A consecutive cohort of men with no clinical evidence of cardiovascular disease underwent comprehensive assessment s for diabetic complications .  Erectile dysfunction was defined according to the definition of the National Institutes of Health Consensus Conference 1992 . Coronary heart disease events were censored with central ized territory-wide hospital data bases in 2005 . RESULTS Of 2,306 subjects ( age : 54.2 + /- 12.7 years ; follow-up : 4.0 [ range 1.7 to 7.1 ] years ) , 26.7 % had ED at baseline . The incidence of CHD events was higher in men with ED than those without ( 19.7/1,000 person-years , 95 % confidence interval [ CI ] 14.3 to 25.2 person-years vs. 9.5/1,000 person-years , 95 % CI 7.4 to 11.7 person-years ) . Men who developed CHD events were older ; had a higher frequency of ED and microvascular complications ; had longer duration of diabetes ; and had higher blood pressure , total cholesterol , low-density lipoprotein cholesterol , and urinary albumin/creatinine ratio but lower high-density lipoprotein cholesterol and estimated glomerular filtration rate than those without CHD events . Erectile dysfunction remained an independent predictor for CHD events ( hazard ratio 1.58 , 95 % CI 1.08 to 2.30 , p = 0.018 ) after adjustment for other covariates along with age , duration of disease , and use of antihypertensive agents and albuminuria . CONCLUSIONS In type 2 diabetic men without clinical ly overt cardiovascular disease , the presence of ED predicts a new onset of CHD events . Symptoms of ED should be independently sought to identify high-risk subjects for comprehensive cardiovascular assessment INTRODUCTION Although testosterone ( T ) has been suggested to play a protective role against the development of atherosclerosis , studies demonstrating an association between low T and incident major adverse cardiovascular events ( MACE ) are scanty in the general population and absent in subjects with erectile dysfunction ( ED ) . AIM To investigate whether low T in subjects with ED predict incident fatal or nonfatal MACE . METHODS This is an observational prospect i ve cohort study evaluating a consecutive series of 1687 patients attending our and rological unit for ED . Patients were interviewed using the  structured interview on erectile dysfunction ( SIEDY ) and AND ROTEST structured interviews measuring components relative to ED and hypogonadal-related symptoms , respectively . MAIN OUTCOME MEASURES Total T was evaluated at baseline . Information on MACE was obtained through the City of Florence Registry Office . RESULTS Among the patients studied , 5.2 , 13.8 , and 22.4 % were hypogonadal according to different thresholds ( T < 8 , 10.4 and 12 nmol/L or 230 , 300 and 350 ng/dL , respectively ) . During a mean follow-up of 4.3 + or - 2.6 years , 139 MACE , 15 of which were fatal , were observed . Unadjusted incidence of MACE was not associated with T levels . Conversely , the proportion of lethal events among MACE was significantly higher in hypogonadal patients , using either 10.4 nmol/L ( 300 ng/dL ) or 8 nmol/L ( 230 ng/dL ) thresholds . However , after adjustment for age and Chronic Diseases Score in a Cox regression model , only the association between incident fatal MACE and T < 8 nmol/L ( 230 ng/dL ) was confirmed ( HR = 7.1 [ 1.8 - 28.6 ] ; P < 0.001 ) . Interestingly , measuring hypogonadal-related symptoms and signs through AND ROTEST , only fatal MACE were also associated with a higher score ( HR = 1.2 [ 1.0 - 1.5 ] for each AND ROTEST score increment ; P = 0.05 after adjustment for age and Chronic Diseases Score ) . CONCLUSIONS T levels are associated with a higher mortality of MACE . The identification of low T levels should alert the clinician thus identifying subjects with an increased cardiovascular risk OBJECTIVES Erectile dysfunction ( ED ) shares common risk factors with coronary artery disease ( CAD ) . It has been suggested that ED may be considered a clinical manifestation of a generalized vascular disease affecting also the penile arteries . The aim of this prospect i ve study was to evaluate angiographically the incidence of asymptomatic CAD in men with ED of vascular origin . METHODS Fifty consecutive asymptomatic men , aged 41 - 74 years , with non-psychogenic and non-hormonal ED were comprehensively evaluated using medical history and examination , exercise treadmill test and stress echocardiography .  Patients who had positive one or both of the two non-invasive procedures were referred for coronary arteriography in order to document CAD and evaluate the severity of the disease . RESULTS The mean time interval between the onset of ED and cardiological assessment was  
    Output:
    
ED is associated with increased risk of CV events and all-cause mortality .