Men with erectile dysfunction may have a greater risk of cardiovascular disease. Assessment of cardiovascular risk, including coronary artery calcium, should be considered in these patients.
Vascular erectile dysfunction is a powerful marker of increased cardiovascular risk. However, current guidelines lack specific recommendations on the role that the evaluation of vascular erectile dysfunction should play in cardiovascular risk assessment, as well on the risk stratification strategy that men with vascular erectile dysfunction should undergo. In the last 3 years, erectile dysfunction experts have made a call for more specific guidance and have proposed the selective use of several prognostic tests for further cardiovascular risk assessment in these patients. Among them, stress testing has been prioritized, whereas other tests are considered second-line tools. In this review, we provide additional perspective from the viewpoint of the preventive cardiologist. We discuss the limitations of current risk scores and the potential interplay between erectile dysfunction assessment and the use of personalized prognostic tools, such as the coronary artery calcium score, in the cardiovascular risk stratification and management of men with vascular erectile dysfunction. Finally, we present an algorithm for primary care physicians, urologists, and cardiologists to aid clinical decision-making.
Despite reductions of cardiovascular disease mortality in the United States and other Western countries in the last 40 years, cardiovascular disease remains a leading cause of death. From a prevention standpoint, sudden cardiac death often presents as the initial manifestation of cardiovascular disease in previously apparently healthy individuals,6 and a concerning proportion of events occur in individuals not identified as high risk by traditional scores. Moreover, the incorporation of Western-like lifestyles in a number of countries around the world has further increased the prevalence of cardiovascular risk factors and disease. Thus, cardiovascular disease remains a worldwide public health issue, requiring further preventive efforts.
Erectile dysfunction is a highly prevalent disorder among adult men. It can be the result of psychogenic and organic causes, or a combination of both. Among its organic forms, vascular erectile dysfunction is considered the most prevalent, with cardiovascular risk factors, atherosclerosis, and endothelial dysfunction being key contributors.
Many studies have shown that vascular erectile dysfunction and cardiovascular disease are strongly linked entities that share risk factors and underlying mechanisms, and often coexist in the same individuals. Of note, 2 key features in the relationship between vascular erectile dysfunction and cardiovascular disease make the former particularly appealing from a prevention standpoint. First, erectile dysfunction symptoms often coexist with subclinical, otherwise silent cardiovascular disease18 and usually antecede cardiovascular symptoms. Second, vascular erectile dysfunction is independently associated with cardiovascular disease and events beyond traditional risk factors. Thus, symptomatic vascular erectile dysfunction provides the cardiologist with a powerful independent marker of increased cardiovascular risk.
Despite its potential importance, vascular erectile dysfunction has been long overlooked in cardiovascular guidelines, which lack specific recommendations regarding the role of erectile dysfunction assessment in cardiovascular risk stratification in men, as well as regarding the best risk assessment strategy for patients with vascular erectile dysfunction. In this context, recent articles and consensus documents from erectile dysfunction experts have provided valuable insights regarding some of these questions.
In this review, we provide perspective from the viewpoint of the preventive cardiologist. In particular, we focus on the role that the interplay between vascular erectile dysfunction assessment and cardiovascular risk stratification can play in clinical practice. In addition, we highlight the utility of currently available advanced cardiovascular risk assessment tools, particularly coronary artery calcium scoring, in further risk assessment of men with vascular erectile dysfunction.
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-Nishant P. Shah, MD, Miguel Cainzos-Achirica, MD, David I. Feldman, BS, Roger S. Blumenthal, MD, Khurram Nasir, MD, MPH, Martin M. Miner, MD, Kevin L. Billups, MD, Michael J. Blaha, MD, MPH
This article originally appeared in the March 2016 issue of The American Journal of Medicine.
