Prognostic Utility of Erectile Dysfunction for Cardiovascular Disease
Prognostic Utility of Erectile Dysfunction for Cardiovascular Disease
Multiple published studies have established erectile dysfunction (ED) as an independent risk marker for cardiovascular disease (CVD). In fact, incident ED has a similar or greater predictive value for cardiovascular events than traditional risk factors including smoking, hyperlipidemia, and family history of myocardial infarction. Here, we review evidence that supports ED as a particularly significant harbinger of CVD in 2 populations: men <60 years of age and those with diabetes. Although addition of ED to the Framingham Risk Score only modestly improved the 10-year predictive capacity of the Framingham Risk Score for myocardial infarction or coronary death data in men enrolled in the Massachusetts Male Aging Study, other epidemiologic studies suggest that the predictive value of ED is quite strong in younger men. Indeed, in the Olmstead County Study, men 40 to 49 years of age with ED had a 50-fold higher incidence of new-incident coronary artery disease than those without ED. However, ED had less predictive value (5-fold increased risk) for coronary artery disease in men 70 years and older. Several studies, including a large analysis of more than 6300 men enrolled in the ADVANCE study, suggest that ED is a particularly powerful predictor of CVD in diabetic men as well. Based on the literature reviewed here, we encourage physicians to inquire about ED symptoms in all men more than 30 years of age with cardiovascular risk factors. Identification of ED, particularly in men <60 years old and those with diabetes, represents an important first step toward CVD risk detection and reduction.
Erectile dysfunction (ED) is defined as the inability to reach or maintain an erection sufficient for satisfactory sexual performance. The fact that ED often coexists with hypertension, hyperlipidemia, and diabetes provides support for a vasculogenic etiology of ED. Beyond its association with vascular risk factors, vasculogenic ED has been recently recognized as a predictor of future cardiovascular events, most strikingly in men in their third, fourth, fifth, and sixth decades. Consequently, the identification of vasculogenic ED in the younger man has potentially significant prognostic import.
Here, we provide evidence that vasculogenic ED precedes coronary heart disease in younger and middle-aged men. Pathophysiologic links between vasculogenic ED and cardiovascular disease (CVD) are explained, and the role of vascular markers is discussed with a focus on those that may enhance the predictive value of vasculogenic ED for CVD. Finally, we provide guidance for evaluation of vasculogenic ED.
Abstract and Introduction
Abstract
Multiple published studies have established erectile dysfunction (ED) as an independent risk marker for cardiovascular disease (CVD). In fact, incident ED has a similar or greater predictive value for cardiovascular events than traditional risk factors including smoking, hyperlipidemia, and family history of myocardial infarction. Here, we review evidence that supports ED as a particularly significant harbinger of CVD in 2 populations: men <60 years of age and those with diabetes. Although addition of ED to the Framingham Risk Score only modestly improved the 10-year predictive capacity of the Framingham Risk Score for myocardial infarction or coronary death data in men enrolled in the Massachusetts Male Aging Study, other epidemiologic studies suggest that the predictive value of ED is quite strong in younger men. Indeed, in the Olmstead County Study, men 40 to 49 years of age with ED had a 50-fold higher incidence of new-incident coronary artery disease than those without ED. However, ED had less predictive value (5-fold increased risk) for coronary artery disease in men 70 years and older. Several studies, including a large analysis of more than 6300 men enrolled in the ADVANCE study, suggest that ED is a particularly powerful predictor of CVD in diabetic men as well. Based on the literature reviewed here, we encourage physicians to inquire about ED symptoms in all men more than 30 years of age with cardiovascular risk factors. Identification of ED, particularly in men <60 years old and those with diabetes, represents an important first step toward CVD risk detection and reduction.
Introduction
Erectile dysfunction (ED) is defined as the inability to reach or maintain an erection sufficient for satisfactory sexual performance. The fact that ED often coexists with hypertension, hyperlipidemia, and diabetes provides support for a vasculogenic etiology of ED. Beyond its association with vascular risk factors, vasculogenic ED has been recently recognized as a predictor of future cardiovascular events, most strikingly in men in their third, fourth, fifth, and sixth decades. Consequently, the identification of vasculogenic ED in the younger man has potentially significant prognostic import.
Here, we provide evidence that vasculogenic ED precedes coronary heart disease in younger and middle-aged men. Pathophysiologic links between vasculogenic ED and cardiovascular disease (CVD) are explained, and the role of vascular markers is discussed with a focus on those that may enhance the predictive value of vasculogenic ED for CVD. Finally, we provide guidance for evaluation of vasculogenic ED.
