Studies suggest that erectile dysfunction is an independent marker for cardiovascular disease. Assessment and management of erectile dysfunction may help identify and reduce the risk of future cardiovascular events.
Abstract
An association between erectile dysfunction and cardiovascular disease has long been recognized, and studies suggest that erectile dysfunction is an independent marker of cardiovascular disease risk. Therefore, assessment and management of erectile dysfunction may help identify and reduce the risk of future cardiovascular events, particularly in younger men. The initial erectile dysfunction evaluation should distinguish between predominantly vasculogenic erectile dysfunction and erectile dysfunction of other etiologies. For men believed to have predominantly vasculogenic erectile dysfunction, we recommend that initial cardiovascular risk stratification be based on the Framingham Risk Score. Management of men with erectile dysfunction who are at low risk for cardiovascular disease should focus on risk-factor control; men at high risk, including those with cardiovascular symptoms, should be referred to a cardiologist. Intermediate-risk men should undergo noninvasive evaluation for subclinical atherosclerosis. A growing body of evidence supports the use of emerging prognostic markers to further understand cardiovascular risk in men with erectile dysfunction, but few markers have been prospectively evaluated in this population. In conclusion, we support cardiovascular risk stratification and risk-factor management in all men with vasculogenic erectile dysfunction.
Cardiovascular disease is a leading cause of death in men. Erectile dysfunction is a common problem in men as they age and may help drive them to seek medical attention in the absence of other cardiovascular symptoms. The link between erectile dysfunction and cardiovascular disease is well established; however, this relationship has been previously characterized primarily by shared risk factors.(1, 2, 3) An emerging paradigm indicates that erectile dysfunction is, in fact, an independent marker of cardiovascular disease risk.(4, 5, 6, 7, 8) Thus, the presence of erectile dysfunction may provide the opportunity for cardiovascular disease risk mitigation in men with otherwise unrecognized cardiovascular disease. This article discusses the evaluation and management of cardiovascular risk in men with erectile dysfunction but no known cardiovascular disease in a primary care setting. It considers the fundamental question: do all men with presumed vasculogenic erectile dysfunction need a cardiovascular workup?
A number of risk factors are shared by erectile dysfunction and cardiovascular disease, including age,(9) sedentary lifestyle, obesity, smoking, hypercholesterolemia, metabolic syndrome,10 insulin resistance,(11) hypertension,(12, 13) and diabetes.(12) The common pathophysiologic bases for erectile dysfunction and cardiovascular disease are believed to include endothelial dysfunction,(14) inflammation,(15) and low testosterone.(14, 16) Furthermore, numerous studies in men with clinically evident cardiovascular disease have established erectile dysfunction as an independent risk marker for cardiovascular disease(4, 5, 6, 7, 8, 17) and shown that erectile dysfunction frequently precedes coronary artery disease,(18, 19, 20, 21) peripheral arterial disease,(22) and stroke.(19) Erectile dysfunction symptoms appear approximately 2 to 5 years before the onset of cardiovascular symptoms,(18, 23, 24, 25) and more severe erectile dysfunction has been correlated with greater atherosclerotic burden,(21) extent of coronary artery disease,(18, 26) and risk of coronary artery disease,(19, 20) peripheral artery disease,(22) and major cardiovascular events.(27)
Compared with traditional cardiovascular disease risk factors (eg, family history of myocardial infarction, smoking, hyperlipidemia), incident erectile dysfunction has demonstrated similar or greater predictive value for cardiovascular events.(28, 29)
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–Martin Miner, MD, Ajay Nehra, MD, Graham Jackson, MD, Shalender Bhasin, MD, Kevin Billups, MD, Arthur L. Burnett, MD, Jacques Buvat, MD, Culley Carson, MD, Glenn Cunningham, MD, Peter Ganz, MD, Irwin Goldstein, MD, Andre Guay, MD, Geoff Hackett, MD, Robert A. Kloner, MD, PhD, John B. Kostis, MD, K. Elizabeth LaFlamme, PhD, Piero Montorsi, MD, Melinda Ramsey, PhD, Raymond Rosen, PhD, Richard Sadovsky, MD, Allen Seftel, MD, Ridwan Shabsigh, MD, Charalambos Vlachopoulos, MD, Frederick Wu, MD
This article originally appeared in the March 2014 issue of The American Journal of Medicine.
