Subclinical Vascular Disease and Subsequent Erectile Dysfunction: The Multiethnic Study of Atherosclerosis (MESA)

Abstract

Background: The association between subclinical cardiovascular disease and subsequent development of erectile dysfunction (ED) remains poorly described.

Hypothesis: Among multiple subclinical atherosclerosis and vascular dysfunction measurements, coronary artery calcium (CAC) score best predicts ED.

Methods: After excluding participants taking ED medications at baseline, we studied 1862 men age 45 to 84 years free of known cardiovascular disease from the Multi-Ethnic Study of Atherosclerosis (MESA) with comprehensive baseline subclinical vascular disease phenotyping and ED status assessed at MESA visit 5 (9.4 ± 0.5 years after baseline) using a standardized question on ED symptoms. Multivariable logistic regression was used to assess the associations between baseline measures of vascular disease (atherosclerosis domain: CAC, carotid intima-media thickness, carotid plaque, ankle-brachial index; vascular stiffness/function domain: aortic stiffness, carotid stiffness, brachial flow-mediated dilation) and ED symptoms at follow-up.

Results: Mean baseline age was 59.5 ± 9 years, and 839 participants (45%) reported ED symptoms at follow-up. Compared with symptom-free individuals, participants with ED had higher baseline prevalence of CAC score >100 (36.4% vs 17.2%), carotid intima-media thickness Z score >75th percentile (35.3% vs 16.6%), carotid plaque score ≥2 (39% vs 21.1%), carotid distensibility <25th percentile (34.6% vs 17.1%), aortic distensibility <25th percentile (34.2% vs 18.7%), and brachial flow-mediated dilation <25th percentile (28.4% vs 21.3%); all P < 0.01. Only CAC >100 (odds ratio: 1.43, 95% confidence interval: 1.09-1.88) and carotid plaque score ≥2 (odds ratio: 1.33, 95% confidence interval: 1.02-1.73) were significantly associated with ED.

Conclusions: Subclinical vascular disease is common in men who later self-report ED. Early detection of subclinical atherosclerosis, particularly advanced CAC and carotid plaque, may provide opportunities for predicting the onset of subsequent vascular ED.

Figure 1

Proportion with ED symptoms at 9‐year follow‐up by baseline subclinical vascular disease measure. Abbreviations: ABI, ankle‐brachial index; CAC, coronary artery calcium; cIMT, carotid intima‐media thickness; CP, carotid plaque; ED, erectile dysfunction; FMD, flow‐mediated dilation; Q, quartile.

Figure 2

Multivariable adjusted ORs for ED for the presence of ≥1 abnormality in each domain of subclinical vascular disease. Data are presented as ORs and 95% CIs. Model 1 adjusted for age, race, education, and MESA site. Model 2 adjusted for Model 1 + smoking, DM, family history, SBP, LDL‐C, HDL‐C, lipid‐lowering medications, antihypertensive medications, and waist circumference. Model 3 adjusted for Model 2 + β‐blockers, depression scale, nontricyclic antidepressants, tricyclic antidepressants, and antipsychotic medications. Measurements for CAC, cIMT, ABI, and carotid distensibility were available in all study participants. CP scores were available in 74.2% of participants and were imputed in the remaining 25.8%. Measurements for aortic distensibility were available in 999 participants and were imputed in the remaining 863. Measurements for FMD were available in 993 participants and were imputed in the remaining 869. Abbreviations: ABI, ankle‐brachial index; CAC, coronary artery calcium; CI, confidence interval; cIMT, carotid intima‐media thickness; CP, carotid plaque; DM, diabetes mellitus; ED, erectile dysfunction; FMD, flow‐mediated dilation; HDL‐C, high‐density lipoprotein cholesterol; LDL‐C, low‐density lipoprotein cholesterol; MESA, Multi‐Ethnic Study of Atherosclerosis; OR, odds ratio; SBP, systolic blood pressure.