Erectile Dysfunction Is a Hallmark of Cardiovascular Disease: Unavoidable Matter of Fact or Opportunity to Improve Men's Health?

Abstract

Erectile dysfunction (ED) is an early manifestation of cardiovascular (CV) disease. For this reason, men with ED should be carefully assessed for CV risk factors in order to prevent future major adverse CV events (MACE). Traditional risk factors are not found in all subjects at high CV risk. In fact, a relevant proportion of MACE occurs in men who are apparently risk factor free. In men with ED, it is important to take into account not only traditional risk factors but also unconventional ones. Several parameters that derive from good clinical assessment of subjects with ED have proven to be valuable predictors of MACE. These include family history of cardiometabolic events, alcohol abuse, fatherhood, decreased partner's sexual interest, severe impairment in erection during intercourse or during masturbation, impaired fasting glucose, increased triglycerides, obesity even without metabolic complications, decreased penile blood flows or impaired response to an intra-cavernosal injection test. Recognizing these risk factors may help in identifying, among subjects with ED, those who merit stricter lifestyle or pharmacological interventions to minimize their CV risk. Effective correction of risk factors in ED men considered as high risk, besides reducing CV risk, is also able to improve erectile function.

Keywords: cardiovascular risk factors; erectile dysfunction; major adverse cardiovascular events; unconventional risk factors.

Figure 1

Conventional and unconventional risk factors associated with major adverse cardiovascular events in subjects with erectile dysfunction. Risk of major adverse cardiovascular events (MACE) over 4.3 years of median follow-up in a population of 1687 men consulting the Andrology Unit at the Careggi Hospital, University of Florence (Florence, Italy) for sexual dysfunction, according to conventional and unconventional risk factors as measured at baseline. (A) risk of MACE associated with conventional risk factors; (B) risk of MACE associated with unconventional risk factors derived from personal and sexual history; (C) risk of MACE associated with unconventional risk factors derived from metabolic factors and hormones; (D) risk of MACE associated with unconventional risk factors derived from instrumental tests. Data are expressed as hazard ratio (HR) and 95% confidence interval (CI) and are derived or adapted from original publications. The original publication is quoted in brackets for each parameter. * Limited to non-diabetic patients without severe ED; ** The outcome is cerebrovascular events. BP = Blood Pressure; CV = cardiovascular; ED = Erectile Dysfunction; FHS = Framingham Heart Study; ICI = intra-cavernous injection; IFG = Impaired Fasting Glycemia; PSV = peak systolic velocity; SCORE = Systematic COronary Risk Evaluation; T = Testosterone.